“Death threats and despair”: A conceptual model delineating moral distress experienced by pediatric gender-affirming care providers

Abstract

Gender-Affirming Care Providers (GACPs) for children and adolescents function within an intricate socio-political landscape that necessitates navigating legislative restrictions, institutional betrayals, and overarching societal prejudices. This manuscript presents a conceptual model that captures the multifaceted factors inducing moral distress among these professionals, including social workers, counselors, nurses, and physicians. Employing a system dynamics lens, our model delineates the complex interplay of legislative, societal, and institutional pressures with individual experiences, coping mechanisms, and resilience-building endeavors. While underscoring the pronounced challenges confronting pediatric GACPs—ranging from societal oversight to the long-term implications of decisions made during adolescence—we also highlight the pivotal role of identity concordance in enhancing patient-provider interactions. Shared identities between transgender and gender-diverse patients and providers can act as catalysts for fostering trust, bridging communication gaps, and serving as affirming representations of societal acceptance and success. Based on these insights, we offer robust recommendations including comprehensive institutional training, technological safeguards against online harassment, community alliances for multifaceted support, and intensified nationwide advocacy campaigns emphasizing the evidence-based nature of gender-affirming care. Through this comprehensive exploration, our aim extends beyond merely outlining challenges; we spotlight potent avenues for intervention, positive change, and reinforced support structures for GACPs. In sum, this paper contributes a profound understanding of the dynamics influencing GACPs, offering a clarion call for proactive measures to support these professionals and their patients in today's challenging socio-political environment.

Keywords

• Moral distress
• Gender-affirming care
• Transgender
• Nonbinary
• Systems dynamics theory
• Identity concordance