Ethical dimensions of child well-being in interdisciplinary decision-making in the treatment of children with hypospadias. A qualitative study with expert interviews

Proximal hypospadias is a complex form of Disorders or Differences of Sex Development (DSD), associated with high rates of complications, revision surgeries and variable long-term outcomes. Since 2021, German law (§1631e BGB) requires that surgical intervention in affected children receive both a positive recommendation from an interdisciplinary commission and approval from a family court. The committees opinion as well as the court decision are supposed to be guided by the principle of serving the child’s best interests (“Kindeswohl”), yet what precisely constitutes the child’s best interest in this context remains ethically and clinically contested.

This study examines how commission members from medical, psychological and ethical backgrounds conceptualize and apply the notion of the child’s best interest when advising on early surgical interventions for proximal hypospadias. It explores the interplay of medical and psychosocial considerations as well as the influence of societal norms and individual experiences on recommendations.

By analyzing the perspectives, priorities and implicit assumptions of commission members, the study aspires to reveal how risks, benefits and the child’s future autonomy are weighed in practice. The findings are expected to enhance transparency, strengthen ethically robust and patient-centered care and contribute to broader debates on timing and justification of surgical interventions for children with DSD.

Aims 

• Examine different conceptualizations of the child's best interest
• Assess the decision-making process
• Identify key influencing factors, personal and societal