The judgment in Keira Bell's case will be given tomorrow

[MaudTheInvincible]

The judgment of the Tavistock's appeal of the case will be given at 2pm.

www.gov.uk/government/publications/royal-courts-of-justice-cause-list/royal-courts-of-justice-daily-cause-list

Brave Keira. You have done so much to protect children from ideologically driven healthcare around the world. Your integrity and courage is inspiring and rare in this ridiculous day and age. 💚🤍💜

I'm interested in broader consequences. I see a couple of negative ones.

The message is going to be broadcast far and wide by trans activists that the Court of Appeal has said that puberty blockers can now be distributed again. I think that when kids, and/or their parents, go to get them, and find that the new regime isn't at all like what has been promised, they'll think "well, puberty blockers are now fine again and should be provided on demand, they're being unreasonably withheld, let's go and get them from abroad". I expect there to be a bonanza in Webberley type arrangements.

The other thing is that since the Court of Appeal has invoked the spectre of responsibility and liability on the part of the medical establishment, many practitioners will consider withdrawing from practice, but not all. The ones remaining will be the right side of history zealots and the unscrupulous.

I don't think the Tavistock is going to get a grip on the Wild West that's been opened up by today's judgment. Let's see what the resultant vacuum sucks in.

Just to be clear I'm not blaming the Court of Appeal for how things have developed. In fact they've aligned themselves with the law and resisted judicial activism, and I support this.

We're looking at a terrible failure by the medical establishment supported by a failure in the laws passed by successive governments. That's where the blame should lie.

@OldCrone

I said 'medically necessary or deemed to be' - i.e. many trans people deem these surgeries to be medically necessary for their mental health, and the prevailing medical guidance certainly makes room for mastectomy etc as part of the treatment, so they are evidently willing to treat these surgeries as having a medical justification, too.

Surely it's not just up to the patients to 'deem these surgeries to be medically necessary for their mental health', there must also be some medical diagnosis by a professional who decides that this is the best way to proceed.

But there have also been cases of doctors amputating healthy limbs because patients decided they wanted this.

In January of this year British newspapers began running articles about Robert Smith, a surgeon at Falkirk and District Royal Infirmary, in Scotland. Smith had amputated the legs of two patients at their request, and he was planning to carry out a third amputation when the trust that runs his hospital stopped him. These patients were not physically sick. Their legs did not need to be amputated for any medical reason. Nor were they incompetent, according to the psychiatrists who examined them. They simply wanted to have their legs cut off. In fact, both the men whose limbs Smith amputated have declared in public interviews how much happier they are, now that they have finally had their legs removed.

www.theatlantic.com/magazine/archive/2000/12/a-new-way-to-be-mad/304671/

There was also the case of a woman who persuaded a psychologist to blind her by pouring drain cleaner in her eyes.

www.bioethics.net/2015/11/can-clinicians-maim-healthy-organs-the-case-of-jewel-shuping/

These people also 'deemed these surgeries to be medically necessary for their mental health', just like the trans people you talk about. What is the difference? Is there a difference?

I'm speechless.

@nauticant

Just to be clear I'm not blaming the Court of Appeal for how things have developed. In fact they've aligned themselves with the law and resisted judicial activism, and I support this.

We're looking at a terrible failure by the medical establishment supported by a failure in the laws passed by successive governments. That's where the blame should lie.

I agree. It will take years for this to be resolved and the failure is with the medical establishment. Probably a class action by de-transitioners, Keira will probably be in her fifties by then. I'll probably be long gone. It just pains me how many others will be hurt in the meantime when the dangers are so apparent.
Justice is slow. Ask the Hillsborough families, thalidomide victims, Stephen Lawrence's family .. The list is long.

It will take years for this to be resolved and the failure is with the medical establishment.

I agree. My first exposure to the idea of being trans was watching the documentary A Change Of Sex about Julia Grant. I was a young teenager and just remember being so perplexed and thinking that it was impossible to change sex, so why were all the professionals telling Julia they could. It all began there, if only they’d been honest to these people decades ago, we wouldn’t be in this mess now.

It's not "people" wanting this, it is trans people, who are the most directly affected. The day we start telling them they don't know what they want is the day we take the first steps on a very slippery path.

Just because they want it doesn't mean they need it. The Tavistock's own research didn't show puberty blockers having a beneficial effect on the mental health of the cohort taking them, while having the negative effects on bone density previously mentioned.

@Youarethecurry

Just read the other day that Jazz Jennings, one of the oldest transitioners, has gained 100 lb which s/he blames on 'emotional eating' and the 'side effects of her medication'.

That's a staggering weight gain for a twenty year old.

None of this is reassuring, is it?

Yes, I saw that - it's really sad, but rather than think about that, the long term consequences of this treatment on the human body, the US media just moves on to a sparkly new younger child like Kai Shappley, plus the even more front-page-grabbing celeb transitioners like Elliot Page.

Just because they want it doesn't mean they need it.

There's so much we want but don't need. Alcohol, cake, cream, cosmetics, to name only a few examples.. Should we be paternalist about one section of society but not others?

