Good Law project have succeeded...

[Wandawomble]

goodlawproject.org/news/tavistock-success/

Picking up from the post by InvisibleDragon about harm, the judgement doesn't consider the harm that might be caused by puberty blockers and decide that either they don't cause harm or the harm is justified. This isn't because the judge forgot to discuss this, nor is it because the judge was implicitly applying the legal principle "Everything which is not forbidden is allowed". It's because they judge knows that the harms of puberty blockers are being considered elsewhere and will allow the findings elsewhere to determine what happens. It was the judge consciously limiting the scope of the decision and letting others tackle that issue.

It's another indication that this is more of a technical decision, to decide a point of law, and deliberately avoids setting out a framework of what might be done.

@nauticant

Every time that the GC side "wins" or the genderist side "wins" the complexities involved become more apparent and the uncertainties grow. It just means more sunlight as time passes.

The Good Law Project might think that with enough litigation, enough resources, and enough pressure, eventually the medics will be put into a position where they will be told what to do and they will comply. Try it then. Push this as far as you can and on the day you can finally turn from your task and announce "we've won!", you'll find yourself looking at a massive crowd of people looking on in horror at what you've done.

From a Dentons point of view this looks like a disastrous way to "win".

Yes, this.

It was the judge consciously limiting the scope of the decision and letting others tackle that issue.

Although how much can they tackle it for private providers? I basically trust that the NHS/Tavistock/NICE etc will ultimately do the right thing, given all the scrutiny and reviews. Either they'll come up with enough to convince us, or they'll stop it.

I'm wary of getting stuck in a nasty limbo on the child+parent+doctor consent combo where the NHS won't do it - doctors refuse due to lack of evidence of benefit - but private providers can and will, and the law can't touch them, due to lack of evidence of harm.

it should be more along the lines of this is the first step to XY and Z. Not this is a breather.
If they do start referring for pb again based on parental consent I think it will have to be on this basis following the bell ruling. One of the reasons the judges said children could not consent was because they were actually consenting for xy & z. Parents would have to consent to that too.

From what Carmichael said in this case it sounds like Gids want to refer children who are not competent enough to consent according to the bell ruling, but do want to go ahead & so do the parents. Whether they can do that based off this ruling I don't know but it reads like that's what they want if they don't overturn bell.

There's one way the Good Law Project have been canny. They've litigated a case that sort of looks like the Bell decision and they won on narrow grounds that effectively are loose ends that were not in question in the Bell decision. I think they're going to be waving this around to create a belief in the mind of part of the public that the Bell decision has been overturned and maybe lobby behind the scenes to get buy-in of this view, perhaps from politicians. Although this shouldn't influence judges in the Court of Appeal, if it creates an atmosphere that the Bell decision is waiting to be overturned, the judges will feel this as pressure.

Fundamentally, the Good Law Project aren't really about law. They're doing something that looks like law but is different.

Am I right in thinking that Keira's Mum was supportive of her transitioning? So doesn't this case just mean that a person like Keira is in the exact same position as they would have been without the Bell case?

No, because the Tavistock stated during Keira’s case that they had never considered a parental consent approach to be appropriate.

This particular case concerns a child that was already on puberty blockers at the time when the judgment in that case was made. This child has already gone through the Tavistock’s original protocol and it was therefore looking at whether it would be necessary to stop the treatment now.

That isn’t at all the same as a new young person coming to the clinic and being referred for commencement of PBs with only parental consent. Tavistock indicated that they had never thought that approach to be suitable.

If this case was about a new child and Tavistock had gone back on their previous statement, that would be a big deal. As it stands, it isn’t hugely significant and confirmed the judgments in Keira’s case.

That's not how I read it AnyOldPrion. The particular claimant in this case was the mother of a child already on PBs but there's nothing in the judgment that limits it to those children.

@Signalbox

As it is, the judge has upheld the existing rules on the legal basis for parental consent and - crucially - said that clinical guidelines are the appropriate place for restrictions on prescribing PBs.

So essentially the GLP have just spent a lot of money to get a judge to confirm the status quo? The only thing preventing GIDS from treating on the basis of parental consent was GIDS own guidelines.

Yep. But sometimes confirming the status quo is an important step. After all, that's what Bell's case did - it upheld the existing position for Gillick competence. The GLP have now blocked off a potential hurdle (lack of certainty in the validity of parental consent) for the prescription of PBs. They aren't just pinning things on this one case, they've got a litigation strategy.

