Clinical Ethics Support for Gender-Affirming Care Teams: Reflections from a Scoping Review

Purpose of Review This review aims to provide gender-affirming providers and ethics practitioners with up-to-date knowledge regarding the models of clinical ethics support (CES) available in the transgender care setting, the activities of CES services, and the benefits and limitations of CES in this context. Recent Findings Literature related to CES in transgender care is limited at present but will likely expand as the number of both transgender care centers and CES services continues to grow internationally. All literature substantively addressing the review question derives from the USA or the Netherlands and describes an "integrative" or "embedded" model of CES, in which ethics practitioners work regularly and collaboratively with multidisciplinary transgender care teams to provide preventive and responsive ethics support. A scoping review of the literature shows that, at some transgender care programs in the USA and the Netherlands, embedded or integrative CES is available to highlight the ethics issues in everyday practice and to help clinicians navigate ethically complex cases. Other forms of CES available to gender-affirming providers include ethics consultation services and ethics committees. CES in transgender care can involve ethics consultation or moral case deliberation for particular cases; participation in clinical meetings to draw attention to and clarify ethical issues at play; and input into treatment protocol development. To further illustrate how ethics practitioners can contribute to a multidisciplinary approach to gender-affirming care, the authors also provide examples of embedded ethics support in one transgender care center in the USA based on their experiences. Clinicians working in transgender care may benefit from engaging with their organization's CES service or reaching out to local and regional healthcare ethics organizations for support.