Keira Bell Appeal

Wow imagine a world where people have different views!!

Also, aside from the consent issue, I'm not sure any doctor should be recommending these treatments, given the complete lack of evidence on their long term benefits vs harms, which currently seem to look something like this:

• Possible benefits: May make you feel happier long term, but conversely may make you feel worse, or make no difference, we don't know


• Possible harms: Possible permanent infertility, possible permanent loss of sexual function, loss of your genitals and/or breasts, long-term risks of osteoporosis and heart disease

For something like abortion the benefit-risk balance for the different options is totally different:

• Possible harms of abortion: Physical and psychological effects of abortion


• Possible harms from no abortion: Physical and psychological effects of pregnancy and childbirth, followed by having to care for a child for life OR psychological effects of giving up a child for adoption

Because it’s not just about the information given, it’s about already having the pre-knowledge and experience to make sense of and fully understand that information.

Brilliant post.
Children can’t give informed consent to losing something (sexual function, fertility) they don’t even have yet.

Ah! I bet he isn't made of cinnamon, didn't come down in the last shower and quite possibly can't yodel either!

notbad great post, I agree entirely with your scenario that illustrates the issues of a child consenting to this.

I agree Keira's brave actions in putting herself out there have had a huge impact in turning this around. As I understand it, the courts haven't changed their view about the treatment approach - I think they're saying "yeah this still looks dodgy as fuck but it should probably be a healthcare decision not a court decision". Which is probably right. And we're now well on the way to those healthcare decisions changing, with the Cass review etc.

For when the post is deleted, the slur is to imply a connection between Keira Bell and the "white supremacist movement". "Imply" because the poster appears too cowardly to say what they mean.

First post on MN, a screenshot of a retweet about a completely unrelated topic, as if a) that matters and b) even if it was something interesting it would negate everything Keira did in her court case.

There are no depths to which people won’t sink to slur this brave woman.

What are you trying to say @greyscott ?

If you have a point be man enough just to say it!

If you want to slur Keira Bell, just come out and say it. Don't pussyfoot around.

Thanks Nauticant. I agree she has done this for all of us.

We're all grateful to Keira Bell. This outcome leaves her with legal costs to pay, including some of those of the Tavistock, and so her crowdjustice funder is still open. A contribution to reduce the financial impact on her would be a good way to say "thank you".

Good examples notbad. Consent isn't about parroting platitudes.

One of the more challenging scenarios I have come across was an adult who refused life-saving surgery but was forced to have it after court intervention. (I've posted about this before) Hugely difficult and emotional situation with many staff believing the patient had the right to their own decisions and very uncomfortable with forced surgery. The decision legally was that they couldn't consent.

In this particular circumstance, The patient insisted they would be fine without the surgery. Had they acknowledged that they would almost certainly die within a short period of time, demonstrating that they accepted that risk, they would have been deemed capable of making their own decision.

The parallel for me is that in the situation I described the patient essentially put their fingers in their ears and said you're all wrong, I'll be fine.

At the Tavi too many people put their fingers in their ears in the name of ideology and Kiera has put a stop to that. Awesome achievement

One positive of this decision is that it frees Keira Bell to choose how much she wants to step back from all of this. She's already done more than enough, by an enormous margin

This

I am in awe of how she has managed to hang In their through everything that has been thrown at her. She is incredibly brave and courageous. She has done all she can and I am incredibly grateful as a mother of 2 .

I hope she is proud of herself for all she has done. And I hope she can now have a well Earnt rest .

She got us all several steps closer to full exposure.

Well done keira and thank you

She may have been Gillick Competant but she was not given sufficient information to make informed consent.

Exactly. Consider this consultation with an 11 year old. I’ve chosen male just for simplicity regarding describing physical changes.

Scenario One: TRA Model

Male Child: I want puberty blockers and “HRT”.

Doctor: Do you understand this will mean you won’t get any puberty and you’ll get breast tissue that will grow?

Male Child: yes! That’s awesome! I want that.

Doctor: great! You clearly understand and are therefore Gillick competent.

Scenario Two: Proper Consent (as determined by the judges in the Bell case)

Male Child: I want puberty blockers and “HRT”.