Maybe for everyone's info, Steensma, the Dutch doctor that is always held up as the example of a supporter of PB, has critised doctors in other countries for just blindly following his protocols. He said a month ago: PB's are experimental, they should never be given to a child without checks and balances, only a third of his patients get them, he won't start treating them until they are at least 11, he rarely agrees to treat a child who says they are transgender after starting puberty becsuse puberty is confusing for all children, he is very concerned about the high number of referrals, especially girls, and he is very clear PB's are underresearched and experimental. This is the doctor that all transallies point to as the leading expert.

So whose consent are they now relying on?

The 'clear wish of the young person to be referred' is not 'consent' - that's what the Bell judgment says - and Tavi said very clearly in Bell that they would not proceed on the basis of parental consent.

Previous thread
"Professor Carl Heneghan was interviewed on last night's Panorama & as a consequence of his analysis concluded that 'informed consent is not possible'

BMJ EBM Spotlight paper:
'Gender-affirming hormone in children and adolescents – Evidence review'
Posted on 25th February 2019

(extract)
"Gender dysphoria occurs when a person experiences discomfort or distress because of a mismatch between their biological sex and gender identity. Gender dysphoria can arise in childhood and adolescent which raises many questions about how best to handle the condition. This post sets out the current evidence for gender-affirming hormones in adolescents and children to aid decision making. (continues)

"Conclusions

There are significant problems with how the evidence for Gender-affirming cross-sex hormone has been collected and analysed that prevents definitive conclusions to be drawn. Similar to puberty blockers, the evidence is limited by small sample sizes; retrospective methods, loss of considerable numbers of patients in follow-up. The majority of studies also lack a control group (only two studies used controls). Interventions have heterogeneous treatment regimes complicating comparisons between studies. Also adherence to the interventions are either not reported or at best inconsistent. Subjective outcomes, which are highly prevalent in the studies, are also prone to bias due to lack of blinding, and many effects can be explained by regression to the mean.

The development of these interventions should, therefore, occur in the context of research. Treatments for under 18 gender dysphoric children and adolescents remain largely experimental. There are a large number of unanswered questions that include the age at start, reversibility; adverse events, long term effects on mental health, quality of life, bone mineral density, osteoporosis in later life and cognition. We wonder whether off label use is appropriate and justified for drugs such as spironolactone which can cause substantial harms, including death. We are also ignorant of the long-term safety profiles of the different GAH regimens. The current evidence base does not support informed decision making and safe practice."
blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/
(continues)

www.mumsnet.com/Talk/womens_rights/3518188-BMJ-Prof-Carl-Heneghan-Evidence-Based-Medicine-Oxford-Panorama-Trans-Kids-Gender-affirming-hormone-in-children-and-adolescents-Evidence-review-concludes-There-are-significant-problems

It all depends on if you believe there is such a thing as a transexual child......and if so-at what age can that child know? 12...8....5......2?

There is nothing wrong with a Childs body-they don't need puberty blockers or cross sex hormones-they need to mature & feel comfortable in their own skin.

I'm really confused.

In the KB case the court said that if the docs want to give blockers a court has to agree it.

Now one of these judges has said in a different case that parental consent is enough?

I was skimming and trying to understand. I saw a few comments about this happening in other situations. Yes there are plenty of medical situations where significant intervention is needed. And the results could go either way. And could be life changing. And doing nothing really is an option. And the child is too young to really comprehend what it all could mean for their life. Parental consent is used for that with the view of the child taken into account.

Surely it's going to be a can of worms to say both parents must agree? I can think of loads of scenarios where that would be a disaster.

As I understand it, in the Bell case the judge said that a person under 16 couldn’t consent, however parental consent as a way to get puberty blockers was never considered, as the Tavi said they didn’t use that model.

What this judgment has done is effectively made the Bell judgment ‘nul and void’, as it’s effectively said that parents should have rights in deciding what medical procedures their child should undertake (like signing consent for an operation).

Today’s ruling means that trans kids no longer need to go to court to get blockers if their parent agrees to give consent on their behalf.

The particular claimant in this case was the mother of a child already on PBs but there's nothing in the judgment that limits it to those children.

I understand that. But if the Tavistock specifically stated they would not employ a model of parental consent, then move to that model in order to sidestep the Bell case, I think it would send a very clear message that they are not acting ethically. There is a difference between a child continuing treatment and starting new treatment. From memory, the Tavistock stated after the ruling that they would stop sending new cases, but would review the ongoing cases, and that is what this is.

I’m not saying definitively that the Tavistock will not try this swerve, but I’m not yet wholly convinced that they are driving towards that.

@WarriorN

When adults who transition later regret and detransition, how on Earth can both parents and children be sure they're making the right decisions?