There's so much we want but don't need. Alcohol, cake, cream, cosmetics, to name only a few examples.. Should we be paternalist about one section of society but not others?

These are children wanting to stop their own puberty and natural development which potentially will lead to infertility because adults are telling them it will solve their mental health problems. It's not remotely comparable.

My son wants cakes, he can get them on his school account and we talk about how he shouldn't eat too many cakes, from a health and financial perspective.
He might want cosmetics or tattoos but what with him being a child and me being poor hes no means of access to these things.
He also wants to drive my car and look at inappropriate content online. Again, because he is a child he cannot have all that is his heart desires. Im there to protect him.
Lots of people want lots of things.
We cant always have what we want.
Children should never be able to access harmful drugs or treatments just because they want them. Where is the evidence?

@Droite

Just because they want it doesn't mean they need it.

There's so much we want but don't need. Alcohol, cake, cream, cosmetics, to name only a few examples.. Should we be paternalist about one section of society but not others?

The section of society being children, though. Towards whom we are consistently "paternalist". We're supposed to be. We're mammals, not turtles.

May I remind you what happens if a minimum-wage member of staff sells alcohol to under-eighteens? A fine, that's what.

As of 2012, the maximum fine for repeated offences (defined as two or more different occasions in a period of three consecutive months) of selling alcohol on the same premise to a person aged under 18 is £20,000.

If Keira had managed to buy WKD from a pub twice in the run-up to her 18th birthday, what, realistically, would the consequences for Keira's health be today? (And yes, I do agree with the Chief Medical Officer that children should have an "alcohol-free childhood".) To go by the average mumsnetter's tales of teenage fun, there would be no consequences. But £20,000 fine nevertheless.

Meanwhile, in America, you can't drink alcohol until 21, if I've got that right.

Surely what has happened to Keira (cross-sex hormones and an elective double mastectomy) is far more serious and has far greater consequences for her future health than being sold 2 WKDs by a 19 year old bartender?

Surely the responsibilities and consequences for graduate and post-graduate NHS staff should be greater than they are for a 19 year old bartender who sells a 17 year old alcopops?

"Should we be paternalist about one section of society but not others?"
What does paternalistic mean in this context?
The section of society you are talking about is children.
It looks like safeguarding to me.
All children should be safeguarded against harms.
Safeguarding is everyone's business.

We're looking at a terrible failure by the medical establishment supported by a failure in the laws passed by successive governments. That's where the blame should lie.

I agree. Judicial recourse was sought because no one else listened.

Really interesting thank you

In between the original ruling in December and the announcement of this appeal ruling we have had the following:

1. the Tavistock staff published their findings on impact of puberty blockers on mental health. They told the original judges the research wasn’t ready, then published it online just a few days after the ruling . It has then gone to print. The paper shows that puberty blockers bring no overall improvement in psychological functioning.

2. NICE published its review into the evidence for both puberty blockers and cross sex hormones and found the evidence to be lacking or poor quality.

3. Sonia Appleby won her case highlighting problems with safeguarding at the Tavistock.

4. the facts in the original ruling came to light, despite the ongoing attempts to deny them. Children all progress from PBs to CSH, they will be infertile, they will have significantly impaired sexual function, they will have reduced bone density, they will suffer from a myriad of other side effects both known and unknown. This appeal result doesn’t change these facts.

What this successful appeal means is that the clinicians commencing puberty blockers for children are doing so in full knowledge that there is no evidence for such practice, evidence in fact that these children’s mental health will not improve and in acknowledgment that they are committing children to a pathway of significant medicalisation and iatrogenic disease. The onus to justify this is back on them.

Only a fool of a doctor would continue on such a path.

""Children all progress from PBs to CSH, they will be infertile, they will have significantly impaired sexual function, they will have reduced bone density, they will suffer from a myriad of other side effects both known and unknown. This appeal result doesn’t change these facts.""

"The onus to justify this is back on them."

Exactly this.
Please if anyone can justify why or how sterilising gay, autistic or traumatised children is ever an ok thing to do im all ears.
Or any children for that matter.
Can anyone tell me the real good reason for sterilising kids??
This is not even an experiment, because nobody bothered to collect the most basic data that would be standard in a gcse science lab.

It just shows how captured they all are. I would have thought the Tavistock would have been secretly relieved at the original ruling. Now they have to confidently stand up and say:

“Yes, we fully believe that this 11 year old autistic female who has a history of trauma and abuse fully understands that the treatment we are going to initiate will not improve their mental health and will lead to infertility, poor sexual function and a host of other negatives. We fully believe that this child has the capacity to to understand these implications. We believed it before we published our evidence when we thought it helped their mental health, and we believe it now even though we now know it doesn’t. This child is cognisant of all of this and we have no reason to doubt this, therefore we will proceed, because despite the negatives, this child wants this treatment and in context of us fully believing they understand, we are not going to object.”

At least for a while they could have passed the buck to say “well a judge says you understand, who are we to argue.”

Now they have to put their money where their mouth is, and demonstrate beyond doubt these children understand.

