A high court in England has ruled that children under the age of 16 who are seeking gender confirmation treatment are “unlikely to be mature enough to give informed consent to be prescribed puberty-blocking drugs”.
This 19-page court ruling was made in an action against the Tavistock and Portman NHS trust, which is responsible forthe Gender Identity Development Service (GIDS), the largest service of this kind for English children. The ruling also stated that children under 18 may need their doctors to consult the courts for medical intervention authorization, another barrier to accessing gender-affirming care.
This action was brought forward by Keira Bell, a 23-year-old woman who began taking puberty blockers at 16, then later de-transitioned, and an unnamed mother of a 15-year-old autistic girl who is on the waiting list for gender-affirming treatment. Bell argued that the Tavistock clinic should have challenged her more over her decision to take puberty blockers. The unnamed mother, known as Mrs. A, fears that her child will “get it wrong”.
The president of the Queen’s bench division stated in this ruling that a child under the age of 16 may only consent to the use of puberty-blocking medication “where he or she is competent to understand the nature of the treatment”, which includes understanding “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”. Therefore, the court ruled that children aged 13, 14, or 15 are not competent to weigh these consequences, assess the risks, and give full consent.
A spokesperson from NHS appreciated the “clarity” of this ruling and stated: “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 authorizes it. Dr Hilary Cass is conducting a wider review on the future of gender identity services.” The trust also stated that it was “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.”
Lui Asquith, legal director of Mermaids, an advocacy group supporting trans children, said that “puberty blockers have been saving lives for many transgender young people for a significant period of time… not all trans young people require medical intervention, but those who do should be able to access it, without discrimination.”
The World Professional Association for Transgender Health, a global organization of doctors specialized in treating trans people, reported that puberty blockers can prevent the mental health impacts of gender dysphoria in puberty.
Sources: The Guardian 12/1/20, BBC 12/1/20