Tiny numbers relative to those who transition. Around 1 - 3%, depending on sources. And of those the vast majority those who have stepped back from the transition process for reasons like family pressure (I have direct knowledge of more than one such instance.)

If a treatment was 99 - 97% effective, it would deserve support, wouldn’t it?

Which is not to say that I would have any difficulty with research to help identify the 1 - 3 %.

Well, its something I have 'imagined I am' since about 7 or8 to my now late 50's - I would call that my gender identity - you might disagreee, but then you arent me. So as long as appropriate processes are in place to ensure that , as far as can be managed, the treatment is given to those who will benefit from it, managed through an appropriate professional environment, then YES RobinMoiraWhite

Gender Identity is a set of assumptions about how each of the sexes should behave, speak, dress, their role in society, relative position to each other. It is entirely socially constructed. Feminists reject these assumptions - we don't believe in a female 'role', we believe we can dress as we like, speak as we like, behave as we like. We are women because we have a female body, that's it.

It's not liberating to say that male and female roles and stereotypes in our society are fixed, and we can either 'identify' with them or with the opposite sex stereotype. That's not liberation, it's imprisonment.

I grew up with a stay at home mum, scared of my dad, who thought it feminine to pretend to be unable to understand basic mathematics. She had 5 children. I loved her dearly but rejected every single element of the woman role she represented and have followed none of it myself. I am, however, still a woman because I have a female body. But I don't inhabit her woman role, a regressive restrictive version of 'being a woman' invented by society to keep women down and which feminists have spent decades dismantling. I am very very grateful that they have. My life has offered me opportunities and respect she never had. Gender Identity is the new regression - 'gender non conforming' means that there is something you should 'conform to'. Feminism says 'no more gender boxes' - and thank God for that.

Tiny numbers relative to those who transition. Around 1 - 3%, depending on sources.

We don't know that. The number's a bit like the Iraq Body Count - a solid lower bound, not a reasonable mid-point estimate.

All the sources giving such numbers have been based on either much older cohorts, when gatekeeping was much tougher and without the new 4000%-increase ROGD demographic, or are based on simple checking of latest information on record in clinics.

The "1%" study I saw was looking for people who actually came back and had regret/detransition recorded on file. Anyone who hadn't come back to the same clinic to get that recorded was not counted. No real follow-up.

I'm not aware anyone is running proper follow-up studies on the children who've been treated in the last 5-10 years.

GIDS certainly hasn't been, as we saw in Bell. Like the court, we find this "surprising".

Surely it's going to be a can of worms to say both parents must agree? I can think of loads of scenarios where that would be a disaster

Presumably it would be essential for both parents to agree. How many parents would stand by and allow their child to be medicated with experimental medication that is likely to render their child infertile if they weren't 100% convinced that there was no alternative?

You are right that it will lead to disaster for those families though. These cases will inevitably end in court and with the breakdown of the family.

If a treatment was 99 - 97% effective, it would deserve support, wouldn’t it?

Even if this figure was correct, (which it probably isn't because they don't collect the data in any meaningful way) then that would mean that 1-3% of healthy GNC children are being mis-diagnosed and being medicated with life altering drugs unnecessarily. I can't think of any other condition where this level of mis-diagnosis would be acceptable.

@RobinMoiraWhite

Tiny numbers relative to those who transition. Around 1 - 3%, depending on sources. And of those the vast majority those who have stepped back from the transition process for reasons like family pressure (I have direct knowledge of more than one such instance.)

The truth is that no-one knows for certain how many detransitioners there are. The study usually quoted giving figures of 1-3% comes from a study done at Charing Cross where the researcher took a random sample of case notes of current patients who had had appointments over the course of a year to see if they mentioned regret. The authors themselves acknowledge the limitations of the approach - asking current patients, who may have just started treatment if they are happy is a bit like asking current members of a gym if belonging to a gym is a good idea. We know that regret tends to set in several years later, and that detransitioners don't go back to the clinic where they were treated.

A second study sometimes cited asked sex reassignment surgeons attending a WPATH conference, to volunteer if they ever saw patients who wanted reversal surgery. Funnily enough not many did. A sample so biased it's hardly worth reporting on.

The only robust evidence comes from the Swedish cohort study. The people studied were, however, adults and hence very different from the GIDS patients. Even so after sex reassignment surgery they found patients had very high rates of suicide and depression, much higher than the general population.

Dr Az Hakeem, Psychiatrist and Psychotherapist who has worked with gender dysphoric patients for many years reports that 25% of the patients he saw, over a 10 year period, were post-op transsexuals still suffering from gender dysphoria.

The only way we can have proper data on detransition rates is for patients to be followed up for 5/10/20 years after treatment. But given that any such research is attacked by trans activists, it is hard to obtain.

