Discrimination against Children and Adolescents with Gender Incongruence or Gender Dysphoria in Medical and Mental Health Care

Abstract

Introduction Non-discrimination is a human right. Yet empirical studies suggest that certain social groups, such as trans people, experience discrimination in the health care system. Why is that? Objectives We address this question by focusing on the health care of children and adolescents with gender incongruence / gender dysphoria (GI/GD). We investigate the specific challenges medical and mental health professionals face, how they understand discrimination, and how they interact with the particular client group. Methods Methodologically, the study follows an empirical-ethical approach. 17 guided, qualitative expert interviews were conducted with medical and mental health professionals who have or have had professional contact with children and adolescents with GI/GD in Germany. They were analyzed according to the rules of thematic content analysis. With the help of a conceptual matrix on discrimination, specific discrimination risks were identified. Advocacy groups were involved in the study in an advisory capacity. Results The interviewees face numerous challenges when providing therapeutic or medical care to minors with GI/GD. These include the ethical tension between protecting minors and respecting their wishes, having to cope with professional work and language routines, and technical challenges. While some professionals are deeply committed to overcoming these challenges, others resort to inappropriate coping strategies such as victim blaming. Conclusion Our results provide new insights into the risks of discrimination which children and adolescents with GI/GD face in health care. Professionals must be sensitized to the fact that professional routines in particular pose specific discrimination risks. Educational programs and institutional support services should be tailored to these needs. However, it remains a task for society as a whole to provide a social and institutional context for health care professionals that promotes non-discriminatory health care.