Jolyon Maugham, GLP and scary stuff re parental consent

If the argument is about the emotional harm and risks then there are many other ways to help; pbs are not the only answer to emotional and psychological distress, and are not the least invasive or permanently altering.

It is interesting that Jolyon changed the crowdfunder which was originally sensible(ish) and fighting for waiting times for children to see gender specialists reduced, to one which is actively trying to undermine the judgement not there judges, and to make children the property of their parents

Perhaps reading The Secret Garden and thinking about the transformation of Colin after he wasn’t pandered to would be useful.

There are loads of children’s books from previous eras about how children who are fawned over and pandered to become poisonous. It often starts with a health issue or an accident and then spirals into little emperors calling the shots destroying their own and the lives of all around them.

A child that is guaranteed to have special treatment, conversations, consideration, special clothes and watches as the world bends around them as it does for no one else can’t possibly be unaffected.

It's the same black and white zero sum thinking that characterises the spaces debate: third ways unacceptable.

The judgement does not refuse pbs, but requires an objective court of protection to establish it is in the child's best interests and they are able to consent. Remove the need for the child to be able to understand consequences fully as a child (and as I keep saying, we have evidence of adults posting on MN in defense of pbs being prescribed who are unable to engage with or acknowledge the facts beyond denial so the judgement seems very reasonable that a child will not be able to do it) and what is left is best interests.

Precedent in situations that involve serious effects on a child are usually based on the minimally invasive and restrictive. There are many less invasive ways to treat a child with severe dysphoria and self harming ideation, which is what this was about in the first place: that psychological supports are essential and should be the main plank of treatment. Self harming and suicidal ideation are also high for children with autism and anorexia, but there is no pbs silver bullet for them, so other treatments, strategies and resources are considered best practice for treating those children and supporting those families in this situation.

If the argument is about the emotional harm and risks then there are many other ways to help; pbs are not the only answer to emotional and psychological distress, and are not the least invasive or permanently altering.

If an adult child takes parents and doctors to court over a kidney transplant or an amputated limb that parents consented to on their behalf as a child, the evidence will be fairly straight forward to show that the harm of not acting would have significantly out weighed the harm of the treatment, and adults made the best decision possible in the circumstances.

This is the line of argument trying to be applied to pbs. That the harm of not acting outweighs.

The issue is that while a septic foot with no circulation will not recover and will end up causing death, and that is a known, objective, scientific, evidenced fact that the same medics looking at the same scans and evidence could replicate diagnosis of, there are many less invasive ways to treat suicidal ideation that do not involve causing permanent lifetime harm. No one can say that the child would not have recovered equally well on other less permanently altering treatments. No one can say that the adult child's distress at their altered body and lifetime of medical needs and infertility was absolutely the only possible solution to their dysphoria and the risk it was causing them when they were a child. Keira evidences this.

Likewise, no one can currently say how many of these children, if supported in other ways and allowed to go through puberty, would either find their dysphoria resolved, or become happily trans as adults as Sharpe has done without the risk of harm caused to a growing body.

realitynotessentialism

PB can’t be compared to something like having a tooth pulled out or an operation because those treatments will usually bring about a notable improvement in the child’s health whereas PBs don’t. The latest from the Tavistock’s own research shows PB don’t improve mental health.

I completely agree. I think the Tavistock used the same consent process as for a specific medical diagnosis with a clear gold-standard treatment protocol.

However, PBs + cross sex hormones is an experimental procedure based on unverified theories (pause button? Better aesthetics to pass?). But the Tavistock implied that this is a well evidenced treatment.

The Bell vs Tavistock case largely sidestepped the issue of whether the treatment is appropriate to the problem by focusing on the ability of the child to meaningfully consent. They noted that the procedure was experimental, so fell into the category of treatments for which children were unlikely to be able to consent, but didn't go into the science of treatment at all.

Because the focus of the ruling was so much about Gillick competence, I very much doubt that the GLC attempt to intervene will be successful in overturning the ruling. They could only win an appeal if they demonstrate that the evidence already presented was interpreted wrongly. I don't think that includes suggesting a new consent procedure at the Tavistock.

The judgement was also very damning about the poor quality of evidence presented by the Tavistock (they were very surprised indeed). So I don't think the Tavistock can easily present PBs as the accepted treatment without some push back.

(Interestingly, the endocrinologists are probably safe here. They prescribe the PBs, but the consent process is carried out by the Tavistock, who also oversee what treatment is given. They can easily argue that their expertise is hormones, not mental health so they were only following the greater expertise of the specialist gender clinic ...)

I'll be very interested to see what happens if the Tavistock do start presenting patients to the court for permission to prescribe blockers. I'm hopeful that this will lead to a detailed review of the treatment offered - like in the Charlie Gard case, where the treatment offered was novel, experimental and unlikely to meaningfully help Charlie. A close review of the Tavistock paper could leave them in quite a sticky mess.

