The current inadequacy of Italian services offering specialized support for GD youth may lead to negative consequences. Omitting or delaying treatment is not a neutral option. In fact, some GD adolescents may develop psychiatric problems, suicidality, and social marginalization. With access to specialized GD services, emotional problems, as well as self-harming behavior, may decrease and general functioning may significantly improve. In particular, puberty suppression seems to be beneficial for GD adolescents by relieving their acute suffering and distress and thus improving their quality of life.

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.

‘Cloning’ is the popular name given to Cell Nuclear Replacement (CNR) or Cell Nuclear Transfer (CNT) techniques. CNR involves a recipient cell, generally an egg (oocyte), and a donor cell. The nucleus of the donor cell is introduced into the oocyte. With appropriate stimulation the oocyte is induced to develop. In some cases, the created embryo may be implanted into a viable womb and developed to term. The first mammal to be born by CNR was Dolly the sheep (1996–2003). It is thought that CNR may have various potential applications ranging from reproduction to treatment of some of the most serious and life-threatening diseases that afflict humankind (such as cancer, Alzheimer’s, Parkinson’s disease, spinal cord injuries). However, many technical problems must be addressed and resolved before CNR becomes viable for use in either therapy or reproduction. Although research on CNR is still at its early stages, CNR (cloning) attracts people’s attention in a way that few other advances in biomedical research do. Public debate on cloning has unfortunately been influenced more by fiction than science. The horrendous or absurd scenarios pictured in novels and films are often mistakenly believed to be possible, or even likely, outcomes of cloning. The international community, immediately after news of the birth of Dolly, imposed restrictions that may make it difficult to refine the technique used. Against ‘reproductive cloning’ a prohibition is enforced virtually everywhere. ‘Reproductive cloning’ is considered offensive to human dignity and a threat to the well-being of the child or even to the future of humankind. Most of these objections are based on either a misunderstanding of CNR or on inconsistent philosophical arguments. Against ‘therapeutic cloning’ objections are also raised. The strongest are that CNR involves the creation and destruction of embryos, and this is widely believed to be unethical. Advocates of this position contend that, although CNR may save human lives, the technique still involves the taking of an innocent life and therefore is the equivalent of killing one person to save another. The debate on the moral status of the embryo is ongoing, in bioethics, philosophy and theology. However, if the arguments against the killing of the embryo for the morally important, life-saving purposes envisaged for CNR were to be accepted, then the current legal and social context of most European countries would have to be revised, and abortion and in vitro fertilization (IVF) made criminal offences. Abortion and IVF (which involves creation of extra-embryos that may be destroyed) are in fact accepted practices in most European countries. Those who believe that abortion, even in its therapeutic form, and IVF are acceptable, admit that it may be ethical to destroy an embryo either to save a life or to treat infertility. If this is accepted, it is unclear why is it unacceptable that embryos are used to treat highly serious and lethal diseases (cancer or Parkinson’s disease for example).

Aristotle, Nicomachean Ethics 1 Demographic Revolution and Related Ethical Issues A demographic revolution is taking place in Europe and worldwide. According to World Health Organization (WHO) estimates, the number of people aged 60 and over is growing faster than any other age group. 2 This change in the population structure affects disease patterns 3 and is deemed to cause an increase in the demands on healthcare systems. 4 This raises concerns about the ethics of healthcare delivery (among others). What criteria should direct healthcare distribution? Is it right to meet the demands of an ageing population, to the detriment of the younger strata of population? International organizations, such as the European Union (EU), the World Health Organization (WHO), and the United Nations (UN) have condemned any form of "ageism," including ageism in healthcare provision. 5 Age-based discrimination is deemed to violate the principle of equality. Virtually all declarations, conventions, and charters on human rights stress the fundamental value of equality. Since the earliest documents, the notion of equality has been at the heart of claims of respect for fundamental human rights, such as dignity, life, and integrity. These rights apply equally "to all members of the human family." 6 In these declarations, equality is understood mainly in terms of nondiscrimination. The Charter of Fundamental Rights of the European Union, for example, reads: Any discrimination based on any ground such as sex, race, colour, ethnic or social origin, genetic features, language, religion or belief, political or any other opinion, membership of a national minority, property, birth, disability, age or sexual orientation. (Art. 21, Nondiscrimination; my emphasis) 7 Similar statements occur in virtually all other declarations and conventions, for example, in the Convention for the Protection of Human Rights and Fundamental This paper has been written thanks to the support of the European Union, which has sponsored my project on ageism with a Postdoctoral Marie Curie Fellowship. More details on this project are available at the website http://les.man.ac.uk/simona/. I thank Prof. John Harris for our discussions on the topic and for his comments on this paper.

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Studies suggest that the majority of gender diverse children (up to 84%) revert to the gender congruent with the sex assigned at birth when they reach puberty. These children are now known in the literature as ‘desisters’. Those who continue in the path of gender transition are known as ‘persisters’. Based on the high desistence rates, some advise being cautious in allowing young children to present in their affirmed gender. The worry is that social transition may make it difficult for children to de-transition and thus increase the odds of later unnecessary medical transition. If this is true, allowing social transition may result in an outright violation of one of the most fundamental moral imperatives that doctors have: first do no harm. This paper suggests that this is not the case. Studies on desistence should inform clinical decisions but not in the way summarised here. There is no evidence that social transition per se leads to unnecessary medical transition; so should a child persist, those who have enabled social transition should not be held responsible for unnecessary bodily harm. Social transition should be viewed as a tool to find out what is the right trajectory for the particular child. Desistence is one possible outcome. A clinician or parent who has supported social transition for a child who later desists will have not violated, but acted in respect of the moral principle of non-maleficence, if the choice made appeared likely to minimise the child’s overall suffering and to maximise overall the child’s welfare at the time it was made.