2. XY came out to her parents as transgender when she was 10 years old in Year 5. According to AB, XY had always only been interested in girls’ toys and clothes. When at primary school she, for a period, tried to conform to a more “male” stereotype but she was utterly miserable, became very withdrawn, and was shy and unhappy, particularly at school.

This breaks my heart. Why can't a kid play with whatever toys they want, wear 'girls' clothes if they want - and why are clothes for girls and boys so differentiated anyway? - and why do they have to conform to any goddam stereotype? The problem isn't with the child - let them get on with things as they want - the problem is with a society that rigidly says 'girls do this and boys do that' and any child who doesn't fit some arbitrary stereotype has something wrong with them.

What if, instead, everyone had been cool with this childs toy and clothes choices. What if the bounds of masculinity had not been patrolled so fiercely that any kid who didn't fit them was an outcast? Would XY have wanted to 'transition'? Especially if that meant a lifetime of drugs unnatural to the body, arrested physical development, sterility and impaired sexual function?

I'm wary of getting stuck in a nasty limbo on the child+parent+doctor consent combo where the NHS won't do it - doctors refuse due to lack of evidence of benefit - but private providers can and will, and the law can't touch them, due to lack of evidence of harm.

I hope that this is where the insurers will start having influence. Some of the major insurers may be captured as employers but I can't believe they won't take action the minute their bottom line is affected.

There are no win, no fee firms gearing up to take the cases from the detransitioners. I'm not sure where Robin gets their numbers from - anecdotally there are significant numbers of detransitioners but offical sources are deliberately not gathering info on them.

Surely GIDS has followed up the tiny number of transitioning subjects of their original study (it can't be hard to keep track of 46 (?) people can it, when the stakes are quite high) and can tell us exactly the situation of every child involved?

In the fairly significant number of intervening years it wouldn't be beyond expectations for GIDS to be gathering some further data tracking progress and outcomes on their patients as they reach adult age (I'm not sure that they 'become' adults in the developmental sense if they are on long term puberty blockers/cross sex hormones).

It would be helpful to understand what measures the Tavistock are putting in place to rectify their previous (and still unacknowledged), rather significant errors where people like Keira have had unnecessary surgery and drug treatment that has changed their bodies permanently and is very likely to be a detriment to their long term health. Surely one detransitioner is too many - I'm sure it is significantly more than one. Keira did everything right as far as GIDS is currently concerned. She had the number of appointments that were offered by GIDS (three, and I think the case in today's judgement had four, poss. five). We have not heard that GIDS are claiming that there was an unusual failure of standards in Keira's case - it seems that Keira's diagnosis followed a standard pattern that applies to all kids.

So what is GIDS doing to avoid the possibility of getting it so wrong again in the future??

The detransitioner board on Reddit had 17,000 members last time I heard. There are many detransitioners on other social media desperately trying to get their voices heard and advocate strongly for not rushing into a medical transition.

Puberty blockers have been elevated to mythical status as a drug that all gender dysphoric children must have. They are called 'lifesaving'. Yet the Tavistock's own study found that they did not alleviate feelings of gender dysphoria or make much difference to the child's overall sense of wellbeing.

Even the Dutch clinic who pioneered the use of puberty blockers is now urging caution:-

Because what is behind the large increase of children who have suddenly registered for transgender care since 2013? And what is the quality of life for this group long after the sex change? There is no answer to those questions. And that must happen, think Steensma and his colleagues from Nijmegen

www.voorzij.nl/more-research-is-urgently-needed-into-transgender-care-for-young-people-where-does-the-large-increase-of-children-come-from/

Setting up a drug in this way, with activists constantly urging parents and children to lobby for it's prescription, is disastrous. For the effectiveness of any drug to be properly assessed, cool, calm, rational and non-politically motivated clinical trial is needed. That is the last thing we are seeing here. For all the heat and argument, activists may well be arguing over the right to be prescribed a drug that doesn't even work.

I'm really confused.

In the KB case the court said that if the docs want to give blockers a court has to agree it.

Now one of these judges has said in a different case that parental consent is enough?

The judgments are not contradictory, GIDS's behaviour is.

KB case - children will not usually be Gillick competent to consent to PB, parental consent not considered because GIDS's stated position was that they cannot 'conceive of any situation where it would be appropriate' to rely on parental consent.

Today's case - simple confirmation that parents can consent to treatment on behalf of their non-Gillick-competent children.

Nothing has changed except for GIDS's sudden willingness to rely (theoretically but not actually) on parental consent.

Desperate arse-covering behaviour is often confusing.