Jolyon Maugham, GLP and scary stuff re parental consent

[RealityNotEssentialism]

goodlawproject.org/update/advisory-group-transgender/

I know that there is another thread on JM but thought I would start a new one as this has just been released. First of all he has named the people on his advisory committee. They include Alex Sharpe, whom we know all about and about whom no more needs to be said.
Second, they are trying to force a change of policy from the Tavistock that they give PBs simply on parental consent to children who cannot consent to them. That is chilling and dangerous and puts an awful lot of power in the hands of adults with nobody to protect the child’s interests. JM has lost the plot.

realitynotessentialism

PB can’t be compared to something like having a tooth pulled out or an operation because those treatments will usually bring about a notable improvement in the child’s health whereas PBs don’t. The latest from the Tavistock’s own research shows PB don’t improve mental health.

I completely agree. I think the Tavistock used the same consent process as for a specific medical diagnosis with a clear gold-standard treatment protocol.

However, PBs + cross sex hormones is an experimental procedure based on unverified theories (pause button? Better aesthetics to pass?). But the Tavistock implied that this is a well evidenced treatment.

The Bell vs Tavistock case largely sidestepped the issue of whether the treatment is appropriate to the problem by focusing on the ability of the child to meaningfully consent. They noted that the procedure was experimental, so fell into the category of treatments for which children were unlikely to be able to consent, but didn't go into the science of treatment at all.

Because the focus of the ruling was so much about Gillick competence, I very much doubt that the GLC attempt to intervene will be successful in overturning the ruling. They could only win an appeal if they demonstrate that the evidence already presented was interpreted wrongly. I don't think that includes suggesting a new consent procedure at the Tavistock.

The judgement was also very damning about the poor quality of evidence presented by the Tavistock (they were very surprised indeed). So I don't think the Tavistock can easily present PBs as the accepted treatment without some push back.

(Interestingly, the endocrinologists are probably safe here. They prescribe the PBs, but the consent process is carried out by the Tavistock, who also oversee what treatment is given. They can easily argue that their expertise is hormones, not mental health so they were only following the greater expertise of the specialist gender clinic ...)

I'll be very interested to see what happens if the Tavistock do start presenting patients to the court for permission to prescribe blockers. I'm hopeful that this will lead to a detailed review of the treatment offered - like in the Charlie Gard case, where the treatment offered was novel, experimental and unlikely to meaningfully help Charlie. A close review of the Tavistock paper could leave them in quite a sticky mess.

(Sorry this is long - it's late and I waffle when I'm tired.)

It's the same black and white zero sum thinking that characterises the spaces debate: third ways unacceptable.

The judgement does not refuse pbs, but requires an objective court of protection to establish it is in the child's best interests and they are able to consent. Remove the need for the child to be able to understand consequences fully as a child (and as I keep saying, we have evidence of adults posting on MN in defense of pbs being prescribed who are unable to engage with or acknowledge the facts beyond denial so the judgement seems very reasonable that a child will not be able to do it) and what is left is best interests.

Precedent in situations that involve serious effects on a child are usually based on the minimally invasive and restrictive. There are many less invasive ways to treat a child with severe dysphoria and self harming ideation, which is what this was about in the first place: that psychological supports are essential and should be the main plank of treatment. Self harming and suicidal ideation are also high for children with autism and anorexia, but there is no pbs silver bullet for them, so other treatments, strategies and resources are considered best practice for treating those children and supporting those families in this situation.

If the argument is about the emotional harm and risks then there are many other ways to help; pbs are not the only answer to emotional and psychological distress, and are not the least invasive or permanently altering.

If an adult child takes parents and doctors to court over a kidney transplant or an amputated limb that parents consented to on their behalf as a child, the evidence will be fairly straight forward to show that the harm of not acting would have significantly out weighed the harm of the treatment, and adults made the best decision possible in the circumstances.

This is the line of argument trying to be applied to pbs. That the harm of not acting outweighs.

