Our Response to the Ruling
The High Court ruling in the case between QUINCY BELL & MRS A v The Tavistock and Portman NHS Foundation Trust is deeply concerning and alarming. It is a potentially serious setback to young people seeking access to puberty blockers.
Puberty blockers have been used for a long time with great benefit. This medication is used routinely, under licence, in cases of precocious puberty in younger children, Currently, before accessing medical intervention, the competency of patients under 16 years of age must be established. In the UK, competency is assumed from age 16, and young people under that age are required to be ‘Gillick competent’. This is achieved by following the ‘Fraser’ guidelines, by which clinicians must ensure that young people can give ‘informed consent’ for their treatment, that is, they understand the positive effects of treatment, but also the potential side-effects.
‘Gillick competence’ does not necessarily require parental agreement but, in practice in the UK, young people must be supported by a parent, or other person(s) with Parental Responsibility to access gender-related treatments. Children are not treated pre-puberty.
The treatment does not trigger gender transition. This period of temporary relief provides a therapeutic interval during which young gender diverse people have an opportunity for less-troubled reflection on future choices; the treatment thereby enables them to make better decisions.
Gender diverse young people need an ‘affirmative’ approach in terms of supporting their gender expression and medical interventions where necessary. A negative approach that seeks to persuade young people that they should conform to the expectations associated with their birth sex, is, effectively, ‘reparative therapy’, a milder form of ‘conversion therapy’. Both these therapies are regarded as bad practice; they undermine the self-esteem of children and young people, and may trigger self-harm and suicidality.
The introduction of further and new barriers to the current procedures would inevitably lead to a rise in depression, self-harm and suicidality in this group. It would literally put lives in danger. The international Standards of Care state that not intervening to interrupt an unwanted puberty, ‘is not a neutral option’; in other words, it would cause entirely-foreseeable and, therefore, inexcusable harm to the mental health of the young person.
Trans young people are not inherently mentally ill – gender incongruence (the mismatch between gender identity and sex assigned at birth) is no longer classified as a psychiatric or psychological disorder by the World Health Organisation, reflecting this fact. However, failure to meet their needs would cause serious mental health issues.
GIRES will respond in full at a later date , and we welcome the Tavistock & Portman NHS Foundation Trust’s stated intention to appeal this ruling.
This result may be devastating to hear for trans young people and their families. In fact, the ruling sets a dangerous precedent not just for the rights of trans young people, but for all young people.
We trust that the NHS England Review, chaired by Hillary Cass, will endorse the supportive approach of doctors in many leading countries and give clarity to trans and gender diverse young people, their families and guardians about how they can continue to access medical support.
We will continue to fight for trans and gender diverse young people to get the support they need, until every LGBTQ+ person is free to be themselves. If you are struggling, please consider getting support at GIRES and other organisations via Tranzwiki
Shaan Surat Knan, MA
GIRES Chair of Trustees