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).

No abstract

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.