The issue is that while a septic foot with no circulation will not recover and will end up causing death, and that is a known, objective, scientific, evidenced fact that the same medics looking at the same scans and evidence could replicate diagnosis of, there are many less invasive ways to treat suicidal ideation that do not involve causing permanent lifetime harm. No one can say that the child would not have recovered equally well on other less permanently altering treatments. No one can say that the adult child's distress at their altered body and lifetime of medical needs and infertility was absolutely the only possible solution to their dysphoria and the risk it was causing them when they were a child. Keira evidences this.

Likewise, no one can currently say how many of these children, if supported in other ways and allowed to go through puberty, would either find their dysphoria resolved, or become happily trans as adults as Sharpe has done without the risk of harm caused to a growing body.

Perhaps reading The Secret Garden and thinking about the transformation of Colin after he wasn’t pandered to would be useful.

There are loads of children’s books from previous eras about how children who are fawned over and pandered to become poisonous. It often starts with a health issue or an accident and then spirals into little emperors calling the shots destroying their own and the lives of all around them.

A child that is guaranteed to have special treatment, conversations, consideration, special clothes and watches as the world bends around them as it does for no one else can’t possibly be unaffected.

If the argument is about the emotional harm and risks then there are many other ways to help; pbs are not the only answer to emotional and psychological distress, and are not the least invasive or permanently altering.

It is interesting that Jolyon changed the crowdfunder which was originally sensible(ish) and fighting for waiting times for children to see gender specialists reduced, to one which is actively trying to undermine the judgement not there judges, and to make children the property of their parents

The judgement also makes mention of the Tavistock's records and assessment for numbers of children identified with Autism, I think with another 'surprise' comment?

If the plank of the argument is that the risk of harm and suicide is so high as to justify pbs then surely it would have to come with first separating out all other possible diagnoses and causative factors alongside the dysphoria, since the reporting of suicidal ideation and risk for children with ASD, mental illness, trauma and history of abuse and eating disorders are equally high and in some cases higher than those reported for dysphoria.

Gerbil, here is an article for Family Law Week written by a firmly pro trans barrister (she has collaborated on seminars with GIDS, according to the bio on her Chambers site).

It seems far more realistic an understanding of what the judges have interpreted the existing law to be in regards to Bell v Tavistock than anything coming from Jollyon’s corner:

www.familylawweek.co.uk/site.aspx?i=ed216529

I found the stuff about sterilisation interesting - apparently that’s another area where a parent cannot consent for a child (and a child cannot consent for his or herself) and doctors cannot proceed without consent so it always goes before a judge.

Considering that sterility is a side effect of the transition pathway (with blockers and hormones being likely to cause it and genital surgery certain to cause it, and in the case if paediatric interventions, no likelihood of storage of gametes either) it seems pretty obvious to a lay person like me that the same sort of formal proceeding should be followed.

'. It often starts with a health issue or an accident and then spirals into little emperors calling the shots destroying their own and the lives of all around them.

A child that is guaranteed to have special treatment, conversations, consideration, special clothes and watches as the world bends around them as it does for no one else can’t possibly be unaffected.'

I know you probably haven't read the whole thread.

I see what you're trying to say but the child is a child. You are putting quite adult motivations around them. And talking about watching as lives are destroyed and little emperors etc is to me really unhelpful.

There is for me no question that the children presenting at these clinics need help. The question is what sort of help they need.

I've posted on this thread about how it feels to be a child who is different, going into a medical setting.

Could I ask you to read them? They may be a bit long but I hope pertinent.

Oh, and I agree there is something in the psychological reinforcement that is similar to children who have been hospitalised for long periods, although I think it’s more of a fantasy or by proxy thing than with actually seriously ill kids (who quite often just want to fade into the background amongst school peers, because they are sick of being special and just want to be ordinary).

Sasha Ayad has observed that amongst the current group of adolescent onset girls, a disabled or SEN sibling or a close bereavement or a seriously ill parent seem to be a contributing factor.

Sorry my last was to basedrops.

They have to keep pushing the suicide myth because it's all they've got.

It's reasonable to ask why these children can't wait until they're old enough to make a properly informed decision about changing their appearance.

