Keira Bell and Mrs A vs. Tavistock - Court of Appeal hearing 23 & 24 June 2021

[FindTheTruth]

The appeal hearing will be live streamed this Wednesday 23 & Thursday 24 June, 10:30am

Background

1. The High Court decided in Mrs A and Keira Bell’s favour on 1st December 2020 that puberty blockers and cross-sex hormones are experimental treatments which cannot be given to children in most cases without application to the court. Full details of the original case:

www.transgendertrend.com/keira-bell-high-court-historic-judgment-protect-vulnerable-children/

1. The High Court decided in the case of AB on 26 March 2021 thatPARENTScan consent to their children receiving puberty blocking treatment when their children lack the capacity to consent.

1. Court of Appeal 23 & 24 June 2021 Keira Bell and Mrs A’s legal team is dealing with legal submissions from 7 intervenors who want to see the judgement of the Divisional Court overturned. “A significant task in defending the judgement of the Divisional Court. We are facing very well resourced opponents – the Tavistock being funded by the State and the other intervenors”.

@GetTheeToTheGulag

Endocrinologists (medical doctors) will supply the drugs in 'safe' doses as directed rather than ever question whether or why there is a need for them in the first place.

I've never understood that bit. I would have thought final responsibility rests with the prescriber. Plus responsibility to monitor. Even if steering clear from mental health, physical side effects of the drugs should surely be followed up by the prescriber. 🤷‍♀️

I flagged this up on an earlier thread. There are very clear rules around who should assess for capacity/gillick competence and it has to be the person who is responsible for making a decision. IE, as a social worker I can't assess someone's capacity in relation to someone accepting antibiotics- it's not my decision to make, the medic does. I was musing at the time about whose responsibility it is in this scenario. By following normal procedures I would say that the GIDS worker would be assessing the child's ability to consent to the referral, not to the actual PB's. A GIDS worker is not qualified to prescribe them, or understand their potential interaction with the child's other health conditions/medications if they have any. It's all probably a moot point now considering how this is going but I'd like to hear the reasoning behind who is doing what and why, it certainly doesn't seem to fit the standard procedure for these things.

There seems to be a total abdication of responsibility at multiple levels.

The endocrinologists (who know about hormones) administer the drugs because the psychotherapists (who don't know about hormones) at GIDS tell them to. They ignore what they know about hormones.

The people at GIDS (who know about psychology) treat the condition with drugs because their service provision tells them to do what WPATH says. They ignore what they know about psychology.

The service provision tells them to follow WPATH guidelines because WPATH (who seem to be a trans cosmetic surgeon org, not a proper health org) have set themselves up as the experts on "trans health" - by just putting in their name, and the NHS has just taken that off the shelf.

Why the NHS feels they have to have "service provisions" following external rules, rather than just directly having in-house expertise, is just utter idiocy due to privatisation.

Guidance is parasitic on correctness of declaration so it will fall away. Gilick competence is matter for clinicians, not court. Practical impact for this cohort of patients, is collapses 3 decisions over 5/8 years into one decision.

Above is a tweet by Sarah Phillimore, I think Mr Mckendrick speaking. It’s suggesting (I think) that if the decision making is moved to court, then an extended progression of consent will be lost.

So the point it comes down to medically is that the Tavistock claims that consent is given in three separate decisions over 5 to 8 years, and Keira Bell’s side are pointing out that if everyone in the experiment progresses directly through the second and third decisions (presumably onto cross sex hormones being one of those) then the second and third consents are moot, THUS the child MUST be able to fully understand and consent at stage one.

Interesting. The end arguments by JH (via SP’s tweeting) sound like he was making some progress in explaining his point, though it’s impossible to guess what the judges’ take was.

@NecessaryScene

There seems to be a total abdication of responsibility at multiple levels.

The endocrinologists (who know about hormones) administer the drugs because the psychotherapists (who don't know about hormones) at GIDS tell them to. They ignore what they know about hormones.

The people at GIDS (who know about psychology) treat the condition with drugs because their service provision tells them to do what WPATH says. They ignore what they know about psychology.

The service provision tells them to follow WPATH guidelines because WPATH (who seem to be a trans cosmetic surgeon org, not a proper health org) have set themselves up as the experts on "trans health" - by just putting in their name, and the NHS has just taken that off the shelf.

Why the NHS feels they have to have "service provisions" following external rules, rather than just directly having in-house expertise, is just utter idiocy due to privatisation.

This seems like a good summation. In addition to that are we now seeing the judicial system washing their hands and saying we don't have primary responsibility/not our problem?

From what I gather Outhere and GetTheeToTheGulag, your comments are highly relevant to the arguments coming up after lunch.

It sounds to me like what SHOULD happen is that GIDS should have a multidisciplinary team, which includes endocrinologists who understand the entire process.

Instead, because of the way the NHS works, separate teams do different bits of the jigsaw and you run a risk of nobody taking ultimate responsibility.

@D7D1

Unfortunately sometime times people and companies are above the law, my heart breaks for Keria but this is one of them. It's not right, it's not fair but it's life. The Judges are terrified, and you can understand why. You can't trust anyone in any type of power.

This sort of tin foil stuff is just nonsense and really unhelpful. The AC aren't going to find against Keira because they are scared, but because the Tavi has strong grounds for appeal within the narrow context of the legal basis of the orginal judgement.

