The judgment in Keira Bell's case will be given tomorrow

It will be interesting to see if Maugham is really serious about suing them to force them to give treatment...

I'm really intrigued by this. One wonders how you could force clinicians to give treatment. I mean the judges have said it's up to them to ensure that there is consent and that it's informed so all they would have to do is say they don't think that the child understands the implications of loss of fertility and loss of sexual function and that would be the end of it. And presumably any child who desists would have a case because firstly the clinicians got the diagnosis wrong and the desister could just say that in hindsight they realise that they didn't understand the implications of treatment. It's so obvious that a child can't (or shouldn't) fully understand the implications of loss of sexual function and loss of fertility during adulthood. Roll on the lawsuits because that is the only thing that will put an end to this experiment.

As I wrote above, many practitioners will consider withdrawing from practice, but not all. The ones remaining will include right side of history zealots, and the unscrupulous.

As I see the whole thing the courts, both at the High Court and Court of Appeal levels, have sent a clear warning to the medical establishment which faces the choices:
build a robust evidence base and reform practices;
try to carry on as before building up horrendous liability, particularly so now that they've been put on notice;
withdraw and invite in the Wild West, including outfits operating outside the UK.

The current situation seems to be that parents can consent, and if they do the courts can't preemptively get in the way. The courts are there to resolve conflicts and deal with criminal cases. If no conflict, and no crimnal charges, they have to stand aside.

But it's been made clear that they're far from satisfied that children can meaningfully consent to this, so if any child experiences regret, an 'informed consent' disclaimer is unlikely to apply. Doctors proceeding with the treatment are leaving themselves wide open to civil cases for damages if anyone later believes they were harmed by it. (Also potentially parents?) And the judges affirmed that this is the legal route left open.

To actually ban treatment in general would need to he a government decision in law (as happened for lobotomy - not banned but tightly restricted), or a medical policy.

And the NHS/Tavistock sensibly seem to be in no rush to go back to the previous policy. They've said no changes until the Cass review finishes, I believe.

It will be interesting to see if Maugham is really serious about suing them to force them to give treatment...

Surely now that eyes are going to be on the Tavistock to ensure that Gillick competence is being applied correctly, they are going to find it very difficult to prescribe blockers to any child, because how can you prove that the child fully understand the full consequences of a pathway starting with puberty blockers - the consequences are huge!

How does it work with parental consent?Gillick is for cases where parents don't consent isn't it? If a parent consents to their child being prescribed blockers pre-16 then does that now mean that those kids can now be prescribed them again? The Bell verdict still didn't mean that parents couldn't consent did it, it just ruled that under 16s were unable to consent?

It's quite confusing, which makes the whole 'this case is going to stop young people having reproductive rights' crap is even more irresponsible.

Let's play a favourite game in these corners of MN: definitions

paternalistic
adjective

relating to or characterized by the restriction of the freedom and responsibilities of subordinates or dependants in their supposed interest.

We're talking about actual dependants (children) whose freedoms and responsibilities are restricted by society and governments and law, and - of course - their parents. We do that not in their supposed interest but in their actual best interest.

Do you have a problem with safeguarding children?

My reading of the two judgments is that neither do so.

In the first hearing, the judge appears to have concluded that the clinicians were almost certainly not applying Gillick properly. The false step was then to try to force them to do so by introducing legal measures, rather than pointing out their failings and reminding them strongly that they must apply it properly.

In the appeal, the judgment appears to be saying the courts cannot insert themselves into Gillick and therefore they will not interfere with what the clinicians are doing, but they would be wise to ensure they are applying Gillick properly. This is a point of how the law should be applied and nothing to do with any judgment that the clinicians had been doing right by their patients and should go back to doing what they were.

Does anyone have any idea what grounds for appeal they might be trying?

FAOD what I said above about the Dutch Protocol not being used on kids who present with gender dysphoria in their teens means that the Dutch clinic would not have approved Keira for a medical transition as a kid. (I don't know how the Dutch assess adults who want to transition.)

That's something we know the Tavistock does differently, because detransitioners tell us, clinicians tell us and IIRC when the High Court judgement came down, they said there was now nothing they could do with referrals, strongly implying that psychological treatment to encourage the child to reconcile mind and body is not an option they consider part of their service.

