Finally a glimmer of good news for trans children in the UK. In England people over the age of 18 can make their own medical decisions. They can accept treatment, and they can decline treatment...
Finally a glimmer of good news for trans children in the UK.
In England people over the age of 18 can make their own medical decisions. They can accept treatment, and they can decline treatment even if that means they're going to die. This can only be over-ruled if they lack capacity.
If a person is 16 or 17 they can consent to get any treatment, but they cannot decline life saving medical treatment.
If the person is under 16 there's a test to see if they can understand and weigh up information. This is called Gillick Competence. If a child is gillick competent they can consent to get treatment. They can decline most treatment, but they can't decline life saving treatment. If the child is not competent their parent can consent for them.
Tavistock and Portman (the only gender clinic for children in the England) went a bit further before referring children on to endocrinology services to see if puberty blockers should be prescribed. (Children do not get surgery nor cross sex hormones). The child had to have capacity to make a decision. The child had to accept treatment. And the parent needed to agree. And then the psych team had to agree. And then the endocrinology team had to agree.
Despite this the courts found (in the Bell case) that children were not able to understand the consequences of puberty blockers, and so were unable to give consent to use PBs. This was an unusual result, and it was based on flawed evidence from supposedly "expert" witnesses -- most of them have not treated, and do not treat, trans people or trans children.
This case reasserts the parental right to make decisions for the child.
Unless I'm misunderstanding there's already a long list of checks involved, Tavistock and Portman aren't handing out puberty blockers in a PEZ dispenser to anyone asking for them. So outside of...
The effect of the decision in the Bell case earlier this year, when read together with the practice hitherto of the Tavistock to treat on the basis of a child’s consent only, was that even when a specialist doctor wanted to prescribe puberty blockers, a child wanted to receive puberty blockers, and their parents believed puberty blockers were in the best interests of the child, an application would still need to be made to the High Court.
Unless I'm misunderstanding there's already a long list of checks involved, Tavistock and Portman aren't handing out puberty blockers in a PEZ dispenser to anyone asking for them. So outside of the obvious (outright transphobia) can anyone explain the reasoning that after a long-ass list of people that are directly involved, that a judge should even remotely be included in the decision? In what world is a judge somehow a better source for the final decisions on the matter than the collective group of the person, their parents, their physicians, and subsequent advisory teams?
I like debate, I enjoy playing devil's advocate, and even I cannot find how including a judge in these circumstances is even remotely tenable.
It's a great question. The Bell case was an unusual decision and it went further than existing law in England. It's quite complicated to talk about because the Bell case applies to people under...
It's a great question. The Bell case was an unusual decision and it went further than existing law in England.
It's quite complicated to talk about because the Bell case applies to people under 16, and people under 18. But it involves mental capacity which only applies to people over the age of 16.
If a person over the age of 16 lacks capacity (for example, they're unconscious) doctors can provide most treatment if that's in the person's best interests. If that treatment is serious they need to pay extra attention to how that decision is made, and they should appoint an Independent Mental Capacity Advocate (IMCA) - who'll advocate for the patient.
If everyone agrees and it's a straightforward decision the treatment will go ahead. But sometimes medical teams have a disagreement about the best course of action, or the IMCA will say that this isn't what the patient would have wanted. And in those cases they go to the courts of protection to get a ruling.
In theory it's to protect the patient. But mental capacity law in England is a mess, and it's likely to be reformed at some point.
In the Bell case the judges are saying that treatment with puberty blockers is "experimental" and so extra care needs to be taken.
Cases involving any of the following decisions should be regarded as serious medical treatment for the purpose of the Rules and this practice direction, and should be brought to the court:
(a) decisions about the proposed withholding or withdrawal of artificial nutrition and hydration from a person in a permanent vegetative state or a minimally conscious state;
(b) cases involving organ or bone marrow donation by a person who lacks capacity to consent; and
(c) cases involving non-therapeutic sterilisation of a person who lacks capacity to consent.
