Hormones to children: UK judges wash their hands of it. The Court of Appeal ruling on the Keira Bell case
In response to the Tavistock Clinic's appeal on the Keira Bell ruling, the Court throws the ball back to the doctors: it is they, not the judges, who have to decide whether a minor is able to express his consent to the experimental "therapy" that blocks development and leads to transition. But the debate is now open. And the fear of lawsuits from repentant minors - detransitioners - leads the medical profession to be cautious

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The English Court of Appeal has partially overturned the ruling that had ruled in favor of the young detransitioner Keira Bell (here her story) against the Tavistock Clinic who hastily started her on puberty blockers when she was 16.

With a Pilatesque sentence and merely formalistic, the Court threw the ball back to the doctors: it is up to them, and not the Courts, to establish whether a minor can access this "therapy" with hormone blockers. It must be doctors and not judges who take responsibility for deciding whether or not the minor possesses the so-called Gillick Expertise, that is, the maturity necessary to evaluate the consequences of hormonal treatments, which are irreversible.

The transactivists welcomed the sentence, but the time of easy transitions for minors is over anyway. As we are seeing all over the world (read here) given the growing number of former gender non-conforming girls who, once adults, regret the irreversible changes caused by puberty blockers, especially Faced with the risk of lawsuits for damages - follow the money - doctors and clinics are increasingly adopting a principle of caution. Therefore it will be increasingly difficult for a minor under the age of 16 to be experimentally initiated into the transition according to the "affirmation only" principle - essentially, blockers do not deny themselves to anyone. In summary, the number of girls treated with blockers is destined to reduce in any case.

The era in which people acted without responsibility to follow an ideology and not correct medical practice is over. Keira Bell, who has asked to be allowed to appeal to the Supreme Court, commented: My case opened a global debate, although much remains to be done. It is a deeply troubling fantasy that a doctor would believe that a 10-year-old child could consent to the loss of his or her fertility.”

Marina Terragni

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The following is the site's commentary Transgendertrend after the ruling of the Court of Appeal.

We are baffled by the decision with which the Court of Appeal today upheld the appeal of the Tavistock and Portman NHS Foundation Trust against the first instance decision of the Court of Justice of London in the case of Bell and Mrs. A v Tavistock.

The appeal was upheld on the basis that the Court of First Instance did not declare the use of puberty blockers to treat gender dysphoria to be unlawful, and that the ruling and guidance issued by the Court of First Instance concerned disputed facts, expert evidence and medical opinions which could not be examined and evaluated in judicial proceedings.

The Court of Appeal ruled that the principles expressed in the GILLICK case were based on medical assessments, e.g It is not up to the judge to decide on the capacity of minors under 16 years of age to give valid consent to medical treatment.

The basis of the Tavistock appeal is the argument that, in its ruling, the Court of First Instance relied on the principles expressed in the Gillick case, which establish that children under the age of 16 are capable of taking valid decisions if deemed competent to do so by their doctor after a specific individual assessment.

Tavistock had objected that the Court “has trespassed into the decision-making area reserved for doctors, patients and their parents, where previously (the Court's note) it had never ventured.

In essence, the Court of Appeal held that "the trial court ruled an improper restriction on the use of Gillick proficiency tests

The appeal judges rejected the idea that the use of puberty blockers for gender dysphoria is an extreme case.

In point 76 of the sentence it is even stated that consent to puberty blockers is no different to consent to contraception:

Nothing about the nature or implications of treatment with puberty blockers allows any real distinction to be made between the assessment of contraception in Gillick and puberty blockers in this case, bearing in mind that when the Gillick case 35 years ago, the issues raised in relation to contraception for children under 16 were highly controversial, in a way that is difficult to imagine today

Overall, the opinion, although in words it acknowledges the fact that there are widespread contrary opinions on the issue, he takes the Tavistock tests at face value without elaborating.

For example: the claim that only children's 16% is later treated with puberty blockers when in previous testimony Dr. Polly Carmichael has suggested that the percentage overall is more like 41-45%; the statement that only 55% of children treated with puberty blockers then move on to therapy with hormones of the opposite sex when on the same GIDS website the percentage indicated is 98%; and the statement that “the primary purpose of puberty blockers was to give the patient time to reflect on his or her gender identity" And "treatment with puberty blockers was separate from subsequent treatment with opposite-sex hormones” when the Health Research Authority, in its checks on the Tavistock Early Intervention studies, established:

“Confusion would have been reduced if the description of the purpose of the treatment had specified that it was offered specifically to children who demonstrated strong and persistent gender dysphoria at an early stage of puberty, so that suppression of puberty itself would have allowed subsequent treatment with hormones of the opposite sex to avoid resorting to surgery to change or otherwise mask the unwanted physical effects of puberty in the gender of birth"

Although much space has been given to the consideration that it is not the role of the courts to evaluate medical evidence, it is inevitable that the courts will be influenced by the evidence that is made available to them.

In the case of puberty blockers, the evidence (provided by Tavistock) is weak, the ethical considerations involved are very serious and in any case Tavistock has never made the administration of alternative, less invasive treatments available. Not even the supervisory bodies have ever questioned the ideological basis of the "affirmative" approach.

The first instance judgment in Bell & Mrs A v Tavistock is cited extensively in the Court of Appeal decision and none of its points are contested except from a purely legal/formal point of view.

All the “concerns” still exist.

The Court of Appeal rules:

Doctors will inevitably have to pay great attention before prescribing treatment to a child, and be astute enough to ensure that the consent obtained from both the child and the parents has been preceded by adequate information on the advantages and disadvantages of the proposed therapy, in light of the evolution of research, and a clear understanding of the implications and long-term consequences of such treatment. Great care is required to ensure that the necessary consents are obtained correctly. As Gillick clarified, doctors may still be subject to disciplinary and civil actions when, in individual cases, problems arise

The original judicial ruling and the subsequent appeal brought the issue of preventing puberty in children to the public spotlight, and to the attention of the medical and political world.

Keira Bell opened the discussion.

Permission to appeal to the Supreme Court will be sought.

(translation by La Crissy)

here the original article

here the High Court ruling


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