BMJ: parents don't get a say in treatment of minors

[NeurotrashWarrior]

https://sci-hub.tw/downloads-ii/2020-01-06/afc5/dubin2019.pdf

Conclusions
*
Despite the absence of clear clinical guidelines for transgender minors seeking medical treatment in the absence of parental consent, there is sufficient ethical precedent and clinical data to conclude that treatment should not be withheld when a minor is at risk of undue suffering. Because there is evidence to suggest dysphoria and associated comorbidities would be relieved by treatment, this logic aligns with Diekema’s criteria for over- riding parental consent and Mill’s Harm Principle. Although guidance is not law, the capacity of a transgender minor should be strongly advocated for in a matter consistent with a provid- er’s general treatment of adolescents in any other medical decision-making settings such as STI services and contraception. The clinician should consider the decision to pursue hormone therapy or surgery in relation to current guidelines, risks to the individual patient and the child’s decision-making capacity.*

I wonder what Kiera would have to say about this article? So many detransitioned women talk about the strength of feeling they had as a teen.

And yet, parent's opinion doesn't count.

Because there is evidence to suggest dysphoria and associated comorbidities would be relieved by treatment

Again, not what Michele Moore has found. In fact the opposite.

clymene Yes. I had a flick through his clinics instagram account.
It's all about the money. Never mind the damage done to healthy bodies.

Is Webberly still a doctor? I thought she was struck off? How can she possibly claim 'no competing interests' - she sells off label drugs over the internet, from Spain, as far as I'm aware.

Ah, interim suspension and a £12k fine, it says here, not struck off.

www.walesonline.co.uk/news/wales-news/helen-mike-webberley-gender-gp-16297750

How can she possibly claim 'no competing interests' - she sells off label drugs over the internet, from Spain, as far as I'm aware.

I was looking for a way of flagging her letter on that page, but I couldn't see any way of doing that, so I don't know how we could alert the editors to the fact that 'no competing interests' is a big fat lie.

I suspect you’d probably have to email the editor directly- I don’t see anything on the page either.

Not related to the BMJ, but I didn’t want to start a new thread- here’s an opinion piece on the talk by Kenneth Zucker at McGill University last week. The event was hosted by Samual Veissiere who has been absolutely fantastic on speaking out on the issue.

www.thepostmillennial.com/provocative-gender-dysphoria-expert-gives-vital-speech-at-mcgill/

The need for parental influence to be removed I feel stems from the same issues of homophobic parents of gay children who would rather see their children "fixed". It needs to be balanced how much credence can be given when sometimes a parents personal beliefs will outway the desires and what is right for the child.

The process of transitioning is thr UK is a long one, which involves a lot of intensive therapy, and at least a year of evidencing living as the opposite gender before even hormones will be prescribed, and then more time before gender reassignment surgery will be considered.
And that's not considering the waiting list to be seens for the therapists and then specilist who can prescribe hormone therapy. The go ahead for hormones and surgery at both stages require the individual to be signed off by 2(or 3) psychologists and requires undergoing very intensive therapy with multiple psychologists before you can even start hormones.

It's not as simple as rocking up to gp saying I want hormones and being given them. Theres ALOT of safeguards in place now, which aim to work out if the decision to transition has to mitigated by traumatic life experiences, comorbid disorders etc before the okay is given.

LittleGirlDragon you are badly misinformed.

One of the worst parts of the process is the fact that there is such a long waiting time post referral. During this period, lots of these children/adolescents are choosing to socially transition - often via the guidance of organisations like Mermaids- and there is little or no support for parents. CAHMS (if under their care) generally want these children/adolescents off their books once GI issues are mentioned and speaking from personal experience, there is no other support via the NHS.

Parents play a key role during this period and if there are long waiting periods to be seen by GIDS, support should be given, particularly as the Tavi does not recommend social transition before being seen there.

Long waiting lists could actually be seen as a good thing, if support were given, as it might allow some of these children/adolescents, particularly those who are not positively affirmed by the adults around them, time to grow and mature past their GI issues.

Personally I don’t think 3-6 hourly sessions (generally a month apart) is anywhere near enough to holistically evaluate an individual and decide whether to refer to blockers/hormones, but to each his own.

@Aesopfable I have a friend currently going through the process so unless her GP and the NHS are badly informed...

LittleDragonGirl I too am going through the process. If your friend would like to join a fellow group of parents (not of the Mermaids nature) , you could point her towards the Bayswater Support Group

www.bayswatersupport.org.uk/ or @BayswaterSG on Twitter

@rodgmum thank you!

@rogdmum

I agree with the therapy side that it's not enough.
BUT, but unfortunately that is the nature of nhs therapy now, for complex mental health issues In my experience was able to have 8 45 minute sessions.. and I'm still no better then where I started, so as a comparison of availability of available therapy it highlights the shortage of available therapists and time constraints the nhs has to work with. I know many therapists on the mental health services side (not gender) who are incredibly frustrated as they dont have the time to really achieve anything, so I imagine therapists dealing with gender probably deal with the same feelings of frustration.

During this period, lots of these children/adolescents are choosing to socially transition - often via the guidance of organisations like Mermaids- and there is little or no support for parents. CAHMS (if under their care) generally want these children/adolescents off their books

The NHS protocol requires that children who present with identified 'gender dysphoria' whether by self or others be seen by GIDS who as as expert tier 4 care inform & guide other health services' repsonse.