The only reason for boys not to wait is because the effects of testosterone will mean that they won't 'pass' as well as adults. This is pretty superficial and makes the whole 'transition' thing look like cosmetic surgery. Most people would think that arresting a child's normal development for such a shallow and superficial reason was inappropriate.

For girls, there are no similar effects at puberty, so there is no reason at all for girls to have this treatment as adolescents.

But they need a reason. The only one they have is - 'they need this treatment otherwise they'll all kill themselves'. It really is all they've got.

It depends probably on what the issue is, plant.

If you have something that will always set you apart, then probably it's different to something that isn't so, like that.

It's an area that needs looking into imo.

What does it do to you if you have always been maybe going to die since you were born?

What does it do to you if it's life changing/ difficult but not a death thing?

How do children who live with difference from birth cope etc compared to those where something happens when they're older?

I mean I don't know.

I do have probably a fairly unusual experience population wise and I didn't realise possible parallels really until this thread.

Interesting questions!

Our local children’s hospital has a psychosocial service, specifically for supporting children in all of the different scenarios you suggest, so there must be existing expertise out there that could participate in gaining a proper understanding of gender distressed kids and what the ‘functional behaviours’ are achieving for them. Impossible in the current political climate, of course, but I do have high hopes for the Hilary Cass review into GIDS because she must be well aware of this stuff (as well as being very knowledgeable about autism is girls).

I’ve got this on the pile next to my bed:

www.amazon.co.uk/Armfuls-Time-Psychological-Experience-Life-Threatening/dp/0822955652?tag=mumsnetforu03-21

Been there a while but not had the mental space to read it yet (it’s relevant to one of my children).

If a child is at risk of serious self harm then they are acutely unwell and need psychiatric care.

That's all they need, it is an emergency. They don't need to be thinking about their hair or nails or packing or binding or anything other than not taking their own life.

Quite how Theresa May and the WHO thought this is not a psychiatric condition is beyond me. If you are threatening serious self harm then you are in need of psychiatric care. Not sexist clothing.

It's not fucking rocket science.

Plantmum thanks for that. My experience was a few decades ago so it's good it's recognised.

Although. And I hate to point this out. Getting time to sit with someone and talk about you is still a pretty big deal. I would have be liked that. Would it have helped in the end? Hard to say.

I'm not a big fan of talking therapy tbh although I know that goes against what I've said.

Bottom line is I suppose. That people come in all sorts mentally, physically. And society is set up in a certain way. And a lot of people, children. Feel they don't fit the narrow bounds of 'normal'.

So ideally rather than medicalising children because they don't fit, we should be working to expand : normal'.

But this goes back to the old feminism, get rid of the roles, let everyone be who they are in terms of personality, presentation.

Society is still not ready for that though.

Interestingly, the endocrinologists are probably safe here. They prescribe the PBs, but the consent process is carried out by the Tavistock, who also oversee what treatment is given. They can easily argue that their expertise is hormones, not mental health so they were only following the greater expertise of the specialist gender clinic ...

InvisibleDragon

The consent process is not carried out by the Tavi. It is carried out by UCLH or Leeds.

From some of my correspondence with the Tavi:

“ the Tavistock & Portman NHS Trust does not provide hormone treatment or obtain consent for treatment. Consent is obtained by the endocrinology clinics at the University College London Hospital (UCLH) and the Leeds Teaching Hospitals NHS Trust. ”

So it turns out that his top legal team consists of a QC who is a specialist on pensions. None of them appear to have direct subject expertise of best interests cases. I’m quite surprised at this. Is it because the specialists didn’t give Joly the answer he wanted in terms of prospects of success of the appeal?

There are also parents who get a kick out of their kid being ‘special’. It is well known that some parents do not know what is in their children’s best interests at all which is why the law exists as a backstop to protect them.
I sometimes think we need a phrase that is akin to the read Munchausen's by Proxy to capture this aspect of this. Something to do with the parent's own narcissism and basking in the child's reflected specialness.

