@OvaHere I think you're right, and there's been a lot of misunderstanding on this thread about capacity. I'm sure you know all this from your training, so in a sense I'm speaking to everyone else here, but...
The bar for having capacity to make medical decisions is a low one. The presumption is that someone has capacity unless it is established that they don't, and that adults with capacity are entitled to make really stupid decisions.
To not have capacity the individual has to have:
- A disorder of the mind and brain
- Which prevents them from absorbing information, weighing up that information to make a decision, and communicating that decision
Both autism and gender dysphoria would count as a disorder in this context, but I see nothing at all to suggest that Tulip's ability to weigh up risks and benefits and make a decision was impaired to the point where he could be said to lack capacity.
Capacity is decision specific (you may have capacity to decide if you want the
cheese or the ham sandwich for lunch, but not where to live, for example) and I'd say that consenting to surgery of this nature needs a relatively high level of capacity. But Tulip, from the podcasts I've heard, is intelligent and articulate, and, had I been the clinician, I don't think I would have questioned capacity.
I know the information we have is very limited, but that's my take on it right now. As someone who occassionally does capacity assessments, I have 'passed' people with far far less decision making ability than Tulip has.
That's different, of course, from saying Tulip should have been offered this surgery. I don't think he should have been. In the same way someone with a broken toe should be offered painkillers and crutches, not amputation of the foot. But that's a seperate reason from lack of capacity.