High court case on puberty blockers and consent

Cross posted with a few as it took me a while to get that in some coherent order.

The point about doctors not being fully aware of the implications is a good one and one I hadn’t considered. In that case, it’s just straight up experimental treatment and should only be used as a last resort.

I think that’s a false equivalence - getting drunk isn’t a medical intervention, it has no benefit. Could a child consent to, for example, other medical treatment that would leave them sterile? What if the treatment was not life-saving? If so, does that also mean they can consent to sex? (also something that is never in children’s interest, whatever the MAP lot say)

I used a hypothetical as I think in practice, this almost never happens. However, I think we should be cautious arguing children can’t understand or consent to any life altering medical intervention (even against parental wishes) - ref the contraception and catholic mother case. From the mother’s POV that is life altering - essentially encouraging her children to move away from their religion and risk contracting STIs. Yet a court held (rightly IMO) that they had capacity to consent to pill contraception.

There’s also the 80-90% desistance rate. For that to be true there must be 10-20% of children presenting with dysphoria who persist, and if my hypothetical child turned up in that cohort, I think it would be unethical to block an intervention that might help them. I think the probability of that happening are almost 0, though, which is why I oppose giving PBs to children. My point is mainly about an individual patient’s best interest vs population level ‘best practice’ - not that we should be giving out powerful drugs like sweets to kids.

Children in Scotland are able to consent to medical treatment if they understand the implications or having the treatment or not having it.

Obviously this depends on many factors, such as the nature and complexity of the treatment and any risk.

So if a parent consents to a child having a vaccine at school and the child refuses on the day, that refusal is of course valid and the parent is informed. The risks are low because the child can always change their mind and get it later.

Same with something like a filling at the dentist, the consequences of not getting it done are mainly Pain for the child, and they will probably change their mind when this occurs.

It’s hard to see how a child can give informed consent to blockers and hormones when doctors don’t know the lifelong implications, except to say that they are life changing in a serious way.

How can a child who doesn’t know what sex is and has no experience of it, then consent to having no sexual desires in the future, when sex is a vital component of most adult intimate relationships?

How can they consent to treatment that will make their chances of Finding a sexual partner virtually nil, when they don’t understand this ?

Cross posted with Datun who put it much more succinctly. And reminded us of where this is heading.

And if you can consent to no sex life, why can't you consent to a sex life?

I think it is possible to maintain that some children are capable of medical consent to some interventions without extending that to sexual consent or universalising it to a blanket ability to consent.

In the case of a child who has not gone through puberty this treatment requires consent to remove their normal sexual function before they really understand what that means. Do you think any child is capable of consenting to this?

To put it another way, a child under the age of 16 cannot legally consent to sex. Hormone blockers taken before a child has gone through puberty followed (inevitably) by cross sex hormones means that a child will have their sexual function removed before they have experienced a normal sexual relationship.

How can a pre-pubescent child consent to a treatment which will remove their ability to have a normal sexual relationship for the rest of their lives? By normal I mean using the healthy functioning organs which they were born with.

I've struggled to write this post as I think it will be an obvious target for deletion since I am talking about the inconvenient facts around blocking puberty in children.

I agree with Datun . Also, these drugs are experimental for this particular purpose. They have been historically been used to delay early onset puberty but are now being used off the shelf for children with GD. There is some evidence of negative effects on bone density and very valid questions about brain development, but at the end of the day, no one knows what the risks are for long term impact to these children.

Surely that in itself means that no child can give any sort of meaningful consent.

I think it is possible to maintain that some children are capable of medical consent to some interventions without extending that to sexual consent or universalising it to a blanket ability to consent.

How? If you can consent to a pathway that will leave you with no sex life be permanently infertile and on drugs for the rest of your life, why shouldn't you be able to drink yourself stupid as well, at nine?

And if you can consent to no sex life, why can't you consent to a sex life?

I think you could imagine a hypothetical, precocious, wise child, who could fully understand and articulate the lifetime implications to fertility, bone density, intellect etc, and is also not autistic or same sex attracted, and can be shown to have come to their decision on their own without parental coaching or social pressure.

I think this hypothetical child could consent to puberty blockers.

I also think children like that are incredibly rare, to the point where it is almost an absolute that these drugs are not appropriate for dysphoric children.

I think it is possible to maintain that some children are capable of medical consent to some interventions without extending that to sexual consent or universalising it to a blanket ability to consent.

*can have been made

No-one can deny, surely, that a decision at 9 years old, affecting the person for life, cannot have been made with informed consent. It's not possible to think so.

Sorry should have specified that for many puberty is the cure. So kids put on.vlockers are denied the opportunity to change their minds.

Stopping or slowing development is a HUGE intervention

Even huger when they are effectively being denied the "cure" for their condition. 80-90 percent desist after puberty.

So only for only 10 percent or so put on.blockers it may possibly have been ( and we cant know for sure still ) the right call.

So what about the other 90 percent?

