Background/Objectives: In recent years, changing paradigms, both culturally and scientifically, have fundamentally altered the approach to the treatment of children with Disorders of Sexual Development (DSD) prior to reaching the age of legal consent. In Germany, the situation changed with the introduction of legislation that includes a partial ban on DSD surgery in children in 2021. This study aims to analyze the impact of this legislation on clinical practice. Methods: From 2014 to 2024, all patients with DSD in our institution were included. The study group comprised all patients operated on after the legislation. All patients operated on before the legislation served as the control group. Karyotype, phenotype, resulting type of DSD, age at presentation and age at operation were recorded. Results: A total of 35 patients were included in this study, with 15 in the study group and 20 in the control group. The operation was authorized by the family court for all patients in the study group. A total of 46,XY patients with severe hypospadias and clinical aspect of intersexual outer genitalia were the largest proportion (25 patients, 71.4%). Nine patients (25.7%) were 46,XX girls with classical congenital adrenal hyperplasia (CAH) type. One patient (2.9%) showed a mixed gonadal dysgenesis. The mean age of the patients at first presentation in our institution was 10.7 months in the control group and 11.0 months in the study group. The mean age at operation was significantly higher in the study group (20.1 months) compared to the control group (15.1 months; p = 0.032, unpaired t-test). Conclusions: The introduction of the legislation with a partial ban of genital surgery in DSD children in Germany has led to a significant delay in surgery. Since the majority of the patients comprise severe hypospadias and 46,XX CAH patients, further amendments of the law are proposed to minimize potential harm.

Due to the Corona crisis, medical ethics has received increased attention. Advances in medicine have also created new ethical dilemmas. This chapter is dedicated to concepts that previously have had less significance in the context of medical ethics: Responsibility, Autonomy, Hope, and Trust. In 1919, Max Weber introduced the concept of moral responsibility for politicians (“Politics as a Profession”). But this also applies to physicians. Responsibility has become a new basic term increasingly replacing the ethical concept of Duty. Weber distinguishes between ethics of conviction and ethics of responsibility. Both complement each other. The principle of Hope plays an essential role in the patient’s recovery. For the principle of autonomy, a relationship of trust between doctor and patient is a basic requirement. Trust is therefore particularly important for the doctor-patient relationship.

Economization and commercialization have led to significant changes in the healthcare system in recent years, with severe repercussions for pediatric and adolescent medicine. As a result, the medical profession is being called into question, and the doctor-patient relationship is being seriously threatened. The following paper primarily describes the situation in the Federal Republic of Germany, with a particular focus on doctors and hospitals. The fundamentals of medical ethics, such as the four-principle model and the Geneva Pledge, are helpful for the ethical assessment of the resulting questions. The diagnosis-related groups (DRG), the profit-oriented financial investors and corporations, and the over-treatment for economic/commercial reasons are discussed. Bonuses for chief physicians, the COVID-19 pandemic, and their relation to ethics in medicine are mentioned. Medical-ethical and economic principles outlined here also apply to all those working in the healthcare sector. After all, the patient, or the human being, is at the center of the healthcare system.