Am I being thick here, or is saying that parental consent can override a lack of capacity to consent not undermining gillick competence and so endangering young people’s access to abortion and contraception

It's an argument I've seen several times now and I'm concerned about it. There may well be unintended consequences. However, I don't know if there are differences for PB because of the long-ranging effects and paucity of clinical evidence.

Quite how Theresa May and the WHO thought this is not a psychiatric condition is beyond me. If you are threatening serious self harm then you are in need of psychiatric care. Not sexist clothing.

Very true. Of course it’s a psychiatric condition to believe that you inhabit the wrong body.

I’m surprised (and quite pleased) that the team aren’t experts in this area. I’m loving all the links to barristers / solicitors who are looking at this and putting forward eloquent and knowledge tweets on this subject. Hilarious and reassuring at the same time. It is also in marked contrast to the ‘opposing’ tweets which fall back on the suicide and ‘but you’re so mean’ arguments.

I mean I don't know, but his output comes across as singularly incisive and focused in one area (the alleged government contracts corruption) and fucking unhinged in the other area.

His job is to represent his client and unpick legislation in a very specific way. When he represents a tax avoidance scheme he doesn’t have to look at the big picture of how it affects other people, he just needs to win.

This isn’t a bad thing - it’s what lawyers are paid to do. However, ability to comprehend detail in some areas may mask an inability to
grasp other subjects. He doesn’t know what he doesn’t know.

I think everything follows from a fundamental belief in the wrong body narrative.

@merrymouse "I think everything follows from a fundamental belief in the wrong body narrative."

This in my view is completely right. It explains why Ben Hunte approaches the issue the way he does, why so many celebs, activists, liberals etc are caught up in this. If you believe it is possible for a human to be "born in the wrong body", then drugs, surgery, GRCs, men in women's spaces etc all make sense. So BH et al all approach this from the position of "these poor children are trapped in the wrong body and it is very sad and unfair" and if you don't you are anti-science and cruel.

It is nonsense, however it fits with the trend of evidence free beliefs that have taken hold with not daft people. Homeopathy, 5G skepticism, various health fads. There are tonnes of them, which is a mix of openness to new scientific discoveries (and therefore who is to say that the "born in the wrong body" is bollocks when there are so many other developments that sound fanciful to a layperson but are actually true) combined with a lack of critical thinking.

NiceGerbil I have read them. I’ve also seen this stuff happen in real life. I’ve seen siblings sidelined for the special one who due to their talent or health condition sucks up every family resource. I’ve watched kids who know that any resistance to what they want will be snow ploughed by their parents. I’m not saying every kid, and actually it’s not even the kid that causes this, it’s the way the adults around them behave.

What I’m saying is that the adults around kids who are different for any reason bear a huge part in how the difference impacts the kid and those around them. I sincerely doubt that having special rules, clothes, exemptions, extras, and endless discussions about everything from where you get changed for school swimming or which uniform you get to wear can not give a kid a false idea of how society works and their place in it.

As EmbaressingAdmissions said - munchausens by proxy. Except the kid isn’t being made to suffer until puberty time. Before that it’s an endless wave of special and validation.

I’ve been listening to two BBC series recommended here, intrigue: Mayday (set with the White Helmets, known from Syria, conspiracy theories about them) and the Great Post Office Trial (suspected problems with the Horizon accounting system and how defending the Post Office meant criminalising local post office people).

Both show defence of a group view to extremes vs impact on individuals.
It’s amazing how we humans can use all our energy to defend something that seems from the outside to have evidence so stacked against it.

There's also Where's George Gibney OneEpisode about how the swimming establishment in Ireland weighed up a "popular" male swimming coach against credible claims that many children had been abused:

www.bbc.co.uk/programmes/p08njhrm

It's an extraordinary listen. But I must add a trigger warning for anyone who would be distressed by victims talking about CSA.

I’m very much enjoying JM getting roasted on Twitter on Foxing Day 😆 I think trying to bully the The Secret Barrister was a bad mistake...

twitter.com/barristersecret/status/1342742740438831104?s=21