Random thought prompted by Jane Fae: Why doesn't Gillick competency apply to hormone blockers or sexual consent?

[ItsAllGoingToBeFine]

Fae tweeted this

We could wait until people reach the age of maturity – 18. Or we could trust individuals, as we do when it comes to contraception, and allow them to choose as soon as they are competent to do so, perhaps aged 12 or 13 (Gillick principle) twitter.com/JaneFae/status/1052842729812692992?s=19 as part of a longer thread.

So if a child can ask for and recieve contraception from a doctor (which has side effects and risks like any other medication), why can't the same child ask for and recieve cross sex hormones, puberty blockers.

I have seen this argument made by many different people, that children are perfectly capable of understanding and consenting things that are done to their body medically.

And if a child is judged competent to ask for and recieve these hormone blockers and cross sex hormones (which is a massive life changing decision) why can't this child be deemed to consent to sex?

It does seem to be a rather short hop, skip and jump from medical consent to sexual consent. Once a childmisngiven complete agency over their body in one area, what prevents them from being given complete agency in other areas?

On MN parents are told to "switch off the router", or to not let their child do X, Y, and Z, but when does the child's "rights" override parental preference.

I know this is a bit of an unstructured ramble and I'm sorry - its just I've been thinking about who and what exerts control over a child, who decides what's good for a child, and at what point someone can legitimately step in and say "no, a child can't consent to that"

Is that the same Jane Fae who argues for the end of censorship of extreme pornography (which often involves abuse of the people involved)?

Gillick competence isn't about asking for treatment, it's about whether a child understands enough about what's involved to consent freely to treatment proposed by a doctor.
So in the case of cross sex hormones, there would need to be a doctor proposing that as treatment, then the gillick competence comes in if the child is sufficiently mature to consent.
Doctors are the miscarrying the can for early prescription of blockers and cross sex hormones and that's why the push for an affirmative approach might be so dangerous.

There are probably people around who can say it better, but with the sexual consent it is a matter of overlooking relationships between peers as it is not in the public interest to prosecute, and making sure they are adequately protected with regards to teen pregnancy - it would be silly to deny a young person contraception because they are not old enough and for this to result in a teen pregnancy.

There should be safeguards to ensure that there is no abuse going on.

With medical stuff, the Gillick thing is taken account of as the medics, parents and child work together to make the best decision so that there is no competing consent going on.

Gillick competence isn't about asking for treatment, it's about whether a child understands enough about what's involved to consent freely to treatment proposed by a doctor

Ok. So it's about a child agreeing to proposed treatment, rather than requesting their own.

But I thought Gillick competency arose from children requesting contraception without their parents knowledge?

Firstly, contraception is separately covered by the Fraser guidelines.

Secondly, as Quentin points out, Gillick competence is not based on a moment where a child reaches competence and is then able to consent to any and all medical procedures. It's case by case.

Thirdly, there have been several subsequent judgements limiting Gillick in certain circumstances.

Fourthly, courts are still able, and do sometimes, apply the principle of parens patriae and impose medical treatment on minors even if both the minor and its parents do not consent.

Gillick is not the be all and end all of anything.

My thoughts on contraception vs blockers/hormones is about the balance of physical harm. If there is a genuine risk a young girl may become pregnant then I would say that contraception is the lesser harm (without going into all the arguments around under age sex).

This is the point where TRA's all tout the suicide statistics thereby making blockers/hormones the less harmful treatment but as we know the evidence for this is shaky and manipulative. We can track teen pregnancy statistics and outcomes much easier.

In some ways asking a child to consent to blockers etc.. is more akin to asking them to consent to pregnancy rather than the contraceptives. Both things have inescapable life long consequences they can't possibly comprehend at the time.

Placemarking, as I need to go out

I remember reading a similar argument in a post recently along the lines of....if children are/become responsible enough to manage contraception or gender reassigment they must also be responsible enough to manage 'age fluid' relationships.

Are these people all using the same handbook?

With medical stuff, the Gillick thing is taken account of as the medics, parents and child work together to make the best decision so that there is no competing consent going on.

Exactly. As R0wan pointed out on the thread Stephen Whittle contributed to yesterday - these are the principles of safeguarding.

Whittle and Fae want to make this an issue of individual rights - a right wing, libertarian ideology. It runs directly against safeguarding, which is a partnership framework aiming to protect the vulnerable.

In my world, individual rights end where safeguarding begins. This is anathema to right wing libertarians such as Fae and Whittle.

Contraceptives are preventative. Hormone blockers, etc, induce long-term, irreversible physical effects.

I remember reading a similar argument in a post recently along the lines of....if children are/become responsible enough to manage contraception or gender reassigment they must also be responsible enough to manage 'age fluid' relationships.

Indeed. As I commented elsewhere, those disregarding safeguarding include among their number people with an active, vested interest in dismantling it.

My thoughts on contraception vs blockers/hormones is about the balance of physical harm. If there is a genuine risk a young girl may become pregnant then I would say that contraception is the lesser harm (without going into all the arguments around under age sex).

This is the point where TRA's all tout the suicide statistics thereby making blockers/hormones the less harmful treatment but as we know the evidence for this is shaky and manipulative. We can track teen pregnancy statistics and outcomes much easier.

In some ways asking a child to consent to blockers etc.. is more akin to asking them to consent to pregnancy rather than the contraceptives. Both things have inescapable life long consequences they can't possibly comprehend at the time.

Yes!

