High court case on puberty blockers and consent

I didn't particularly. But the recent HRA directive will/should feed directly into this case.

I imagine Mrs A's lawyers will introduce it. But it may not have the weight you expect. The Tavi's lawyers will likely argue that:

(A) a 15 year old can understand what infertility entails. The legal standard for understanding tends to be lower than I think most posters imagine. (Remember that we tried two 10 year olds for murder - the law held them to have a sufficient understanding of the crime to be tried in the same way as adults)

(B) PBs are not materially different from other treatments for which Gillick competence is considered sufficient, e.g. a termination which, in extreme cases, can lead to infertility or even death (via infection or haemorrhage). They will argue that PBs are as necessary to a GD teen as a termination is to a teenager with an unwanted pregnancy. I would consider that absurd, but there is no guarantee the court will do so.

What a lot of arrogance. As a trans child I had worked out my gender-identity by around 11 all for myself in the far-away non-Internet 1970’s and if offered puberty blockers would have gratefully and informedly chosen the treatment (with all the attendant risks and uncertainties) over the horror of male puberty. How dare folk contemplate treating equivalent children today with the arrogance those bringing the case propose. Capacity to decide is plainly important. Given that I achieved 13 O-Levels, 5 A levels And 2 S-levels as a teenager and shortly afterwards a first class science degree from the UK’s premier science university (and all ‘before my brain had stopped developing’ as an earlier poster has said), I think I could have fully appreciated the issues.

Robin, I respectfully disagree.

I had already achieved my degree and was 25 years old when I started these drugs. I was experiencing constant, unbearable, unmanageable pain. I consented to the treatment believing I was making an informed decision. When the six months were up, given that’s the time limit on the license for women with my condition to have this treatment, I believed I was making an informed decision to continue.

This drug ruined my life. That’s not an exaggeration. I lost my career and inability to work. I lost my health - now I have constant pain, alongside crippling fatigue and a list of other symptoms as long as your arm. No libido whatsoever, for what will be 13 years this year, and the problems that this brings in terms of my marriage. I am mainly housebound, often bedbound. It is absolutely brutal.

And the consent I gave was not informed because the chances of this happening to me were simply never explained or mentioned. Because doctors simply don’t know and don’t care to know. I’ve had no help from anyone in the medical profession because they have no idea what the problem is or what they are looking for. So according to them there is no problem and if there is it’s some non-specific, not provable, unrelated issue, and it’s just a coincidence that there are thousands of women around the world reporting the same response to these drugs.

As a PP has pointed out, these are extremely powerful drugs which disrupt every aspect of your physical and mental health. I had simply no idea of the extent of the roles that hormones play in every area of your health until I agreed to disrupt mine. I’ve been paying for it ever since and it seems I will continue to do so. I’m in my late 30s and my life has essentially been over since my mid 20s. Doing the same to children is unconscionable and I find it very difficult to believe that anyone who’s actually experienced these drugs would advocate for their use in children. You think you could have made an informed decision at 11 years old when even now you don’t understand what you would have been agreeing to.

No XX I do think u are right. Not only do we need a law firm/medical expert/everything involved to have not been infiltrated and "trained" , but winning would mean that every single establishment that has been trained to help start this journey as young as 4 years old will have to admit they were wrong.

And of course it also means the police for once arent called at truthful medically accurate language being used to describe the consequences.

These sugar coated, played down words we have to use to describe what's happening do not have the ability to make the impact needed. But we dont have a police force on speed dial ready to spring to action for thought crimes.

I dont think I've ever been so scared and angry In my.life that I am now for children I've never even met...

Not sure if this means me

I didn't particularly. But the recent HRA directive will/should feed directly into this case.

Anyone on this thread suggesting that this does not have a significant impact on Gillick competence is being misleading. It's possible that a Tanner III child could "consent" to a pause but it's a very different matter to think the same child could "consent" to sterilisation and permanent loss of sexual function*

Not sure if this means me but, if it does, just a reminder that I am only expressing an opinion on how the case will pan out. I am not in a position to mislead as, like everyone else, I don't know what will happen, I can only speculate.

If I understand correctly what Mrs A's lawyers will argue, it will indeed be that Gillick was never intended to permit consent to a procedure with these potential consequences. Ethically, I agree. Legally, I think it will be tricky. I think the most likely outcome is that the case fails or that it succeeds but only on the basis of the individual child's lack of capacity, but not the principle of Gillick. I would be absolutely delighted to be proven wrong though.

I'm reminded of that tweet where a certain person stated ",removal of sterilisation clause is key"

Precisely.

It's possible that a Tanner III child could "consent" to a pause but it's a very different matter to think the same child could "consent" to sterilisation and permanent loss of sexual function

I'm reminded of that tweet where a certain person stated ",removal of sterilisation clause is key"

The recent HRA investigation at GIDS told them to stop telling children (and their parents) that PBs are pauses to allow reflection and to be upfront that they lock in a medical pathway that will lead to sterilisation (and a host of other possible side effects).

Anyone on this thread suggesting that this does not have a significant impact on Gillick competence is being misleading. It's possible that a Tanner III child could "consent" to a pause but it's a very different matter to think the same child could "consent" to sterilisation and permanent loss of sexual function.

Jeez robin you passed some exams so what.

We are talking here about children

And deciding the rest of their adult life’s

Not just some exams

11 y/o boys and younger are a tiny minority of GIDS referrals. That cohort has remained fairly stable over the years compared to what has happened with adolescent girls and to a smaller extent adolescent boys.

but I think 15 is still too young to make a decision about whether to be sterilised

Well yeah, when you consider how women in their late 20's, 30's and even 40's are treated by the NHS when actually requesting a sterilisation.