If the AC judgement goes against Keira, I will be sad for her personally, but I doubt it will make much difference to future PB prescribing at the Tavi because there is so much more scrutiny now - largely thanks to Keira. Her victory has been bringing the scrutiny, and that can't be underdone by an AC judgement on quite narrow legalistic points. Stop undermining what she has achieved and handing a victory to her opponents.

there is so much more scrutiny now - largely thanks to Keira. Her victory has been bringing the scrutiny, and that can't be underdone by an AC judgement on quite narrow legalistic points

Whenever I've found my heart sinking at the CoA suggesting that the solution is for the Tavistock to get its house in order rather than courts to be managing everything, I think back to this key point.

By the way, you've been making good points in this thread MissLucyEyelesbarrow. Thanks.

Well said @MissLucyEyelesbarrow

McKendrick’s argument seems to be somewhat painting a target on the backs of endocrinologists. If he’s saying it’s their responsibility not the Tavistock to assess Gillick competency and the AC allows the appeal on a technical matter about the scope of JR, it still means a judge has found, on the evidence, that a child is unlikely to have Gillick competency for this treatment. He has argued that a court has not heard the submissions of his clients and that seems correct however it would be something of a lawyer’s victory. The endocrinologists will be in a difficult situation. I think this applies generally to a technical win by the Tavistock. They would be taking a huge risk in going back to business as usual, although they seem fairly light on risk assessment.

Back for the final session:

@FloraFox

McKendrick’s argument seems to be somewhat painting a target on the backs of endocrinologists. If he’s saying it’s their responsibility not the Tavistock to assess Gillick competency and the AC allows the appeal on a technical matter about the scope of JR, it still means a judge has found, on the evidence, that a child is unlikely to have Gillick competency for this treatment. He has argued that a court has not heard the submissions of his clients and that seems correct however it would be something of a lawyer’s victory. The endocrinologists will be in a difficult situation. I think this applies generally to a technical win by the Tavistock. They would be taking a huge risk in going back to business as usual, although they seem fairly light on risk assessment.

Thanks for this. I can't listen in today so it's interesting that this issue has raised its head - I've been pondering it for a while and wondered how it hadn't featured in the first case.

McKendrick’s argument seems to be somewhat painting a target on the backs of endocrinologists. If he’s saying it’s their responsibility not the Tavistock to assess Gillick competency

How can they if they are not fully au fait with the results of the GIDS experiment, which strongly suggests that the second and third consent stages are moot?

@yourhairiswinterfire

D7D1's second post was deleted, but I agree, and it's a worry.

If 10-12 year olds are competent enough to consent to sterilisation (despite evidence suggesting it doesn't benefit them) when even grown women are refused in case they change their minds, what else could it be argued that these 10-12 year olds are competent enough to consent to?

Feels like we're on a slippery slope?

The core point of Gillick is that under-18s can consent to any treatment, as long as they meet the tests of competency. There are no exceptions to this (to the best of my knowledge), which is one of the problems for Keira's case.

If Gillick is a slippery slope, it's one we have been on for 30+ years.

As I mentioned above, one of the judges in the Court of Appeal said that in the High Court case one part of the outcome sought was a declaration that it was impossible for a child to consent to receiving puberty blockers for gender issues and this claim was lost. However, a fall-back position was won by Keira Bell that it should require a court to determine whether a particular child could give consent.

McKendrick: Puberty blocking treatment for gender issues is not experimental. Because there is no inevitability of puberty blockers leading to cross-sex hormones, puberty blockers are reversible.

there is no inevitability of puberty blockers leading to cross-sex hormones

Just that 99% of those on PBs went on to the hormones ...

Counsel for Transgender Trend is now up.

@nauticant

McKendrick: Puberty blocking treatment for gender issues is not experimental. Because there is no inevitability of puberty blockers leading to cross-sex hormones, puberty blockers are reversible.

No inevitability, but almost 100% of children on PBs progress to CSH

Whenever I've found my heart sinking at the CoA suggesting that the solution is for the Tavistock to get its house in order rather than courts to be managing everything, I think back to this key point.

Yes, very true. Ultimately that is what has to happen - not to have children left in limbo because a clinic says its hands are tied, but to have good, solid, evidence-based treatment that is in the best interests of the child/young person.

How can he say that puberty blockers are reversible. If you should have entered pubity at 13 and it is delayed until 16 how do you know there aren't any irreversible consequences. Did they produce evidence? Is it it the bundle?

But what actually ia the point of puberty blockers?

We're told it's a pause button and biys time for the child to think about what they want. BUT if you block puberty, you aren't just stopping physical maturation you're stopping their cognitive maturation, too.

So don't you just end up with a developmentally delayed child who is a bit older, rather than a child with the necessary mental capacity...?

sorry puberty

Another thing that could flow from a successful appeal is that once the court has said "this isn't a matter for us because it relates to potentially wrong but lawful behaviour by the Tavistock", then the government, which naturally will be watching closely, will be wondering whether it needs to legislate. I would expect it not to act because, before, this issue was incendiary but now it's nuclear.

McKendrick's argument that the consent decisions should not be collapsed to the earliest point overlooks the issue that if a child takes PBs, they will not be in any better position to make a decision about loss of sexual function if they wait a few years. They won't have experienced sexual function at the later date.

How can an 16 year old who has not experienced sexual arousal make a decision about never experiencing it any better than a 10 year old?