Examples of serious medical treatment may include:
(a) certain terminations of pregnancy in relation to a person who lacks capacity to consent to such a procedure;
(b) a medical procedure performed on a person who lacks capacity to consent to it, where the procedure is for the purpose of a donation to another person;
(c) a medical procedure or treatment to be carried out on a person who lacks capacity to consent to it, where that procedure or treatment must be carried out using a degree of force to restrain the person concerned;
(d) an experimental or innovative treatment for the benefit of a person who lacks capacity to consent to such treatment; and
(e) a case involving an ethical dilemma in an untested area.
Just a heads up, you've got the parenthesis and square brackets swapped. This: [Gillick Competence](https://en.wikipedia.org/wiki/Gillick_competence) Turns into this: Gillick Competence
This is called (Gillick Competence)[https://en.wikipedia.org/wiki/Gillick_competence].
Just a heads up, you've got the parenthesis and square brackets swapped.
This: [Gillick Competence](https://en.wikipedia.org/wiki/Gillick_competence)
Turns into this: Gillick Competence
Finally a glimmer of good news for trans children in the UK.
In England people over the age of 18 can make their own medical decisions. They can accept treatment, and they can decline treatment even if that means they're going to die. This can only be over-ruled if they lack capacity.
If a person is 16 or 17 they can consent to get any treatment, but they cannot decline life saving medical treatment.
If the person is under 16 there's a test to see if they can understand and weigh up information. This is called Gillick Competence. If a child is gillick competent they can consent to get treatment. They can decline most treatment, but they can't decline life saving treatment. If the child is not competent their parent can consent for them.
Tavistock and Portman (the only gender clinic for children in the England) went a bit further before referring children on to endocrinology services to see if puberty blockers should be prescribed. (Children do not get surgery nor cross sex hormones). The child had to have capacity to make a decision. The child had to accept treatment. And the parent needed to agree. And then the psych team had to agree. And then the endocrinology team had to agree.
Despite this the courts found (in the Bell case) that children were not able to understand the consequences of puberty blockers, and so were unable to give consent to use PBs. This was an unusual result, and it was based on flawed evidence from supposedly "expert" witnesses -- most of them have not treated, and do not treat, trans people or trans children.
This case reasserts the parental right to make decisions for the child.
The case is here: https://www.bailii.org/ew/cases/EWHC/Fam/2021/741.html
Unless I'm misunderstanding there's already a long list of checks involved, Tavistock and Portman aren't handing out puberty blockers in a PEZ dispenser to anyone asking for them. So outside of the obvious (outright transphobia) can anyone explain the reasoning that after a long-ass list of people that are directly involved, that a judge should even remotely be included in the decision? In what world is a judge somehow a better source for the final decisions on the matter than the collective group of the person, their parents, their physicians, and subsequent advisory teams?
I like debate, I enjoy playing devil's advocate, and even I cannot find how including a judge in these circumstances is even remotely tenable.
It's a great question. The Bell case was an unusual decision and it went further than existing law in England.
It's quite complicated to talk about because the Bell case applies to people under 16, and people under 18. But it involves mental capacity which only applies to people over the age of 16.
If a person over the age of 16 lacks capacity (for example, they're unconscious) doctors can provide most treatment if that's in the person's best interests. If that treatment is serious they need to pay extra attention to how that decision is made, and they should appoint an Independent Mental Capacity Advocate (IMCA) - who'll advocate for the patient.
If everyone agrees and it's a straightforward decision the treatment will go ahead. But sometimes medical teams have a disagreement about the best course of action, or the IMCA will say that this isn't what the patient would have wanted. And in those cases they go to the courts of protection to get a ruling.
In theory it's to protect the patient. But mental capacity law in England is a mess, and it's likely to be reformed at some point.
In the Bell case the judges are saying that treatment with puberty blockers is "experimental" and so extra care needs to be taken.
https://www.judiciary.uk/wp-content/uploads/2015/06/copd-pd-9e-serious-medical-treatment.pdf
Just a heads up, you've got the parenthesis and square brackets swapped.
This:
[Gillick Competence](https://en.wikipedia.org/wiki/Gillick_competence)Turns into this: Gillick Competence
Thank you! I keep making that mistake and I don't know why because I know that () delimit urls.