Keira Bell Appeal

[Signalbox]

Just seen on Twitter that the Supreme Court have refused Keira's permission to appeal...

www.39essex.com/a-victory-for-gillick-competence/

That's not necessarily a shame. Keira Bell had already won in any case, discrediting the existing medical protocols, revealing the lack of a sound evidence base, revealing the experimental nature of the treatments, and revealing that "wholly irreversible" was a political/ideological statement rather than a scientific one.

The outcome of her case is the Cass Review, not a hearing in the Supreme Court.

Even if trans activists celebrate an apparent victory they'll know how hollow it is because the uncontrolled medical treatments from before 2020 are not likely to return.

Yes. I think the breaks have been put on massively thanks to Keira. I don’t think things will go back to the way they were any time soon.

*brakes

It's noteworthy how chosen names are, and are not respected. In that online update, they could just say Bell, as in: Bell v Tavistock as per the second sentence. And it could just read "permission has been refused in the first sentence. But no.

Keira Bell won on the establishment finally having to acknowledge in public that there was a medical scandal.

Trans activists won on being able to say that using judicial review was not a good way to get court room victory bragging rights.

Which win looks best?

(Although using judicial review did turn out to be highly effective from a tactical point of view in terms of getting the best result.)

I agree that this is likely to have been the best way to get attention to the issue. IIRC, "a review" was promised by Mordaunt in Sept 2018. Nothing happened until Sept 2020 when the Cass Review was announced. You have to wonder if it would have happened without her. The GEO did announce "research" but that would not have been a review like there is now, especially with Javid's further announcement in the last week or so.

for Keira

I agree that we all owe Keira a huge debt for what she's done. The exposure of the dire state of the offer from GIDs to children has been exposed and there was a massive public acknowledgement of the hazards of transitioning for children and young people.

I am in awe of so many courageous women like Keira who have spoken up and acted - and endured so much hate and hostility as a result. Thank you Keira.

One positive of this decision is that it frees Keira Bell to choose how much she wants to step back from all of this. She's already done more than enough, by an enormous margin.

This is a very good point.

Keira, thank you.

She won anyway. She changed everything.

“A Victory for Gillick Competence”

What a load of nonsense. It’s been about who decides that a child IS Gillick competent: the clinic that has been ideologicallly captured into believing the no-evidence treatment pathway is the right thing to do without consideration of whether the child understands the impact on their future physical health, sexual function and fertility, OR a judge who is independent of all that.

You can only determine a child is Gillick competent if you ask the right questions and discussion all the problems, not just assume that they’re going to be “asexual anyway” so it doesn’t matter 🙄.

A lot of the posts and comments I've seen on this seem to suggest that people believe that Gillick competence is something that applies across the board to all minors. Let a different age of consent for certain things. The distinction you are making would be totally lost on anyone thinking that way.

Yes, they say “Children can always decide their own treatments for everything and anything because Gillick said so.”

Er, no. Not remotely.

Keira's work is done. What she has achieved has had an impact around the world. The 'Bell case' is frequently mentioned in reports from other countries reviewing their practice over puberty blockers. Amazing outcome.

To Keira💐, you absolute star.

She may have been Gillick Competant but she was not given sufficient information to make informed consent.

Thank you Keira .. you raised awareness of the issues involved and some amazing actions have happened as a result.

She’s already won, turning the whole course of the conversation.

And no, I still don’t think she could have been Gillick competent. I think the doctors making these decisions are wrong.

But that’s probably not how this will all end. It’s a bad treatment for a condition we don’t understand, that some of the people presenting with features of it do not have.

Yes Kiera won 💐

She may have been Gillick Competant but she was not given sufficient information to make informed consent.

Exactly. Consider this consultation with an 11 year old. I’ve chosen male just for simplicity regarding describing physical changes.

Scenario One: TRA Model

Male Child: I want puberty blockers and “HRT”.

Doctor: Do you understand this will mean you won’t get any puberty and you’ll get breast tissue that will grow?

Male Child: yes! That’s awesome! I want that.

Doctor: great! You clearly understand and are therefore Gillick competent.

Scenario Two: Proper Consent (as determined by the judges in the Bell case)

Male Child: I want puberty blockers and “HRT”.

Non-captured doctor: Okay. Do you understand that this might make you feel happier immediately but won’t necessarily make you happier in the long run because we don’t have any evidence of long term psychological benefit? [i) the immediate consequences of the treatment in physical and psychological terms;]

Male Child: okay but I’ll be happier, right?

Doctor: to start with maybe, but not forever.

Male Child: but as long as I don’t have to do puberty.

Doctor: okay…do you understand that if we start these blockers, you will end up on oestrogen? [(ii) the fact that the vast majority of patients taking puberty blocking drugs proceed to taking cross-sex hormones and are, therefore, a pathway to much greater medical interventions;]

Male Child: yes! That’s what I want!

