AIBU about transgender person taking legal action against NHS for allowing her to transition? [[title edited by MNHQ on OP's behalf]]

[HollyGoLoudly1]

A 23 year old is taking legal action against the NHS for giving her treatment to transition to male as a teenager. She has since decided to live as a female and is taking legal action against the NHS as they should have 'challenged her' more when she wanted to transition rather than giving her the treatment.

The NHS can't do right for doing wrong here. Cash strapped to the point of collapse and being sued for giving someone the treatment they asked for. I despair.

AIBU or is this absolutely ludicrous?

www.bbc.co.uk/news/health-51676020
from MNHQ - this title and OP originally said the person concerned was suing the NHS. They are in fact just taking legal action. The OP has asked us to make this clear but you may find some of the early posts reflect the words in the original title

The fact that you have purposefully mistitled this thread is causing a lot of headaches and redundant arguements. People would have happily participated in the conversation without the lie.

we were initially talking about chemo

It's interesting, isn't it? In 2009, 40 girls presented for gender reassignment at Tavistock. In 2018, 1806 girls presented for gender reassignment at Tavistock. Keira Bell was put on puberty blockers after a couple of doctor appointments, then cross sex hormones then breast amputation at 20 years old. It didn't 'cure' her depression, but it might cause infertility. Doctors have an ethical obligation to do no harm. Keira Bell has been harmed. Given the dramatic increase in girls asking to be changed into boys during the last ten years, how many more Keira Bells? The comparison with cancer? False. It is a deliberate attempt to distract attention from the fact UK doctors are giving 16 year old girls drugs that can make them infertile. This is shocking. About time it made headline news.

Doctors have an ethical obligation to do no harm.

What does this mean? Lots of treatments cause harm, or have the potential to cause harm. Sometimes, unintentionally, that harm is worse than the original illness. How are many of the current drugs or treatments in use if drs must do no harm?

You know what it means. If harm is certain then the path of least harm is the one to take.

Chemo is harmful. Are you seriously arguing that oncologists shouldn't administer because they do harm? Not doing anything is MORE harmful.

Sometimes, unintentionally, that harm is worse than the original illness

Keira Bell didn't have any original illness Unless of course you think being a girl who doesn't conform to regressive sex stereotypes is an illness. That's an extraordinary view for an advanced Western democracy in the 21st century.

Consent for 16 year olds can certainly be overridden if they refuse treatment. They will look into the child's best interests at that age, even if they have capacity.

That is a fact.

It’s not that children can’t consent to medical procedures, the key is informed consent.

If medical professionals are discouraged from exploring the thought processes around the desire to transition because of accusations of transphobia then how can they properly assess if the treatment is appropriate.

If no scientifically rigorous studies have been done into the effects of puberty blockers have been done then how is it possible for a young person to weigh up the risks of taking them or not taking them especially as what evidence does exist suggests the effects may not be reversible.

Surely the outcome of giving a potentially harmful medication should be balanced against the harm of not giving it.

^She felt there wasn't enough investigation or therapy before she reached that stage.
"I should have been challenged on the proposals or the claims that I was making for myself," she said. "And I think that would have made a big difference as well. If I was just challenged on the things I was saying."^

titchy

But cancer isn't the only illness that drs treat. Many other non life threatening illnesses are treated with drugs or surgery that may have, or are known to have, harmful side effects. That's doing harm.

I have arthritis. I'm currently taking 2 drugs, one of which is used to treat cancer, to control the arthritis. Both of these have the potential to cause serious side effects and have also lowered my immune system so that I'm at risk of developing a life threatening infection. I'm also on opiate pain killers which have harmful side effects.

I don't have cancer or any life threatening illness yet I'm taking drugs that are causing me problems with my bone marrow and liver and have the potential to cause life threatening complications. Does that fulfill your do no harm expectation?

Gillick/Fraser competence is a red herring here. Consent is always specific to the decision in question. At any age. It requires the person to demonstrate that they understand the risks associated with the procedure, or less frequently, the risks of not having treatment.

It is possible to be competent to consent to some decisions and not be competent to make others.

So a 15 year old requesting contraception, can demonstrate that they understand the risks of pregnancy associated with unprotected sex and the requirement to comply with treatment, say by taking the pill at the same time every day. If a health prof is satisfied, they may legally be prescribed treatment.

That is very different to a fifteen year old demonstrating that they understand the full implications of hormonal treatment rendering them infertile for life and lowering their IQ. And It’s very different from a sixteen year old evidencing that they have capacity to understand the life-long effects of surgery to remove sexual organs, meaning they can never achieve orgasm.

“It will all be fine/that doesn’t apply to me/I will harm myself if you don’t agree” don’t count as weighing the risks.

I have very considerable concerns that a lot of treatment has been given without the legal standard for consent being achieved.

Hooves This isnt about you.

Oh, R0Wan, Hooves has great form for spectacular me-rails.

But cancer isn't the only illness that drs treat.

Obviously

I assume your arthritis is debilitating enough physically and mentally for the small risk of your medication to make taking it the lesser of two evils.

I assume you wouldn't take similarly risky drugs for a small cut?

It's balance, the lesser harm, when all aspects of a patients well being are considered.

Reposting this from the previous page:

Excellent overview on what ‘Competent minors’ can and cannot consent to/refuse consent for.

