Keira Bell and Mrs A vs. Tavistock - Court of Appeal hearing 23 & 24 June 2021

Some live tweeting has resumed that might help clarify matters:

twitter.com/search?q=(from%3ASVPhillimore)&src=typed_query&f=live

Is the court of appeal’s job not just to consider if the lower court erred in law? Not to revisit the arguments.

Yes, another judge is making clear that argument needs to be focused on whether the Tavistock's treatment with respect to consent by patients was lawful.

This doesn't sound good to me.

Judge says the court can't engage in a debate about guidelines because that's not what the judicial review is about.

I think what the judge was getting at is that judicial reviews are about whether public bodies are acting lawfully or unlawfully and wanted to draw attention back to that.

Whether it's the best treatment in the world, or the worst, it all comes down to whether the children can fully understand what they're consenting to?

Court is not deciding whether this treatment is a good or bad idea. A great deal of public interest, so making that clear. This makes me think a lot of their stuff is trying to do exactly that???

Judge:" This court is not here to decide whether this treatment is a good idea or a bad idea."

Did the Judge say that he didn't understand what they were trying to do?

The difference between PB and an abortion is a solid evidence base about the risks of the various methods for terminating a pregnancy. No such evidence base exists for PB.

Not even for their use in treating precocious puberty. The evidence base there is assumed to be solid because they've been prescribed for around 20 to 30 years or so (triptorelin was licensed for use in the UK to treat precocious puberty in 2003 and 2005 for Scotland in girls under nine and boys under ten. IIRC, it remains the only PB officially licenced for that purpose in the UK.)

But when you read the research papers into puberty blockers used for precocious puberty, the subject pool is tiny, the methodology questionable and the overall numbers of papers is smaller than one would expect given the experimental nature of the treatment.

I wish the court would be made aware of that fact.

Thinking about nauticant's pause upthread - I wonder whether any of the allegations in the Sonia Appleby case will be put forward? There are serious allegations that suggest a children's medical service with significant safeguarding issues, homophobia, an openly expressed fear of political activist groups dictating policy and practice, lack of data, lack of research? Just wondering.

It may come down to whether the AC accepts that it is harmful for trans-identifying children to have to go through natural puberty. If the Court accepts that, it will be much easier for the Tavi to argue that PBs are no different in principle from other treatments where there is a trade-off of risk vs benefit.

It requires a finding that PB treatments are sort of life saving, or perhaps clearly life-enhancing in the long term to a significant degree, and the number of false positives are very small, ie there are almost no detransitioners. For the latter it's a shame that the courts are still looking at evidence gathered years ago in respect of small numbers of transsexuals and don't have solid evidence of what's happening now with detransitioners.

I'd just like to comment on puberty blockers being reversible. From a medical point of view they are reversible in that the drugs stop production of hormones, once you stop taking them hormone production resumes.

This doesn't mean the impact or side effects of having taken the drugs are necessarily reversible.

The understanding of the word "reversible" is a bit different in clinical contexts than in general usage.

It's a bit like at the start of the pandemic doctors saying 80% of Covid-19 cases would be (clinically) mild and therefore not require hospital treatment.

However, I doubt that many people who developed pneumonia but didn't need hospital treatment would consider themselves to have had a mild case of COVID-19.

Is there a different link for this afternoon‘s session?

I just don't feel that the Court of Appeal will put PB treatment for gender issues into the same category as the other medical treatments discussed. However, if it goes into its own category (sui generis Latin fans!) it's still open for the Court of Appeal to overturn the decision of the High Court.

The other use of PB the barrister referred to was for children with intellectual disabilities whereby they are old enough to be going through puberty but delaying it until they have gained some more maturity to be able to deal with it emotionally and psychologically is thought to be beneficial. That's what their expert is going to give evidence on.

I can't speak for necessary but I was arguing the point, not arguing you, iyswim lucy

There's an argument that an abortion is preventative of an otherwise permanent, life- changing thing though.

Basically once conception occurs any course of action is permanent.

An abortion is permanent

It's permanent for the aborted foetus, but not for the mother. Fertility is (normally) not affected, so she can have another child.

If an abortion is permanent, so is a hair cut.