High Court Rules On Under-16's Access to Puberty Blockers
Children under the age of 16 considering gender reassignment are unlikely to be mature enough to give informed consent to be prescribed puberty-blocking drugs, the high court has ruled.
Even in cases involving teenagers under 18 doctors may need to consult the courts for authorisation for medical intervention, three senior judges have ruled in an action brought against the Tavistock and Portman NHS Trust, which runs the UK’s main gender identity development service for children, according to ‘The Guardian’.
An NHS spokesperson welcomed the “clarity” the decision had brought, adding: “The Tavistock have immediately suspended new referrals for puberty blockers and cross-sex hormones for the under 16s, which in future will only be permitted where a court specifically authorises it. Dr Hilary Cass is conducting a wider review on the future of gender identity services.”
The judgment in effect introduces guidelines for the way in which the London clinic handles young patients who experience gender dysphoria – the condition where they are distressed because of a “mismatch between their perceived identity and … their sex at birth”.
The claim was brought by Keira Bell, a 23-year-old woman who began taking puberty blockers when she was 16 before detransitioning, and the unnamed mother of a 15-year-old autistic girl who is on the waiting list for treatment.
In their decision, Dame Victoria Sharp, president of the Queen’s bench division, Lord Justice Lewis and Mrs Justice Lieven, said a child under the age of 16 may only consent to the use of medication intended to suppress puberty “where he or she is competent to understand the nature of the treatment”.
Such an understanding must include “the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life-changing consequences for a child”.
The judges said there would be enormous difficulties for young children weighing up this information and deciding whether to consent to the use of puberty-blocking medication.
“It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers,” the judges added. “It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”
For the treatment of those over 16 it is normally presumed that they have the ability to give consent. But in gender reassignment cases where puberty blockers may lead to subsequent surgical operations, the judges said: “Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.”
A spokesman for the Tavistock and Portman NHS trust said the trust would seek permission to appeal against the ruling, adding: “The trust is disappointed by today’s judgment and we understand that the outcome is likely to cause anxiety for patients and their families.
“Our first duty is to our patients, particularly those currently receiving hormone blocking treatment, and we are working with our partners, University College London hospitals NHS foundation trust and Leeds teaching hospitals NHS trust, to provide support for patients concerned about the impact on their care.”
Speaking outside the Royal Courts of Justice after the ruling, Bell said she was “delighted” with the ruling: “This judgment is not political, it’s about protecting vulnerable children … I’m delighted to see that common sense has prevailed.”
Paul Conrathe, the solicitor who represented both claimants, said the ruling was “a historic judgment that protects children who suffer from gender dysphoria … This may have led to hundreds of children receiving this experimental treatment without their properly informed consent.”
Lui Asquith, from the trans children’s charity Mermaids, said: “It’s frankly a potential catastrophe for trans young people across the country and it cannot be exaggerated the impact that this might have, not only on the population of trans young people that require hormone blockers, but it may potentially open the floodgates towards other questions around bodily autonomy and who has the right to govern their own body.”
Read related myGwork articles here:
UK Trans Teen In Legal Action Over NHS Gender Clinic Delay
New Study Shows That Puberty Blockers Could Save The Lives Of Trans Teens
South Carolina To Ban Medical Treatments for Trans Kids
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