Non-captured doctor: Okay. Do you understand that this might make you feel happier immediately but won’t necessarily make you happier in the long run because we don’t have any evidence of long term psychological benefit? [i) the immediate consequences of the treatment in physical and psychological terms;]

Male Child: okay but I’ll be happier, right?

Doctor: to start with maybe, but not forever.

Male Child: but as long as I don’t have to do puberty.

Doctor: okay…do you understand that if we start these blockers, you will end up on oestrogen? [(ii) the fact that the vast majority of patients taking puberty blocking drugs proceed to taking cross-sex hormones and are, therefore, a pathway to much greater medical interventions;]

Male Child: yes! That’s what I want!

Doctor: But it also means you will be seeing doctors regularly for the rest of your life because of the health problems we will be inducing as a result of this. Your body will never mature past the point it is now.

Male Child: I don’t care, that’s ages away. And I don’t want my body to mature, that will be horrible.

Doctor: And if you stop puberty and your penis and scrotum don’t grow, it means it will be very difficult for anyone to do surgery, it will require the surgeons to use bowel to create any form of vagina. [(iii) the relationship between taking cross-sex hormones and subsequent surgery, with the implications of such surgery;]

Male Child: I don’t really want to think about surgery, I’ll think about that when I’m older.

Doctor: And if we do this, you won’t be able to ever have children or your own because you won’t have developed any sperm. [(iv) the fact that cross-sex hormones may well lead to a loss of fertility;]

Male Child: I don’t mind that, I don’t really want children.

Doctor: But you’re only 11, so you think you’re sure at this age?

Male Child: Oh I’m sure! I don’t even want to think about having kids!

Doctor: And what about sex. What do you know about sex so far? [(v) the impact of cross-sex hormones on sexual function;]

Male Child: Well I kind of know what it is from PSE at school.

Doctor: Do you think you might have sex when you’re older?

Male Child: I guess, maybe 😳 But I think I might be asexual.

Doctor: Do you know what erections are and have you had one?

Male Child: not really 😳😳

Doctor: because if we do this you won’t ever be able to have proper erections and sex when you’re older. This is something you might want to do if you meet someone you like when you’re older. [(vi) the impact that taking this step on this treatment pathway may have on future and life-long relationships;]

Male Child: I don’t really want to think about that right now, I just don’t want my body to change.

Doctor: Okay…finally, do you understand that if we start this, we can’t tell you or your parents what this will lead to in the long term? That there might be serious problems we don’t know about and we don’t really know if it will help you? We do know if we support you through puberty there’s a good chance you’ll be happy with that as an adult. [(vii) the unknown physical consequences of taking puberty blocking drugs; and (viii) the fact that the evidence base for this treatment is as yet highly uncertain]

Male Child: that’s okay, I’m sure this will be right for me 🤞, everyone tells me it’s the best thing to do otherwise I might get suicidal.

Doctor:…..

And this scenario imagines a child who can talk reasonably, might be a bit precocious. I have seen children who don’t talk, can’t verbalise their concerns, some with ASD, intellectually impaired, children with trauma, children in care, all put on puberty blockers. How many children who have been placed on puberty blockers around the world have had even half of such a conversation prior to their first injection?

Show me a child who is at Tanner stage 2, aged 11, 12, 13, who can provide good solid answers to these questions to remove any doubt about Gillick competence for this treatment pathway and I’ll show you a unicorn.

Keira’s case put this out there. Doctors now need to show the child understands those implications. The successful appeal against Keira didn’t remove those implications, it just changed the responsibility of who makes sure the child understands back from the courts to the doctors. So as well as showing me a child who understands those things, show me a doctor who thinks they have a child competent enough to understand those things and I’ll show you a doctor who should be in front of a competency assessment.

Children just cannot consent.

Yes Kiera won 💐

But that’s probably not how this will all end. It’s a bad treatment for a condition we don’t understand, that some of the people presenting with features of it do not have.

And no, I still don’t think she could have been Gillick competent. I think the doctors making these decisions are wrong.

She’s already won, turning the whole course of the conversation.

She may have been Gillick Competant but she was not given sufficient information to make informed consent.

Thank you Keira .. you raised awareness of the issues involved and some amazing actions have happened as a result.

To Keira💐, you absolute star.