Mermaids also calling for GIDS to ignore all that’s been revealed and simply reverse the decisions made after the first judgment.

”We call on the NHS to reverse its position as a priority and with urgency”

mermaidsuk.org.uk/news/mermaids-statement-on-the-bell-v-tavistock-appeal/

I have been looking at Twitter and the way that the Gillick competence principle is being misrepresented is astonishing!

His suggestion that the pill was as controversial in a comparable way to puberty blockers now was ridiculous.

His comment is irrelevant; any historical controversy around the pill is irrelevant. Controversy is not the issue. Permanent harm is the issue.

The fact that puberty is a normal life event that is being pathologised is the issue that they don't want to discuss.
Why is puberty suddenly so triggering and controversial?

Can someone tell me what the situation is with regard to Dutch protocol in the Netherlands - has it been suspended/withdrawn etc...?

Oh, and Finland has also revised guidance. palveluvalikoima.fi/en/recommendations

Also noting that in the interim between Keira's first case and yesterday's, Sweden banned puberty blockers for all children:

segm.org/Sweden_ends_use_of_Dutch_protocol

We're objecting to non-treatments, not to treatments.

Exactly. Which is why I think the question which really needs to be asked is 'What is the condition that they are treating with these drugs?'

It's not enough to waffle on about gender dysphoria and gender identities not matching sex. We need a description of what the actual symptoms of this condition are in children. Because all the ones I've seen have been about stereotypes and/or internalised homophobia.

God he's slimy (ie the Tavistock chappie) 'At what age would you say that a young person's brain is fully developed?' - and he won't answer, he slides all over the place. "It's very much an individual" - the lying toe-rag, does he have NO medical knowledge?

He sounded clueless. It's fairly well known that the brain isn't fully mature until the early twenties. As CEO of an NHS trust treating children, who is on national radio trying to defend a controversial and experimental treatment being used on children, surely it's his job to know basic facts like this.

I like MH's interviewing style. She asked straightforward questions in a calm and non confrontational way, and let Jenkins tie himself in knots when he couldn't answer them.

Issues around contraception or abortion are all to do with potential indirect harm - concerns about encouraging promiscuity, underage sexual activity, and other moral or religious issues.

In the end, the direct benefit and other ethical considerations outweigh those.

But for puberty blockers we're concerned about the direct harm of the "treatment" itself, and the lack of evidence of any direct benefit.

If doctors were prescribing a "contraceptive" that caused development problems, and didn't prevent pregnancy, we'd be objecting to that too.

We're objecting to non-treatments, not to treatments.

God he's slimy (ie the Tavistock chappie) 'At what age would you say that a young person's brain is fully developed?' - and he won't answer, he slides all over the place. "It's very much an individual" - the lying toe-rag, does he have NO medical knowledge?

Then the question '...more girls coming forward than boys... does it not make you wonder if there is something else going on which would make you proceed with much more caution on the medical interventions?" - doesn't answer, goes on about the regulators, and 'my point is..' and that we shouldn't have to be taking this to the courts. BUT HE DOESN'T ANSWER THE B**Y QUESTION.

Paul Jenkins is the Chief Executive Officer at The Tavistock and Portman NHS Foundation Trust. He's on record for conflating "gender critical" with "transphobic":

twitter.com/BayswaterSG/status/1435203206427160580

You can listen here until the programme ends at 9. It starts at about 7.48 with an interview with Keira Bell's lawyer.

www.bbc.co.uk/sounds/play/live:bbc_radio_fourfm

Paul Jenkins is a health apparachik, not a doctor or any sort of clinician by background.

I thought Mishal H did well.

His suggestion that the pill was as controversial in a comparable way to puberty blockers now was ridiculous.

I do think an appeal would be good, even if it doesn't succeed in the end, as it may be a clinical matter not a legal one, but they need to be challenged on this experimental treatment, the more sunlight the better.

Paul Jenkins sounded very flustered and unable to give a straight answer to Mishal Husain's questions.

I wish she'd asked him what they were trying to achieve by giving this treatment to teenage girls.

Tavistock bloke, Paul Jenkins, says that the best comparison to puberty blocking treatment is children having access to contraception. When Mishal Husain challenged this comparison on the basis of reversibility he said: "Treatments can be reversible." Vague enough to be true in some contexts, but still willing to push that something that's essential untrue.