201 General discussion 10 up for each individual minor who enters a gender identity clinic. Despite the justification of the use of early medical treatment, various concerns as described in this thesis still need to be weighed with each individual minor. The results of this thesis show that, among others, the minors’ medical decision-making competence (MDC), the possible physical and/or psychological harmful effects of early medical interventions and of refraining from interventions, the consequences for fertility, the co-occurring psychosocial challenges, physiological puberty in developing a consistent gender identity, and the social context play an important role regarding early medical treatment and therefore should be taken into account when determining the most appropriate care for the minor in question. Additionally, dissemination of knowledge and support concerning the assessment of MDC and encountered ethical dilemmas is desirable in order for clinicians to adequately support minors and their parents in the decision-making process regarding early medical treatment. A good step to do so has been taken by some Dutch researchers; they have, largely based on the findings gained in several of the studies included in this thesis, developed an ethics support tool, the so called ‘Competence Consultant’ (De Snoo-Trimp et al., 2022a). This tool provides clinicians with information and direction on how to deal with minors’ MDC. The tool provides clinical guidance on assessing minors’ MDC, for example regarding what aspects the minors should understand about the treatment before they are considered competent (De Snoo-Trimp et al., 2022a). It would be very helpful if such an ethics support tool could be made available to clinicians in other countries as well. However, despite the grip these developments offer, ethical challenges and complex cases will be indistinguishably linked to care for transgender minors (Vrouenraets et al., 2021). The use of moral case deliberation (MCD), a relatively well-established form of clinical ethics support, shows to help clinicians to more effectively deal with these ethical dilemmas and complex cases (Dauwerse et al., 2014; Molewijk et al., 2008a; Vrouenraets et al., 2020). This thesis shows that care for transgender children and adolescents inherently involves ethical dilemmas, even if more clinical research data will be provided to underpin the evidence-base. Evidence alone will likely not be able to provide answers to all raised uncertainties concerning adolescent gender-affirming medical care. Ethical dilemmas will therefore probably remain part of this sensitive field of care. This thesis illuminates some of these ethical dilemmas and proposes ways of dealing with them in clinical practice.
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