No child can consent to being sterilised..
They cant.
Even if it was just that.
Just. Hah.
It's not just being sterilized.
Its all the other side effects aswel.

@NotBadConsidering

It just shows how captured they all are. I would have thought the Tavistock would have been secretly relieved at the original ruling. Now they have to confidently stand up and say:

“Yes, we fully believe that this 11 year old autistic female who has a history of trauma and abuse fully understands that the treatment we are going to initiate will not improve their mental health and will lead to infertility, poor sexual function and a host of other negatives. We fully believe that this child has the capacity to to understand these implications. We believed it before we published our evidence when we thought it helped their mental health, and we believe it now even though we now know it doesn’t. This child is cognisant of all of this and we have no reason to doubt this, therefore we will proceed, because despite the negatives, this child wants this treatment and in context of us fully believing they understand, we are not going to object.”

At least for a while they could have passed the buck to say “well a judge says you understand, who are we to argue.”

Now they have to put their money where their mouth is, and demonstrate beyond doubt these children understand.

If they have an ounce of sense, they might wait for the Cass report instead. Now these judges have removed all legal barriers to child transitioning, the pressure on her increases. It will be her policies that will come under spiraling legal scrutiny as, after the earlier (now overturned) judgment, it is becoming more difficult to clain anyone is unaware of the paucity of evidence.

Given the changes in policy in other parts of the world, following the earlier judgment, it will be interesting to see whether there are any reversals. If not (and it seems unlikely to me that they will all backtrack, given the publicity) it makes it less controversial than it would have been for Hilary Cass to go for a more restrained pathway.

The fact that those other countries (and indeed the Tavistock itself) didn’t push on with their policies while waiting for the appeal is hopefully a sign that they are now giving much more consideration to the evidence base, or rather, the lack of one.

I might be wrong, of course. GIDS may joyfully return to their original activities without a qualm. But if they have any sense at all, they will express their delight that they have been vindicated, while quietly attempting to continue with a much more moderate pathway.

Pressure from Gendered Intelligence towards the NHS:

”To our knowledge, not a single patient has been put forward to the endocrinology teams since the Divisional Court’s December 2020 decision. The Court of Appeal highlighted that at no point were the Tavistock’s policies and procedures found to be unlawful. It is therefore clear that there is no reason for NHS England to not return to its original treatment pathways.”

genderedintelligence.wordpress.com/2021/09/17/bell-v-tavistock-quashed-on-appeal/

@NotBadConsidering

In between the original ruling in December and the announcement of this appeal ruling we have had the following:

1. the Tavistock staff published their findings on impact of puberty blockers on mental health. They told the original judges the research wasn’t ready, then published it online just a few days after the ruling . It has then gone to print. The paper shows that puberty blockers bring no overall improvement in psychological functioning.

2. NICE published its review into the evidence for both puberty blockers and cross sex hormones and found the evidence to be lacking or poor quality.

3. Sonia Appleby won her case highlighting problems with safeguarding at the Tavistock.

4. the facts in the original ruling came to light, despite the ongoing attempts to deny them. Children all progress from PBs to CSH, they will be infertile, they will have significantly impaired sexual function, they will have reduced bone density, they will suffer from a myriad of other side effects both known and unknown. This appeal result doesn’t change these facts.

What this successful appeal means is that the clinicians commencing puberty blockers for children are doing so in full knowledge that there is no evidence for such practice, evidence in fact that these children’s mental health will not improve and in acknowledgment that they are committing children to a pathway of significant medicalisation and iatrogenic disease. The onus to justify this is back on them.

Only a fool of a doctor would continue on such a path.

Quoting for truth.

We should remember to go back to first principles and ask “what is the condition that they are trying to treat? What are the symptoms that would be expected to be relieved by this treatment?”

Children
 A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1):
1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender)
2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing
3. A strong preference for cross-gender roles in make-believe play or fantasy play
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender
5. A strong preference for playmates of the other gender
6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities
7. A strong dislike of one’s sexual anatomy
8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender
 B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning

Despite the insistence that “it’s not about stereotypes”, the main thrust is that the child won’t adhere to the clothes, playmates and games that are stereotypically appropriate to their sex.

Other than that, the remaining criteria is the distress. I absolutely do believe that these children are distressed. But that makes it all the more pressing to fully explore the roots and nature of their distress- and more urgent to protect them from making irrevocable decisions that will have a lifelong impact on their health while in that distressed state. Upset, unhappy, tramautised minors don’t make good decisions about the long term. Anyone who has been in such a state would tell you that they would do anything to make the pain stop.

Instead of weaponising these children’s trauma in the way that transactivists do (“better a live son than a dead daughter!”), we should respect it and take even more care than normal that their treatment is of the highest quality.

Promising a distressed child of trauma something that can’t be delivered is just passing the distress down the line.

First proper coverage of this on Radio 4 right now. on the Today programme.

Tavistock bloke, Paul Jenkins, says that the best comparison to puberty blocking treatment is children having access to contraception. When Mishal Husain challenged this comparison on the basis of reversibility he said: "Treatments can be reversible." Vague enough to be true in some contexts, but still willing to push that something that's essential untrue.