It's so odd that as youth gets longer, people seem more and more certain that children's lives are completely fixed and set into categories so early.

I'm not trying to say that children dont have views and opinions on their lives - they do and they should be listened to with great attention. But who on earth just does whatever a three, six, nine year old thinks is best for them? Who thinks that's the last word on the subject?

Stopping or slowing development is a HUGE intervention. Look at the life impact of a head injury on a child/not fully developed brain vs impact on an adult/fully developed brain. There could hardly be a more extreme action to take than to try and disrupt a child's development in any way.

Rupert Everett has spoken about this before. This is from 2016.

www.theguardian.com/film/2016/jun/19/rupert-everett-dangers-of-child-sex-change-operations-gender

I am listening to Robert Everett on Desert Island Discs describing his persistent wish to be a girl from a young age. He grew out if it. Nowadays he would have been on puberty blockers

And I also hope its pointed out that our brains dont fully developed until our 20s so even if people do link it to 14 and 15 year olds , that we arent talking about 3 or 4 years but we are robbing kids of up to ten years of time to mature and developed

I also think the headline is misleading. Well not so much the headline but the note under it.

I think fir the most part when people think of under 18s they think the argument links to the few weeks or months before hand which they dont feel that makes much of a difference.

Puberty blockers at 16/17 isnt the case. It's too late by then.

Theres no mention in the article that puberty can start at 9 so blockers potentially issued at much younger ages than most people would probably realise.

I should have said that Susan Evans is the nurse mentioned in the OP.

Link to Susan Evans's twitter. There's a link on there to a site with more information (I don't think I'm allowed to link directly to that).

mobile.twitter.com/sueevansprotect?lang=en

The research team described the purpose of pubertal suppression as ‘to induce a sex hormone-neutral environment to provide young people with space to decide whether to progress further with gender reassignment treatment as an adult.’ This phrase appears to have caused confusion as it has been interpreted by some that the puberty suppression was for use in any children presenting to the clinic, that there would be no change in the course of any gender identify dysphoria during this time, and that the child could then choose to progress to cross-sex hormone treatment or to stop treatment with subsequent onset of puberty in the birth gender. It has been noted that the participants in this study and other research involving early puberty suppression have progressed to cross-sex hormones. This has raised concerns that the treatment might be responsible for generating persistence, rather than ‘creating space to decide’.

It would have reduced confusion if the purpose of the treatment had been described as being offered specifically to children demonstrating a strong and persistent gender identity dysphoria at an early stage in puberty, such that the suppression of puberty would allow subsequent cross-sex hormone treatment without the need to surgically reverse or otherwise mask the unwanted physical effects of puberty in the birth gender. The present study was not designed to investigate the implications on persistence or desistence of offering puberty suppression to a wider range of patients, it was limited to a group that had already demonstrated persistence and were actively requesting puberty blockers.

It's also completely reversible.

They say puberty blockers are so this will be hopefully pointed out and noted on.court that nearly 100 percent go on to cross sex hormones.... so no reversing anything...

I do hope so. The HRA investigation into their dodgy study made the following recommendation:

Researchers and clinical staff working in gender identity development should consider carefully the terms that they use in describing treatments e.g. avoid referring to puberty suppression as providing a ‘breathing space’, to avoid risk of misunderstanding.

www.hra.nhs.uk/about-us/governance/feedback-raising-concerns/investigation-study-early-pubertal-suppression-carefully-selected-group-adolescents-gender-identity-disorders/

How can you give informed consent when the medical profession are completely clueless about the longterm impact of these drugs? I gave consent based on my understanding of what these drugs do and the risks - that information was inaccurate (and in some cases deliberately withheld it seems - just have a look at some of the Lupron survivors websites). The difference I suppose is that lots of people (rightly) care about the impact on children - the medical community seemingly gives no shits about the impact on a bunch of (mostly) middle aged women whose lives have been ruined. It’s like mesh all over again. I hope these kids get some justice, and I hope all of this prompts the medical community to actually start paying attention to those harmed by these drugs.

The trouble for GIDS is that even they don't understand the implications of giving puberty blocking drugs to children.

Elizabeth van Horn interview starts at 13:14 but the whole thing is worth watching.

Contraception is of course different as they know.

A 13 year old having sex isnt having sex she is being abused. Pregnancy could kill her and a baby would tie her to the abuser for life if he doesnt kill her.

And theres more hope of getting them support if theres an adult in their life they can trust ( the dr)

It's also completely reversible.

They say puberty blockers are so this will be hopefully pointed out and noted on.court that nearly 100 percent go on to cross sex hormones.... so no reversing anything...

Is it too much to hope that I'm this case all info is explored . Like why stagg at the clinic walked out, how drs are planning to put trans children onto bone density measurements results tables so kids will appear in " normal range " ( sure I read that somewhere)

If the stereotypes and the back ground of the patient isnt taken into account here we are fucked royally fucked