There’s a great deal of difference between taking medication or undergoing procedures that are well researched and where the risks can be clearly explained and understood by a suitably intelligent and well informed young person, and where the consequences of not doing so are equally clear and predictable, and undergoing treatments where the reasons, risks and future consequences cannot be properly understood even by experts.

Medical treatment doesn't operate on-demand. Medics are gatekeepers to treatment no matter what age you are. Decisions about hormone treatment are not based on the desires of dysphoric people no matter what their age. An adult can't walk in to a medic and demand hormone treatment just like they can't demand antibiotics.

The majority of children experiencing gender dysphoria desist and so physical interventions are a long way off being offered to many, regardless of Gillick Competence.

Contraception isn't a treatment, it is a prevention and medics still gate contraceptives that have contraindications for some people (eg hormone based ones rather than simple barrier based ones). Even if a young person is deemed to be Gillick Competant, they may still not be prescribed a contraceptive implant or pill if there are risk factors present.

I really, really dislike this attitude of ‘all medicine has risks / impacts’ it’s totally disingenuous IMO.

You may well trust your 12 year old to tell you when they need to take some paracetamol. Doesn’t mean you’d let them say oh my headache is really bad this time I need morphine.

Comparing contraception to hormone blockers is so ridiculous I would struggle to engage in conversation about it tbh. Contraception has minimal side effects and prevents serious physical changes bringing with it the risk of permenant disability and death. The point of contraception is to prevent harm.

The point of hormone blockers is to stunt natural growth in the form of puberty. It’s not preventative, it’s not done to prevent harm. It’s done to change the path of a child’s development.

I feel like TRA arguments always bloody underestimate or dismiss the risks of pregnancy. Contraception is only given out to minors because pregnancy is a HUGE DEAL. The ability to create LIFE shouldn’t be compared to...well, anything else. It is unique.

You may well trust your 12 year old to tell you when they need to take some paracetamol. Doesn’t mean you’d let them say oh my headache is really bad this time I need morphine.

Exactly. And this is what Gillick competence is. It's not a point at which an individual child becomes competent to consent to any and all medical procedures. It's the possibility of a medical procedure arising and then an assessment of whether that child is competent to consent to that procedure.

Here's a link talking about the effects on East German athletes who were given male sex hormones as part of a doping program. They are dying 10 or so years earlier than their peers.

m.dw.com/en/the-victims-of-east-germanys-doping-program-are-still-suffering/a-18038630

So we do know, to some extent that prescribing male sex hormones to teenage females will result in early death. I don't see how any doctor could conciously prescribe them, when evidence suggests dysphoria improves after puberty.

Here’s the link I meant

www.zeit.de/sport/2018-03/doping-east-germany-research-harald-freyberger-english

www.zeit.de/sport/2018-03/doping-ddr-sport-dopingopfer-kinder-folgen-hilfe-english

Sorry for being incompetent, another link:

As a general rule of thumb, I've now come to assume that whatever Fae thinks, I probably feel the opposite.

1. Most adults do not understand the difference between sex and gender, and that you cannot actually change sex.
2. Most adults do not understand the actual science regarding transgender children, they don't know this is all still essentially experimental, the desistance rates are up to 80% if children are left alone, the risks involved with this treatment are still not known but drugs have significant side effects, by taking action you are potentially locking children into one specific pathway.
3. Medically transitioning children results in permanent sterility. I can think of no case where a child would be allowed to make that kind of irrevocable decision regarding their fertility.

I honestly don't think most adults are capable of consenting, because the issue is so complex and there is SO much misinformation out there.

And if most adults don't seem to be getting it, how can we expect children to?

It's funny how some adults seem to want to give children so much responsibility to do things that are hazardous, isn't it? It's as if they can't look back at their own young lives and recall the risks they took that they'd never take now.

For example - I was 21-22 when I lived in a city across which I would cheerfully walk, alone, in the early hours of the morning. I wouldn't set foot out of the door and go more than 50 yards at that time now.

As adults, we're supposed to prevent children from doing things that are really not a good idea - yet here are the TRAs, bizarrely wanting to shove life-changing medication down the necks of kids who in most cases will eventually look back at their trans phase with something like embarrassment.

Contraception prevents a pregnancy, which would irrevocably alter the course of a child's life, and damage their health.

Cross sex hormones will sterilise a child, irrevocably alter the course of their life, and damage their health.

Gillick arose from a particular case in which a mother (Gillick) argues that she should have been informed her daughter was being prescribed contraception as she was a minor and therefore parents had a right to know. The case concluded that in certain circumstances it was acceptable for parents not to be informed when their children are being prescribed contraception. The wider guidance around this and ability to consent to contraception is covered by Fraser guidance as Lang said. Children aged under 13 are not considered able to consent to contraception since under age 13 they are not considered legally to be able to consent to sex and therefore sex between even 2 13 year olds who both think they are consenting are considered legally not to be competent. Generally there is considered no public interest in prosecuting 2 13 year old for secually assaulting each other, but legally this is the position.

In terms of consenting for other medical care it is case dependent, time sensitive and ability to consent can fluctuate depending on the situation. For example, a 12 year old can generally be considered competent to consent to having a plaster cast applied to a broken wrist but not to major surgery. For consent to be valid the person must be able to understand, retain and weigh up information given in order to reach a decision. Generally held views are that the more serious and significant a treatment is the less likely a child will be competent. 16 and 17 year old are a grey area and broadly speaking should be considered competent to consent but may not be competent in more serious or complicated matters, particularly where there are significant risks associated with treatment.