Children are “highly unlikely” to be able to consent to taking puberty blockers, rules High Court
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4699 (Published 01 December 2020) Cite this as: BMJ 2020;371:m4699
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Dear Editor
I am not sure what Dyer says in her opening paragraph and the title of this news item is accurate.
Under “OVERALL CONCLUSIONS”, at para.151, the High Court said:
“A child under 16 may only consent to the use of medication intended to suppress puberty where he or she is competent to understand the nature of the treatment. That includes an understanding of the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life changing consequences for a child. There will be enormous difficulties in a child under 16 understanding and weighing up this information and deciding whether to consent to the use of puberty blocking medication. It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”
It is clear, the Court said “highly unlikely” in relation to a child under the age of 13 [1] rather than a child under 16 as Dyer suggests.
References
[1] https://www.bailii.org/ew/cases/EWHC/Admin/2020/3274.html
Competing interests: No competing interests
Re: Children are “highly unlikely” to be able to consent to taking puberty blockers, rules High Court
Dear Editor,
We, the Executive Committee of GLADD – The Association of LGBTQ+ Doctors and Dentists, have reflected extensively on this judgement and find some aspects concerning. As a community of LGBTQ+ clinicians, many of us feel both a personal and professional apprehension regarding this outcome and its implications for young trans people in this country.
Firstly, we have concerns for the safety and wellbeing of patients currently taking puberty blocking medication, who now face profound uncertainty about their access to this treatment, and the possibility of its imminent cessation. The threat of abrupt removal of what many young trans people feel to be a cornerstone of their care may pose an immediate risk to their mental health, which must be considered in arrangement of immediate services and support for them.
Secondly, accessing gender identity services in the NHS is already onerous. Almost 70% of adult trans people report that waiting times for accessing gender identity services are too long, and this process is unfortunately even harder for young trans people [1]. The Gender Identity Development Service has stopped reporting waiting times but is currently seeing patients for their first appointment who were referred to the service in 2018 [2]. We have concerns that the addition of a potentially lengthy legal process may leave young trans people in a state of stress and uncertainty.
Thirdly, we have concerns about the inadequate representation of trans and non-binary individuals within the decision-making process regarding a fundamental aspect of their healthcare. Very few trans and non-binary voices appear to have been involved in a discussion that will define the healthcare of their communities, in a manner that seems paternalistic.
Clinicians make assessments of capacity every day in many varied contexts, and some of these can be exceedingly difficult. We agree that improving culture in healthcare regarding patient autonomy, clinician learning and systems improvements should continue, with the aim of improving the state of healthcare for young trans people. However, as a collective of healthcare professionals and LGBTQ+ activists, we fear that there may be consequences to this ruling which will inadvertently worsen the state of healthcare for young trans people in this country.
We urge the courts and involved clinicians to work together and take responsibility to ensure that any delays to young trans people undergoing this process are minimised so as to reduce the burden of additional distress. We will be reaching out to our trans members, in order to better inform our efforts in activism to improve trans healthcare in this county; and we would encourage the courts to take a similar stance, discussing with young trans people the implications that this will have on their healthcare.
There is a paucity of high-quality evidence available in this field, and to improve the health inequalities faced by the trans community we encourage our colleagues outside of GLADD to prioritise more high-quality, robust studies to improve the state of gender identity healthcare. We eagerly await the outcome of the Independent Review of The Gender Identity Development Service by Dr Hilary Cass, which we believe will support the case for an improved evidence-based service.
References
[1] Government Equalities Office. National LGBT Survey: Research report. https://www.gov.uk/government/publications/national-lgbt-survey-summary-... (2018).
[2] How long is the wait for a first appointment at GIDS? | GIDS. https://gids.nhs.uk/how-long-wait-first-appointment-gids
Competing interests: No competing interests