(Sorry this is long - it's late and I waffle when I'm tired.)

I tweeted that to Myerson on that thread. He's liked the tweet so assume he''s read it. Wonder if the tax lawyer has.

The pathway from blockers onto hormones needs looking at.

There is a whole load of stuff that needs looking at. Properly.

We're all on violent agreement on this thread though. Has anyone got a source or place where I can read a decent argument for?

I've seen loads of stuff but not anything that has swayed me yet tbh.

The lack of looking into the presenting child as a whole (what is going on with them?), the lack of long term follow up (understandable for an NHS clinic but still not right under the circs), the lack of interest in the blockers> hormones pathway and why does one seem to pretty much always lead to the other. The lack of consideration that a child who is probably feeling like an outsider is getting loads of attention from this. I'm sure there's more. Where is it?

Why are so many adults who are not trans so heavily focused on this?

The psychology of children who have had lots of medical intervention is interesting I bet. Have any studies been done on that? I might have a search.

There were many cases where the parents, as well as the child wanted this treatment. The High Court would have seen lots of evidence of that.

They weren't making these decisions in a vacuum of knowledge.

Apart from not being able to adequately explain the implications to a minor, one of the reasons for them not being able to consent was that it was experimental, wasn't it?

And it's no less experimental because a parent consents.

The full implications and side-effects of puberty blockers is unknown. No one can make informed consent.

I really don’t understand puberty blockers for girls. What does it achieve?

It’s obvious what it does for boys.
Makes them pass more easily, with no sexual function, a pre-adolescent brain and a penetrable faux vagina constructed from stomach or bowel that needs daily work to stop it closing. What an achievement.

Which is good that it's low, isn't it?

You would think so.

But I suppose its similar to how activists like to make out transpeople are really likely to be murdered for being trans. That this is not the case at all, is ignored and you are called bigoted for even mentioning it. When, you would think the fact that transpeople in the UK are one of safest demographics, was a good thing also. Who gains, really, in transpeople being convinced via constant mantras that they are massively hated in society and likely to be attacked?! Its actually cruel, IMO, to keep pretending this is the case when it is clearly not. Scaring the shit out of them for no reason at all. Possibly contributing to any anxiety issues, and so on.

Its a bit of a mystery, why activists keep pushing lines like this, as they really really do not help transpeople in the slightest. In some cases, especially with the constant suicide baiting (which is what it is in reality) the way they behave actively makes things worse for the group they supposedly care about.

From much earlier on:

They’re in very real danger of opening up a path to the very opposite thing they want to achieve. Aren’t they?

brought this to mind:

Roper: “So, now you give the Devil the benefit of law!”

More: “Yes! What would you do? Cut a great road through the law to get after the Devil?”

Roper: “Yes, I'd cut down every law in England to do that!”

More: “Oh? And when the last law was down, and the Devil turned 'round on you, where would you hide, Roper, the laws all being flat? This country is planted thick with laws, from coast to coast, Man's laws, not God's! And if you cut them down, and you're just the man to do it, do you really think you could stand upright in the winds that would blow then? Yes, I'd give the Devil benefit of law, for my own safety's sake!”

If they are so sure children can consent then there should be no issue with them taking a child to court, and presenting their competence and ability to adequately address the 8 points of consent set out by the judges. Child gets puberty blockers after everyone is satisfied about consent.

There are only two reasons they could object to this. The first is the belief that family court judges wouldn’t be capable of assessing the capacity of children, and that these judges would find the child wasn’t able to consent when in the view of the GLP would be incorrect, which for a law project is highly insulting.

The second is if you think taking time to adequately consent children for such a monumental decision is not necessary, and the process should be bypassed.

Anyone who thinks this should not be involved in the care of children.

I read a piece a while ago about the suicide in young people/ children thing. For children who ID'd as trans, and forgive me I can't remember get exactly, the number was zero or 1. Which is good that it's low, isn't it?

I really do think, and the doctors who have left the tavistock, and what the bell case was all about. Is that there is way too little exploration of the drivers for the children who present.

Stats and anecdote point to complex issues. Autism. CSA. Families with firm ideas about what boys and girls should be like.

Women on here have been saying forever that for many girls, when their bodies start developing, this comes with a whole host of other stuff. Stuff which is not welcome. It can be subtle but still constant and wearing.

And these days with the prevalence of porn. Let's face it if a girl sees that. It's going to be pretty bloody unsettling if not downright scary.

The approach should be a load of psychological assessment and counselling until there is no doubt whatsoever that medical intervention is the best thing to do.

Thing is that's expensive. And doesn't feel quite so much like something is 'being done' when a child is distressed.