GIDS service is rooted (as it was from the start by DiCeglio) in the belief that a child has a 'gender identity' & therefore that " some children experience anxiety and other forms of distress associated with the difference incongruence between their assigned sex classified at birth and the gender characteristics
and behaviours they identify with"

The NHS protocol for GIDS service illustrates the reliance on WPATH etc

www.england.nhs.uk/wp-content/uploads/2017/04/gender-development-service-children-adolescents.pdf

LittleDragonGirl I completely agree. We’re lucky enough to be able to afford private therapy for DD for as long as she needs. A lot of parents would not have that option. In addition, few therapists/child psychologists/psychoanalysts in the U.K. have the experience to deal its the issue, and even fewer will take a neutral approach. It’s an incredibly difficult situation which I think will only lead to more and more detransitioners over the coming years.

@givethemseeds posted the full article on Twitter today if Old’s suggestion doesn’t work and you want to see the whole article.

I've just had a look, and the article posted on twitter is the one in the OP. Helen Webberley's letter was in response to a different article in the BMJ, "The struggle for GPs to get the right care for patients with gender dysphoria" by Sally Howard, a journalist.

I've just tried my trick for getting past the paywall again and it doesn't seem to work any more.

Here's the link for anyone who does have access.
www.bmj.com/content/368/bmj.m215

You can send in a complain to the BMJ. Just saying.

Sorry, Old I got myself into a muddle with articles.

The BMJ’s competing interests policy is:

“A competing interest — often called a conflict of interest — exists when professional judgment concerning a primary interest (such as patients' welfare or the validity of research) may be influenced by a secondary interest (such as financial gain or personal rivalry). It may arise for the authors of an article in The BMJ when they have a financial interest that may influence, probably without their knowing, their interpretation of their results or those of others.

We believe that, to make the best decision on how to deal with an article, we should know about any competing interests that authors may have, and that if we publish the article readers should know about them too. We are not aiming to eradicate such interests across all article types in the BMJ. However, certain articles (see below) fall under a stricter policy announced in 2014. This means that authors whose financial conflicts of interest are judged to be relevant by the BMJ team are not permitted to write these articles. We also ask our staff and reviewers to declare any competing interests.“

www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests

I might email the editor and query it.

Jo Bartosch article in The Critic, " ‘Her penis’ and other facts we all should know"

(extract)
"According to the NHS and WHO, each of us has an innate gender identity, and this may or may not correspond to our biological sex. No conclusive evidence has been found as to where exactly this feeling of gender resides, or how it might be expressed without relying on sexist stereotypes. We are told proof rests in the small proportion of the population who feel they have been born in the wrong body. That people feel discomfort in their sexed bodies cannot be disputed, but the idea that this is because of a mismatch between gender identity and their sex is unverifiable, not to mention a substantial leap of logic.

The urge not to cause offence coupled with successful lobbying has plunged the UK into what might best be termed a “gender theocracy”." (continues)
thecritic.co.uk/her-penis-and-other-facts-we-all-should-know/

current thread:
www.mumsnet.com/Talk/womens_rights/3807601-Jo-Bartosch-in-The-Critic-Her-Penis-and-Other-Facts

I’ve not had a chance to watch it yet, but Samuel Veissiere has put up a video of Kenneth Zucker’s lecture at McGill last week:

Full tweet here with other links: twitter.com/samuelveissiere/status/1222219633278758913?s=21

Although guidance is not law, the capacity of a transgender minor should be strongly advocated for in a matter consistent with a provid- er’s general treatment of adolescents in any other medical decision-making settings such as STI services and contraception.

Under Gillick /Fraser competence, adolescents consenting to their own treatment need to demonstrate that they fully understand the risks of the treatment/not being treated. There is a whole world of difference between understanding that contraception reduces the chances of unplanned pregnancy and the emotional maturity to understand the life-long effects of hormonal treatments with or without surgery.

What I think is particularly tragic is that young people are essentially sold the snake oil as a solution to their “problems”. It can’t work because it’s trying to solve the wrong issue, which may not even be an issue once the child becomes an adult.

Under Gillick /Fraser competence, adolescents consenting to their own treatment need to demonstrate that they fully understand the risks of the treatment/not being treated.

As it seems the medical profession do not fully understand or have agreement as to the risks of the GIDS treatment / not being treated it seems unlikely that a patient who is a child (under 18) possibly could.

Doesn’t Gillick also require the assessment of the child’s ability to manage influences? I don’t often see that argued, but in many cases, these children/adolescents have been highly influenced by social media, peers and in some cases, adults- shouldn’t that also be a factor in many of these cases?

rogdmum

This CQC article seems a good summary:

"In 1983 the judgement from this case laid out criteria for establishing whether a child under has the capacity to provide consent to treatment; the so-called ‘Gillick test’. It was determined that children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options.

If a child passes the Gillick test, he or she is considered ‘Gillick competent’ to consent to that medical treatment or intervention. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. Additionally, a child may have the capacity to consent to some treatments but not others. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Therefore each individual decision requires assessment of Gillick competence." (continues)

www.cqc.org.uk/guidance-providers/gps/nigels-surgery-8-gillick-competency-fraser-guidelines

general treatment of adolescents in any other medical decision-making settings such as STI services and contraception.

There are permanent major lifelong consequences to medical transition, it’s nothing like treating an STI or prescribing contraception. It’s not a valid comparison at all. I hope someone highlights that in a letter to BMJ.

Doesn’t Gillick also require the assessment of the child’s ability to manage influences?

Tavistock & Portman NHS Trust "Our Gender Identity Development Service"
4 November 2018
(extract)
"The GIDS was founded in 1989 and is one of the longest standing services for gender diverse children and young people in the world. Domenico Di Ceglie, who founded the service, wrote a set of therapeutic aims which we still abide by today. This includes the unconditional acceptance and respect for young people’s gender identity" (continues)

tavistockandportman.nhs.uk/about-us/news/stories/our-gender-identity-development-service/