Grown women with multiple children, who know another pregnancy would seriously harm their health, cannot get a sterilisation because they might change their minds or meet a man in the future who wants babies () but we are saying young teens are competent to make these decisions?

The children referred to GIDS today are not 'equivalent children' to those who were in your situation.

Some of them are. I linked earlier to an interview with Rupert Everett who said this:

“I really wanted to be a girl. Thank God the world of now wasn’t then, because I’d be on hormones and I’d be a woman. After I was 15 I never wanted to be a woman again.”

The gender clinic might be seen as a good idea by homophobic parents of effeminate boys. I think boys still outnumber girls in the youngest age groups referred to the clinic.

But this case is about girls who exhibit ROGD.

Unless you're just borrowing the name you're the barrister who represented Katherine O'Donnell against the Times at an employment tribunal. You lost that one.

Hi RobinMoiraWhite, I'm very clever too and got lots and lots of O levels. It didn't stop me from making some incredibly stupid and unwise decisions during my teens and early adulthood. I'm still living with the results of some of those unwise decisions now, in middle age. Respecting children and teenagers involves acknowledging that brain development in adolescence is uneven and someone can exhibit academic brilliance years before they can properly appreciate the long term consequences of their actions and decisions. To treat young teens as fully competent just because they are good at passing exams is extremely disrespectful and dangerous because it takes no account of their vulnerability at this stage of development.

The children referred to GIDS today are not 'equivalent children' to those who were in your situation. We are primarily concerned in this case with those who exhibit ROGD. This is an entirely new cohort.

• There has been a complete reversal in the sex ratio - around 70% of referrals to GIDS are now female
• These children show no signs of gender dysphoria prior to adolescence
• Many of these children do not identify as the opposite sex but as non-binary or something else
• These children arrive at GIDS having already socially transitioned

And for this particular brand new cohort there has been an increase of 4000+% in yearly referrals in less than a decade.

These children are nothing to do with you.

Will it be assumed that because a 15-year-old is deemed competent that an 11-year-old can also consent to this treatment?

No. The big difference between under 16s and over 16s is that over 16s are presumed to have capacity, whereas, for under 16s, you have to assess each child and each situation individually. If this case is lost, nothing changes. If it is won on the principle of Gillick's applicability (as opposed to the individual child's capacity) - and it is bound to go to the Court of Appeal and probably the Supreme Court if it is - it would be a momentous change.

For puberty blocking these children, we are talking at Tanner Stage 2, right, so 9-11 years old for girls and ~11 for boys

If Gillick competence is assessed using age and severity, is it likely that these children will reach it at this age? I guess there can’t be a blanket answer here, but it seems like quite a high bar

Very unlikely to reach it at 9-11, I would think. There is no case law for that age group, though, AFAIK. And, in practical terms, it's also much less likely that a younger child would be able to obtain treatment without a parent's support.

I think I share the reservation about this case being winnable and really addressing all the matters of concern, but it’s certainly heading in the right direction, and as I said earlier, the key thing here is exposure Agree. If the case is lost, we are no worse off than we are now in medico-legal terms. The downside is that Mermaids et al will claim that the courts have found that PBs are safe but, balanced against that, is the publicity and people waking up to the fact that children are receiving these drugs at ever younger ages.

Oh and we know a lot about when and how to remove an appendix because we do it a lot and have been doing it for a long time.

Neither apply to PB used in this way.

The consequences of not having your appendix removed when it needs to be are

1. Well established scientifically and clinically
2. Easy to explain to a 15yo.

The consequences of having puberty blockers are not.

Where have I said that I think that?

You said: I would be astounded if this case succeeds unless there is a particular reason why the individual child concerned might have an impaired capacity to consent, such as cognitive impairment.

Sorry. I confused the discussion about children being given puberty blockers aged around 11 with this case which is about a 15-year-old. So the situation is slightly different, but I think 15 is still too young to make a decision about whether to be sterilised which is what puberty blockers inevitably lead to.

I'm not sure how the outcome of this case will influence policy going forward - if it is found that a 15 year old is competent to consent, will there be any discussion around what the minimum age should be, or will that require another case to be brought? Will it be assumed that because a 15-year-old is deemed competent that an 11-year-old can also consent to this treatment?

Old Crone thanks. Yes - completely different clinical indication. Two different patient populations.

So why do you think the court is likely to find that an 11-year-old is competent to consent to being made infertile and having no sexual function as an adult

Where have I said that I think that?

You would also have lost any chance of fathering kids (even through sperm storage) and sexual desire/orgasm. You might look back with the benefit of age and say that none of this matters to you but you cannot make that decision for children today, many of whom would escape a life as a medical patient as they find they are happy with their body after surgery

This. If we could reliably know which children would identify as trans all their lives, I would have far fewer problems with PBs (though I would still be concerned about osteoporosis etc). At the moment, though, as oldcrone says, we are treating patients blindly, knowing that many if them would have desisted if left untreated. And, if treatment continues past the natural age of puberty, it is irreversible.

happy with their body after puberty*

I think most 15 year olds would easily be Gillick competent to consent to having their appendix out, but many 13 year olds would not, though they could consent to a BP check

So why do you think the court is likely to find that an 11-year-old is competent to consent to being made infertile and having no sexual function as an adult?

&Given that I achieved 13 O-Levels, 5 A levels And 2 S-levels as a teenager and shortly afterwards a first class science degree from the UK’s premier science university*

Would this still have been possible if your IQ had been lowered by 10% through the use of PB? And presuming you have had surgery, this would have been made a lot more complicated. You would also have lost any chance of fathering kids (even through sperm storage) and sexual desire/orgasm. You might look back with the benefit of age and say that none of this matters to you but you cannot make that decision for children today, many of whom would escape a life as a medical patient as they find they are happy with their body after surgery.