Assessing decision-making competence in transgender and gender-diverse adolescents is a complex task, as care in this area involves supporting a developing gender identity and making decisions about treatments that often lack international agreement. Even when competence assessments are performed, moral dilemmas can arise during the decision-making process. Traditional clinical ethics support approaches, such as moral case deliberation, may be insufficient because they do not provide thematic guidance tailored to these situations. This study therefore sought to create a practical ethics support tool to aid care providers in navigating moral challenges related to decision-making competence in transgender adolescent care. A participatory design approach was used, involving care providers in all stages of the tool’s development and dissemination. Initially, nine care providers were interviewed to explore their experiences with moral challenges and identify their ethics support needs. These insights informed the tool’s structure and content, which were refined through two focus group discussions. Subsequently, four care providers tested the tool, and feedback was collected from the development team and an advisory board. The finalized tool was then presented to all Dutch providers working in transgender adolescent care. Care providers highlighted the need for guidance in defining and assessing decision-making competence. Key moral challenges included conversations about fertility options, addressing co-occurring mental health conditions, and clarifying the role of parents in decision-making. The resulting tool, named the Competence Consultant, is an interactive PDF composed of four sections: (1) Clarifying information, (2) Identifying doubts and moral questions, (3) Guidance for conversations, and (4) Overview and conclusions. Developing an ethics support tool for a contentious area of care is crucial, as it helps providers navigate real-world moral challenges, enhancing their moral awareness and competence. The Competence Consultant offers a practical example of an innovative, thematic ethics support instrument tailored to the needs of transgender care providers.
