16 Chapter 1 will help to adequately support these adolescents in their decision-making process, and give them the information and care they need. MEDICAL DECISION-MAKING COMPETENCE A major issue in paediatric ethics in general is decision-making competence for medical treatments. The right balance needs to be struck between protecting minors who are not fully capable of making the decision themselves to start or refuse a medical treatment, and respecting minors’ evolving autonomy (Appelbaum, 2007). According to the international transgender guidelines, an important prerequisite to start treatment with PS is that transgender adolescents are competent to give informed consent (Coleman et al., 2022; Hembree et al., 2017; see also table 3 which can be found at page 14). There is increasing public discussion whether adolescents are actually competent to make a decision regarding PS treatment, especially because the treatment has far-reaching long-term consequences (e.g. Baron & Dierckxsens, 2021; D’Abrera, D’Angelo, Halasz, Prager, & Morris, 2020; Giordano, Garland, & Holm, 2021; Levine, 2022; Pang, Giordano, Sood, & Skinner, 2021; Siddique, 2021; Tampier, 2022). To date, little empirical research exists regarding minors’ medical decision-making (MDC) competence to decide on starting PS in the transgender context. In addition, little is known about the perceptions of transgender adolescents, their parents, and clinicians on the minors’ MDC to decide on starting PS. Research regarding these aspects is needed to underpin both the ethical debate and clinical practices. MEDIA ATTENTION In recent years, not only the number of referrals increased enormously in various parts of the world, there has also been an explosion of media attention regarding transgender children and adolescents worldwide. Actually, one of the suggested causes for the increased number of referrals, is the increased media attention regarding transgender children and adolescents (de Graaf & Carmichael, 2019). Newspapers, television programs, magazines, movies, and the internet pay increasing attention to transgender children and adolescents (Pang et al., 2020; Sadjadi, 2013; Zucker, Bradley, Owen-Anderson, Kibblewhite, & Cantor, 2008). Most portray these children and adolescents as fascinating and sometimes somehow strange, and simultaneously as ones to feel compassion for (Sadjadi, 2013). The media have an increasingly important influence on the development of adolescents’ identity, especially in western communities (Alper, Katz, & Clark 2016; Henrich, Heine, & Norenzayan, 2010). One could therefore wonder if the increasing media attention has an influence on the number of children and adolescents referred to gender identity clinics. In addition, the question can be asked whether this influence is positive or negative.
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