In the short term is cheaper to dish out drugs. Women know this. We are given anti depressants like nobody's business, more or less irrespective of what we go to the GP for.

And then once that diagnosis/ route is accepted, you're on a conveyer belt.

The other point, and I know this from experience. Is that being different is hard. At school etc. And that when you're in hosp etc you get a lot of attention. You get a place out of normal life. You are kind of important. I really think that side of things needs to be looked at more. And I say this as a person who was a child who got all that attention. I have very fond memories of my various stints in hospital. Which is weird but true. I'm sure I'm not alone there.

Oh final point. I started this post about suicide stats. Boys are most at risk. The highest rising group is girls though. There was stuff on the news about it a while back. What of them?

It's all just so icky.
I'd love to ask Jolyon or these doctors straight out 'what sort of person would appreciate a vulnerable/confused 18 year old, with the body of a 14 year old? '


twitter.com/Claire_Bradley0/status/1341842698043617281

I would argue it is life saving. The suicide statistics for trans people is 1 in 3. 32% of trans kids end up dead or attempt to kill themselves. The fatality statistics are similar to those for leukaemia and often involve similar decision making processes, for the same reasons.

One of the replies on there. It kind of shows how ridiculous the suicide myth is, when its claimed that 32% of trans kids end up dead, or actively tried to kill themselves. Meawhile, GIDS say this is extremely rare. But IF it was true even slightly, where are all the children who have sadly taken their own lives? Luckily, child suicide is quite rare. Those preteding its really really common, for the sake of advancing their own agenda, are fucking vile.

The Tavistock procedure of requiring informed consent from the child themselves is highly unusual. I can help wondering whether this is because a surprisingly high number of parents disagree with the proposed treatment.

I've just looked on the GIDS website to check what I said earlier about GIDS requiring parental consent as well as that of the child.

gids.nhs.uk/informed-consent

This is what they say about consent in under 16s:

For young people of 16 and under, consent to treatment should usually be sought from the child and from one or both parents, except under exceptional circumstances.

The point is that the body is fine. There is nothing wrong with it.

So it's completely different to eg removing a brain tumor. Or for abortion/ contraception you are preventing or stopping something that would cause massive change/ danger. An abortion is way safer than giving birth. Even without all the other stuff.

This is a psychological issue. I'm sure it's keenly felt for some people who can and do access hormones etc which is aok as adults (NHS funding issues notwithstanding).

So it seems all of the incorrect suicide stuff, and the wrong body stuff, was to position these interventions as a life saving treatment like for cancer or similar?

And the the threat is. If you don't let us do this we'll work to take away abortion and contraception from underage girls? Because it feels like a threat. The way it's suddenly being raised.

Invisibledragon it sounds to me like they are aiming towards a judicial review of the Tavistock policy to require the child's informed consent (and not the parent's) on that basis. Bringing it on line with other medical interventions.

If you believe that there's a high risk of suicide without puberty blockers, then you could view it as similar to parents giving consent to risky treatments to illnesses which would cause death without treatment. It's why they whip up the suicide claims so constantly. The Tavistock's evidence doesn't support the suicide risk claims that are made, but there are other studies which trans rights advocates point to. Will this force the NHS to argue in court against the suicide claims?

Bringing it all into public view to be scrutinised by judges will be good whatever the motives.

OldCrone yes- loads of children have surgery/ treatments all the time that they are too young to give informed consent for.

It's on the basis of harm v risk. So a small child can't give informed consent to something like a brain tumour being removed. Where the surgery might kill them or render them permanently disabled. The family sit down and the expert lays out the facts. There's some thinking. Depending on the age of the child their assent would be sought. I mean obviously not a baby for example. So yes parents can and do consent on behalf of children. And if the child is old enough their assent is sought. If they don't give it I imagine what happened next would depend on their age etc. In some cases parents would be consenting for adults eg if their child has severe learning difficulties.

I say this not from an expert medical or law place but what is my experience years ago and also what is just obviously the way it is.

The hiking onto

Contraception and abortion
And
Going on about it being life saving (one person on that Twitter thread said trans kids commit suicide all the time, it's just not true)

Is just. I mean they are leveraging the health and wellbeing of girls. And also telling outright lies which even if they were true shouldn't be chucked around like that (Samaritans)
To get what they want

It's completely mind boggling.

The proponents of this really don't care what consequences are as long as they get what they want.

And I think a lot of them genuinely believe they're doing the right thing :/

Presumably if it is being suggested that an expert clinician can recommend the medicalised route so the parents and child can consent/assent, they would need to have a clear and rigorous diagnostic procedure designed to ensure the instances of misdiagnosis are zero.

There would be huge outcry if doctors in any other area of medicine misdiagnosed numbers of patients so why would this be any different? Again, people with vested interests advocating for substandard care for these children.