TLDR: day to day medical, surgical and dental, up to them, anything unusual or life threatening, not up to them, but decided by a judge.

www.uhs.nhs.uk/HealthProfessionals/Clinical-law-updates/Children-refusing-treatment.aspx

Quote:
‘ The first and paramount consideration (of the court) is the wellbeing, welfare or interests (of the minor) and I regard it as self-evident that this involves giving them the maximum degree of decision-making which is prudent. Prudence does not involve avoiding all risk, but it does involve avoiding risks which, if they eventuate, may have irreparable consequence or which are disproportionate to the benefits which would accrue from taking them ’.’

Italics are mine.
———
This is what I believe the judicial review will hinge on, are the irreparable effects of GNRH analogues on healthy teenage bodies less harmful than the alternative, which is watchful waiting until adulthood?

GIDS will need to provide evidence that the consequences of not blocking puberty are worse than the consequences of taking triptolerin.
If they cannot do that, then a competent minor cannot consent to the treatment and a judge will have to decide.

Good. The NHS should be sued for transing children too young. They've damaged childrens bodies, people who are too young to consent, without proper checks and balances in place. Now they will have to compensate.

Oh, and I don’t believe the Tavistock HAS the evidence required.

Now they will have to compensate.

Keira isn’t suing for compensation. There is no money in it for her, this is a judicial review to find out if GIDS is currently acting lawfully. Keira is being brave and selfless.
I agree with everything else you said though!

Hooves
Do you understand the risks associated with the medications you are taking?
Have you balanced the risks against the benefits to you of taking them?
Were you able to consider a variety of treatment options with the potential risks and benefits explained to you?

Because that is not what is happening for young individuals with gender dysphoria.

I have arthritis. I'm currently taking 2 drugs, one of which is used to treat cancer, to control the arthritis. Both of these have the potential to cause serious side effects and have also lowered my immune system so that I'm at risk of developing a life threatening infection. I'm also on opiate pain killers which have harmful side effects.

I presume your arthritis is sufficiently severe and debilitating to mean that the side effects and potential consequences of your treatment are preferable to remaining un-medicated?

It's all relative and certainly not the same as a child insisting that they should be allowed to cut off perfectly healthy parts of their bodies, because of a feeling. The majority of those with gender dysphoria who don't pursue treatment by way of physical interventions, come through it by the time they reach adulthood. That is 'first do no harm'.

DuLANG Neither does Professor Carl Heneghan

"An Archive of Diseases in Childhood letter referred to GnRHa treatment as a momentous step in the dark. It set out three main concerns: 1) young people are left in a state of ‘developmental limbo’ without secondary sexual characteristics that might consolidate gender identity; 2) use is likely to threaten the maturation of the adolescent mind, and 3) puberty blockers are being used in the context of profound scientific ignorance."

[https://blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/]]

I assume your arthritis is debilitating enough physically and mentally for the small risk of your medication to make taking it the lesser of two evils.

This, plus you're clearly aware of the risks involved. Informed consent can't happen without the relevant information being shared.

What does this mean? Lots of treatments cause harm, or have the potential to cause harm. Sometimes, unintentionally, that harm is worse than the original illness. How are many of the current drugs or treatments in use if drs must do no harm?

FIRST do no harm. Non-maleficence - the principle that all medical professionals must factor in the risk that a treatment could harm the patient more than the condition that you sought to treat. It's a fundamental principle in medical ethics, and taught in all medical schools across the world, as far as I'm aware.

The idea is that you balance risks. There is no physical illness such as cancer here here. You are treating a dysphoria. It should be first principles to ensure that the interventions are necessary and proportionate, especially when they have such potentially cataclysmic effects on a young person's life (both in terms of possible risks and complications, and in terms of the risks that they will regret those interventions).

"First do no harm" is the principle that you ensure you don't leave a patient worse than you found them, if that is reasonably forseeable at the start of the intervention. Obviously, that's never wholly knowable. The only medical interventions to be risk free are placebos. But it's a pretty good guess that treating an autistic young girl, with trauma in her past, and possible anorexia, as though her insistence that she is a boy will fix all her woes... is potentially neither beneficent, nor non-maleficent. Especially if that progresses to care that will render her infertile, may well render her incontinent, and will block any chance that she can simply outgrow the dysphoria and walk away from it in later life, unaffected.

If Keira Bell had been offered proper psychological care and adequate gatekeeping, she would simply have outgrown her dysphoria and moved on and past it". As it is, the effects of treatment will remain with her for life. She's simply asking that proper safeguards be put in place to prevent that happening to thousands of other young people.

I find it quite distressing that posters are arguing against the need for this JR. The treatment under review is slightly irrelevant because any treatment protocol should be open to scrutiny. I am very suspicious of people who want to shut these discussions down.

If I understand correctly hooves' argument against seems to be that because some mumsnetters, who are not judging in this case, have the opinion that a child (from as young as 11, not just 16-20 year olds) doesn't haven't the mental capability to consent to this kind of treatment, that will scare doctors away from treating any child no matter what the cause of illness is?

Flora didn't listen about butter, I doubt the judge is going to be trawling Mumsnet for advice on how to handle a judicial review. And I like to believe that most adults are capable of understanding that what is best for one specific situation is not what's best for every single situation.

This is child abuse by the NHS.