Doctor: But it also means you will be seeing doctors regularly for the rest of your life because of the health problems we will be inducing as a result of this. Your body will never mature past the point it is now.

Male Child: I don’t care, that’s ages away. And I don’t want my body to mature, that will be horrible.

Doctor: And if you stop puberty and your penis and scrotum don’t grow, it means it will be very difficult for anyone to do surgery, it will require the surgeons to use bowel to create any form of vagina. [(iii) the relationship between taking cross-sex hormones and subsequent surgery, with the implications of such surgery;]

Male Child: I don’t really want to think about surgery, I’ll think about that when I’m older.

Doctor: And if we do this, you won’t be able to ever have children or your own because you won’t have developed any sperm. [(iv) the fact that cross-sex hormones may well lead to a loss of fertility;]

Male Child: I don’t mind that, I don’t really want children.

Doctor: But you’re only 11, so you think you’re sure at this age?

Male Child: Oh I’m sure! I don’t even want to think about having kids!

Doctor: And what about sex. What do you know about sex so far? [(v) the impact of cross-sex hormones on sexual function;]

Male Child: Well I kind of know what it is from PSE at school.

Doctor: Do you think you might have sex when you’re older?

Male Child: I guess, maybe 😳 But I think I might be asexual.

Doctor: Do you know what erections are and have you had one?

Male Child: not really 😳😳

Doctor: because if we do this you won’t ever be able to have proper erections and sex when you’re older. This is something you might want to do if you meet someone you like when you’re older. [(vi) the impact that taking this step on this treatment pathway may have on future and life-long relationships;]

Male Child: I don’t really want to think about that right now, I just don’t want my body to change.

Doctor: Okay…finally, do you understand that if we start this, we can’t tell you or your parents what this will lead to in the long term? That there might be serious problems we don’t know about and we don’t really know if it will help you? We do know if we support you through puberty there’s a good chance you’ll be happy with that as an adult. [(vii) the unknown physical consequences of taking puberty blocking drugs; and (viii) the fact that the evidence base for this treatment is as yet highly uncertain]

Male Child: that’s okay, I’m sure this will be right for me 🤞, everyone tells me it’s the best thing to do otherwise I might get suicidal.

Doctor:…..

And this scenario imagines a child who can talk reasonably, might be a bit precocious. I have seen children who don’t talk, can’t verbalise their concerns, some with ASD, intellectually impaired, children with trauma, children in care, all put on puberty blockers. How many children who have been placed on puberty blockers around the world have had even half of such a conversation prior to their first injection?

Show me a child who is at Tanner stage 2, aged 11, 12, 13, who can provide good solid answers to these questions to remove any doubt about Gillick competence for this treatment pathway and I’ll show you a unicorn.

Keira’s case put this out there. Doctors now need to show the child understands those implications. The successful appeal against Keira didn’t remove those implications, it just changed the responsibility of who makes sure the child understands back from the courts to the doctors. So as well as showing me a child who understands those things, show me a doctor who thinks they have a child competent enough to understand those things and I’ll show you a doctor who should be in front of a competency assessment.

Children just cannot consent.

One positive of this decision is that it frees Keira Bell to choose how much she wants to step back from all of this. She's already done more than enough, by an enormous margin

This

I am in awe of how she has managed to hang In their through everything that has been thrown at her. She is incredibly brave and courageous. She has done all she can and I am incredibly grateful as a mother of 2 .

I hope she is proud of herself for all she has done. And I hope she can now have a well Earnt rest .

She got us all several steps closer to full exposure.

Well done keira and thank you

Good examples notbad. Consent isn't about parroting platitudes.

One of the more challenging scenarios I have come across was an adult who refused life-saving surgery but was forced to have it after court intervention. (I've posted about this before) Hugely difficult and emotional situation with many staff believing the patient had the right to their own decisions and very uncomfortable with forced surgery. The decision legally was that they couldn't consent.

In this particular circumstance, The patient insisted they would be fine without the surgery. Had they acknowledged that they would almost certainly die within a short period of time, demonstrating that they accepted that risk, they would have been deemed capable of making their own decision.

The parallel for me is that in the situation I described the patient essentially put their fingers in their ears and said you're all wrong, I'll be fine.

At the Tavi too many people put their fingers in their ears in the name of ideology and Kiera has put a stop to that. Awesome achievement

We're all grateful to Keira Bell. This outcome leaves her with legal costs to pay, including some of those of the Tavistock, and so her crowdjustice funder is still open. A contribution to reduce the financial impact on her would be a good way to say "thank you".

Thanks Nauticant. I agree she has done this for all of us.