Articlegreen2021

Assessing Medical Decision-Making Competence in Transgender Youth

Lieke Josephina Jeanne Johanna Vrouenraets · Annelou L. C. de Vries · Martine Charlotte de Vries · Anna I. R. van der Miesen · Irma M. Hein

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LGBTQ Health, Identity, and Policy Ethics and Legal Issues in Pediatric Healthcare Adolescent and Pediatric Healthcare

Abstract

BACKGROUND: According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents' competence to give informed consent (IC). In society, there is doubt whether transgender adolescents are capable of this, which in some countries has even led to limited access to this intervention. Therefore, this study examined transgender adolescents' medical decision-making competence (MDC) to give IC for starting PS in a structured, replicable way. Additionally, potential associated variables on MDC, such as age, intelligence, sex, psychological functioning, were investigated. METHODS: A cross-sectional semistructured interview study with 74 transgender adolescents (aged 10-18 years; 16 birth-assigned boys, 58 birth-assigned girls) within two Dutch specialized gender-identity clinics was performed. To assess MDC, judgements based on the reference standard (clinical assessment) and the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a validated semistructured interview, were used. RESULTS: Of the transgender adolescents, 93.2% (reference standard judgements; 69 of 74) and 89.2% (MacCAT-T judgements; 66 of 74) were assessed competent to consent. Intermethod agreement was 87.8% (65 of 74). Interrater agreements of the reference standard and MacCAT-T-based judgements were 89.2% (198 of 222) and 86.5% (192 of 222), respectively. IQ and sex were both significantly related to MacCAT-T total score, whereas age, level of emotional and behavioral challenges, and diagnostic trajectories duration were not. CONCLUSIONS: By using the MacCAT-T and clinicians' assessments, 93.2% and 89.2%, respectively, of the transgender adolescents in this study were assessed competent to consent for starting PS.

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2012Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 2017Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline 2007Assessment of Patients' Competence to Consent to Treatment 1988Assessing Patients' Capacities to Consent to Treatment 1998Assessing Competence to Consent to Treatment 2000Manual for the Aseba Preschool Forms & Profiles : An Integrated System of Multi-Informant Assessment 1997The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions 2010Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study

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