The Times view on the Keira Bell case: Fine Judgment 02.12.20

The original article is here.

The verdict of the High Court could hardly have been more emphatic. It is “highly unlikely” that a child aged 13 or under would ever be competent to consent to being treated with puberty blockers and it is “doubtful” that a child aged 14 or 15 could do so either, given the long-term risks and consequences of drugs prescribed to children suffering from gender dysphoria. That is a condition in which people believe themselves to have been born into the wrong biological sex. Indeed, the court went further and recommended that doctors should not prescribe puberty blockers even to 16 and 17-year-olds without first seeking the consent of the courts. That sets such a high bar as to effectively rule out any further use of these drugs to treat gender dysphoria in children.

This is a victory for Keira Bell and Mrs A who brought the case against the Gender Identity Development Service (GIDS) clinic at Tavistock Hospital in London. Ms Bell is a 23-year-old woman who had been prescribed puberty blockers as a child and went on to transition to become a man but has since reverted. She argued that she was in no position as a troubled 15-year-old to understand the long-term physical and psychological consequences of her treatment which has caused her long-term harm. Mrs A was seeking to prevent the Tavistock from prescribing puberty blockers to her autistic 15-year-old daughter.

But the verdict is also a victory for sanity. The Times has in recent years reported the repeated concerns of whistleblowers at the way that the Tavistock had been too readily dispensing puberty blockers to children as young as ten, most of whom they believed needed psychological help rather than potentially life-changing treatment. Doctors at the clinic had argued that puberty blockers were simply a pausing strategy until children were old enough to decide whether to proceed to cross-sex hormone treatment, which is only allowed to those over 16 and whose physical effects are irreversible. The court gave this short shrift, noting that practically all children prescribed puberty blockers go on to take cross-sex hormones. What’s more, it heard that it was extremely unusual for the clinic to refuse puberty blockers on the basis that a child could not give informed consent.

The reality is that no child can adequately comprehend the consequences of embarking on a path that will almost certainly lead to cross-sex hormones and surgery. Those consequences include likely loss of sexual function and fertility and the psychological impact that might have on future relationships. That’s on top of the possible long-term effects of the puberty blockers themselves about which there has been a worrying lack of research. As Ms Bell told the court: “I made a brash decision as a teenager . . . trying to find confidence and happiness, except now the rest of my life will be negatively affected. I cannot reverse any of the physical, mental or legal changes that I went through. Transition was a very temporary, superficial fix for a very complex identity issue.”

Indeed that is the nub of the issue. No one disputes that gender dysphoria is a serious condition affecting a growing number of young people, particularly girls. The number referred to the GIDS has risen from 97 in 2009 to 2,519 last year, of which well over 50 per cent were under the age of 15 and 76 per cent were female. In 2009, the gender split had been 50:50. There will be some for whom transitioning to a different gender is the answer. But for many it is possible that, as with eating disorders and self-harm, the underlying condition is psychological. About one third of the children referred to the clinic have autism. What these children need above all else is access to far better mental health services to help them to reconcile themselves to their gender — not life-changing physical interventions that might alleviate short-term distress at the price of long-term trauma.

 

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