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

From what I gather Outhere and GetTheeToTheGulag, your comments are highly relevant to the arguments coming up after lunch.

Guidance is parasitic on correctness of declaration so it will fall away. Gilick competence is matter for clinicians, not court. Practical impact for this cohort of patients, is collapses 3 decisions over 5/8 years into one decision.

Above is a tweet by Sarah Phillimore, I think Mr Mckendrick speaking. It’s suggesting (I think) that if the decision making is moved to court, then an extended progression of consent will be lost.

So the point it comes down to medically is that the Tavistock claims that consent is given in three separate decisions over 5 to 8 years, and Keira Bell’s side are pointing out that if everyone in the experiment progresses directly through the second and third decisions (presumably onto cross sex hormones being one of those) then the second and third consents are moot, THUS the child MUST be able to fully understand and consent at stage one.

Interesting. The end arguments by JH (via SP’s tweeting) sound like he was making some progress in explaining his point, though it’s impossible to guess what the judges’ take was.

There seems to be a total abdication of responsibility at multiple levels.

The endocrinologists (who know about hormones) administer the drugs because the psychotherapists (who don't know about hormones) at GIDS tell them to. They ignore what they know about hormones.

The people at GIDS (who know about psychology) treat the condition with drugs because their service provision tells them to do what WPATH says. They ignore what they know about psychology.

The service provision tells them to follow WPATH guidelines because WPATH (who seem to be a trans cosmetic surgeon org, not a proper health org) have set themselves up as the experts on "trans health" - by just putting in their name, and the NHS has just taken that off the shelf.

Why the NHS feels they have to have "service provisions" following external rules, rather than just directly having in-house expertise, is just utter idiocy due to privatisation.

D7D1's second post was deleted, but I agree, and it's a worry.

If 10-12 year olds are competent enough to consent to sterilisation (despite evidence suggesting it doesn't benefit them) when even grown women are refused in case they change their minds, what else could it be argued that these 10-12 year olds are competent enough to consent to?

Feels like we're on a slippery slope?

Endocrinologists (medical doctors) will supply the drugs in 'safe' doses as directed rather than ever question whether or why there is a need for them in the first place.

I've never understood that bit. I would have thought final responsibility rests with the prescriber. Plus responsibility to monitor. Even if steering clear from mental health, physical side effects of the drugs should surely be followed up by the prescriber. 🤷‍♀️

There's always this which I posted earlier

Finally, which is not a direct issue concerning the Gender Recognition Act, but is relevant, making sure that the under 18s are protected from decisions that they could make, that are irreversible in the future. I believe strongly that adults should have the freedom to lead their lives as they see fit, but I think it’s very important that while people are still developing their decision-making capabilities that we protect them from making those irreversible decisions.

anyone know what happened to this. A statement by Liz Truss on 20th April 2020

McKendrick is being effective in his use of timing. His introduction is to put a lot of ideas into heads, when he's done in the next few minutes there'll be a break for lunch, then after lunch he'll be expanding on the ideas are going in much more deeply.

McKendrick is also pointing to the fact that claimants should have made a negligence claim or similar against the Tavistock. A judicial review was the wrong way to go.

So has KB's counsel already had his time?

And now there are a bunch of intervenors? Are they all intervening on the same side?

Trying to figure out if there's any way this could be turned around from where it looks like it's headed.

If the Tavi wins the appeal they know a spotlight is on them - Sonia Appleby's case and Cass review as just 2 examples.

But what about private practitioners - here or abroad? Surely it would give a green light to all the Webberlys of this world?

I bet that 6-12 months of rigorous assessment is one or two appointments.

A new counsel, with a very clear voice, Mr Mckendrick, is now up representing endocrinologists. Sounds like he'll have interesting arguments to make.

Who is this giving evidence now?

I'm feeling sick reading the comments from the judges. It all looks like it's going wrong

I suspect if the Tavistock win this, there will be huge celebrations and a rush to return to former activities. I think that may even happen if the judgment given urges caution. If the original decision is wholly overturned, I think it will be seen as a green light. This feels like a horrible pivotal moment.

I think it's important to remember that the vast majority of the clinicians working at GIDS are not technically 'medical' professionals.

I don't think that the judges have fully grasped this either.

They are psychologists, social workers, psychotherapists, nurses etc, no doubt with plenty of high level skills, relevant experience and training but most of the doctors we have heard from, Polly Carmichael for one, are academic doctors rather than because they have done a medical degree.

Dr Sinha is a psychiatrist so has done a medical degree. Dr Bell is another - not that he worked for GIDS.

Endocrinologists (medical doctors) will supply the drugs in 'safe' doses as directed rather than ever question whether or why there is a need for them in the first place.

Anyone know if there are any other medical doctors other than Dr Sinha currently working for GIDS as the website is very vague about the team?

The appeal can be lost but it still leaves the Tavistock with a nightmare. They know they have no evidence base and they know that everyone else knows it

I don't think they will have any incentive to care, though, will they?

I have a question about the crucial point in the original judgement, where children on PB almost universally go on to cross-sex hormones, and therefore consenting to the first stage of the treatment involves consenting to the second.

I think everyone's agreeing that kids age 10 are too young to consent to losing their sexual function as they have no idea what they're consenting to?

But how is a kid age 14, who's been on puberty blockers since age 10, any better equipped to make that decision than the 10 year old was? Their sexual development is in exactly the same stage as it was when they went on puberty blockers, that's the entire point of puberty blockers.

The question doesn't seem to have much relevance to the direction the judges are going in now, but it's annoying me.

Hyam appears to be fighting for a compromise position in which something more is required than simple consent being given by parents on behalf of children, that there might be some situations where the court does need to be involved in making the ultimate decision for puberty blockers to be prescribed.

Hyam comes up with a sensible analogy which I imagine the court will try not to engage with: prescribing puberty blockers is akin to sterlisation.

Unfortunately sometime times people and companies are above the law, my heart breaks for Keria but this is one of them. It's not right, it's not fair but it's life.
The Judges are terrified, and you can understand why.
You can't trust anyone in any type of power.