MORALITY AND HEALTHCARE: AN SEM INVESTIGATION OF ADULT ATTITUDES TOWARDS TRANSGENDER ADOLESCENTS' HORMONE REPLACEMENT THERAPY CHOICES

Author

Ann Miranda Nelson, Southern Illinois University CarbondaleFollow

Date of Award

12-1-2024

Degree Name

Doctor of Philosophy

Department

Psychology

First Advisor

Lee, Yueh-Ting

Second Advisor

Habib, Reza

Abstract

Adolescents largely cannot legally make their own medical decisions, and in some cases, the debate around whether this is right or wrong is an ethical dilemma. Researchers, philosophers, social justice workers, child rights advocates, and healthcare providers have long debated how much say, if any, adolescents should have in making medical decisions about their own health. This decision generally involves two contrasting approaches: (1) a paternalistic approach, where decisions are made for the adolescent, and (2) an autonomous approach, where the adolescent is granted the authority to make their own choices. These decisions are inherently moral in nature, as they involve judgments about what is morally right or wrong (Rozin, 1999). The present research examines how two key moral theories—Theory of Dyadic Morality (TDM) and Moral Foundations Theory (MFT)—apply to the issue of supporting adolescent autonomy in medical decision-making, specifically regarding transgender youth. Dyadic Morality posits that moral decisions are made through a cognitive process involving perceptions of norm violations, negative affect, and perceived harm (Schein & Gray, 2018b), whereas Moral Foundations Theory suggests that moral judgments rely on cognitive heuristics, or "foundations," such as harm/care, fairness/cheating, and purity/degradation (Haidt & Joseph, 2004; Graham et al., 2009). Despite extensive research on moral judgments, little work has applied these theories to the context of transgender adolescents’ healthcare decisions.In the present research, 507 participants were recruited via Prolific to complete a survey assessing their moral judgments about transgender adolescents' autonomy in hormone replacement therapy (HRT) decisions. Structural Equation Modeling (SEM) was employed to test several hypotheses and address four research questions regarding the role of both morality theories on support for adolescent autonomy. The results provide mixed support for Moral Foundations Theory (MFT) and challenge the applicability of the Theory of Dyadic Morality (TDM) within the context of transgender healthcare, indicating that these moral frameworks may not fully capture the complexities involved in medical decision-making for transgender adolescents. While both MFT and TDM offer valuable insights into the cognitive processes underlying moral judgments, they may fall short in accounting for the deeper ideological and cultural factors that shape support for or opposition to transgender healthcare. This study did not provide strong theoretical support for morality research, but policy and medical implications are worth noting. To effectively advance transgender rights, particularly adolescent autonomy in medical decisions, it is essential to engage with the broader sociocultural and ideological frameworks that influence public opinion. Both healthcare providers and advocates must address these beliefs in ways that respect the values of individuals and communities while simultaneously promoting inclusive and supportive environments for transgender individuals.