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Letters Consent to puberty blockers ruling

High Court ruling on puberty blockers will worsen trans healthcare

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n219 (Published 28 January 2021) Cite this as: BMJ 2021;372:n219

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Re: High Court ruling on puberty blockers will worsen trans healthcare

Dear Editor

High Court ruling on puberty blockers will worsen trans healthcare: paternalism or respect for people's free choice?

Reading the commentary by McGregor and Phillips[1] on the recent judgment of the High Court of Justice[2], about the administration of puberty blockers to children under 16 years of age, shows that there is a lack of evidence on this issue and there is a lot of ideology.

The authors show their concern for the well-being of young patients, and state that they encourage the prioritization of robust studies to improve attention to the gender identity of minors.

However, from these premises it is not understood that the aforementioned authors criticize the measure adopted in the Judgment - designed precisely to ensure that the minor grants valid consent to the administration of puberty blockers - as paternalistic.

I reject said criticism of being paternalistic tailored because the basis of the Judgment is precisely in guaranteeing respect for the patient's autonomy, an autonomy that requires adequate and respectful informed consent, even more so in the case of a minor.

On the other hand, and referring to evidence, the recent unannounced inspection of Tavistock and Portman by The Care Quality Commission (CQC), has highlighted - in line with the arguments on which the said Judgment is based -,the shortcomings of the process of obtaining informed consent for the administration of minor trans pubertal blockers[.3]

This confirms that the measure adopted by the High Court of Justice is not paternalistic, but rather prudent, in trying to ensure that minors will not be subjected to abuse for lack of respect for their autonomy. Even, and in a contrary sense held by McGregor and Phillips, the fact of proposing treatments to minors without sufficient guarantees that the minor has understood their present and future scope could be branded as paternalism.

[1] McGregor D, Phillips C. High Court ruling on puberty blockers will worsen trans healthcare. BMJ, 2021; 372:n219/ doi:10.1136/b,j.n219.
[2] Royal Court of Justice. Case No: CO:60.2020, 1.12.2020. https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Jud...
[3] Dyer C. Gender dysphoria service rated inadequate after waiting list of 4600 raises concerns. BMJ, 2021; 32:n205/ doi:10.1136/bmj.n205.

Competing interests: No competing interests

22 February 2021
José López-Guzmán
Professor of Pharmaceutical Humanities
Pharmacy Faculty, University of Navarra
Research Building, University of Navarra, 31008 Pamplona (Spain)