NHS Trust sued over children ‘consenting’ to puberty blockers

Carys Moseley comments on news that the Tavistock Clinic is being taken to court over illegal use of puberty-blockers in under-18s.

On Wednesday, lawyers acting for Susan Evans, who was a psychiatric nurse at the Tavistock and Portman NHS Foundation Trust, lodged legal papers at the High Court to file a judicial review against the trust and NHS England. Evans is working with the mother of a 15-year old girl on the autistic spectrum who is on the waiting list for the Gender Identity Development Service for Children and Adolescents. The lawyers will argue that it is illegal for clinicians at the Trust to administer puberty-blocking drugs and cross-sex hormones to children under 18, because they cannot give valid consent to such treatment.

Going to court as a last resort

Evans says she has tried, along with colleagues, to talk to the clinical management team at the Tavistock Trust but got nowhere. This is why she is taking the case to court, as a last resort.

Such is her concern about the issues involved that Evans has crowdfunded the case. The fact that she has raised around £28,000 shows the strength of public support for her.

Age for puberty blockers lowered from 16 to 10

Evans told The Daily Mail,

“I used to feel concerned it was being given to 16-year-olds, but now the age limit has been lowered and children as young as perhaps nine or 10 are being asked to give informed consent to a completely experimental treatment for which the long-term consequences are not known.
“The Tavistock will say the effects are fully reversible but the truth is nobody knows that for sure.”

Evans revealed that ‘virtually 100%’ of the children who were given puberty blockers went on to receive cross-sex hormones treatment, warning that this would lead to profound physical problems, possibly infertility and impaired sexual functioning in the future.

‘Not enough psychological work with children’

Crucial to the case is Evans’ view, shared by other clinicians who have been critical of the GIDS, that too little psychological work has been done with these children referred. She said that during the work with the GIDS, some clinicians would only see children four or five times. At the same time, she said that many children initially came along “completely convinced they are the other sex” but that after some time they came to accept ‘who they are’, i.e. ceased to live in a transgender fantasy.

Evans also revealed to The Telegraph that at least 30% of the children are on the autistic spectrum, many have suffered trauma in early life, suffering from anxiety and confusion, or may experience same-sex attraction

The trouble with Gillick Competence

The Guardian reported Paul Conrathe, the lawyer from Sinclairslaw representing Evans and the mother, as saying that the Tavistock’s treatment of young people under 18 is illegal due to absence of ‘valid consent’. He argues that puberty blockers and cross-sex hormones cannot legally be delivered “as a matter of general approach”, but only due to “a specific order of the court on a case-by-case basis”. He then implies that the case being brought is “pressing the case of Gillick to its breaking point”.

What the lawyers are fighting here is the NHS Trust’s use of the legal principle of ‘Gillick Competence’, which has a long and unfortunate history as regards undermining parental rights and Christian moral reasoning in medicine. Back in 1983 Victoria Gillick, a Catholic mother of ten children, issued a legal challenge to the ‘right’ of doctors to prescribe contraceptives to girls under 16 (the age of consent to sex) without either parental permission or even knowledge that this was happening. She lost her case in 1985 when the House of Lords took the side of doctors, ruling that parental rights to choose whether a child under 16 receives medical treatment terminates if and when the child achieves sufficient understanding and intelligence to fully understand what is proposed”. This is known as ‘Gillick competence’.

Paul Conrathe is arguing that this ‘Gillick competence’ test should be deemed irrelevant to puberty blockers and cross-sex hormone treatment, saying that the focus should be on whether or not a child is sufficiently mature and capable of understanding the long-term consequences of receiving these ‘treatments’, which are in fact lifelong. He argues that medics’ opinion that children have given consent to such treatments is legally invalid. Effectively he is arguing that no child can truly understand the long-term consequences of puberty blockers and cross-sex hormones on their lives.

Is the Department of Health to blame?

There needs to be a thorough investigation of how Gillick Competence has been used as the legal principle to allow puberty blockers and cross-sex hormones for minors across the NHS and the Department of Health which is ultimately responsible for it.

Back in 2018 the Department of Health made a very sinister pre-emptive response to a CitizenGo petition calling for gender reassignment for under-18s to be banned. It did this in the form of a lengthy official announcement effectively justifying gender reassignment for minors on the basis of patients’ rights, really a radical reinterpretation of children’s rights. I covered this scandal extensively at the time. The Department of Health announcement ignored problems with both the medical validity of treatments as well as psychological problems involved.

At the time I made a Freedom of Information Request to the Department of Health asking for information about all the legal sources for this advice on treatment. The reply I received was that there were none. This was thoroughly unconvincing as a close read of the announcement makes it obvious that Gillick Competence is what was being assumed of children, i.e. ‘patients’.

Then in January 2019 the Telegraph revealed that it had received responses to over 100 FOI requests it made to NHS trusts in England, admitting that children are allowed to undergo gender reassignment against their parents’ wishes, even when those children are not deemed ‘Gillick competent’. This proved my hunch was correct.

Long history of clinicians’ support for puberty blockers

There is evidence that the late Richard Green, former clinician at Charing Cross Hospital Gender Identity Clinic, Britain’s oldest gender identity clinic for adults, was strongly pushing for puberty blockers and cross-sex hormones from at least the early 1990s, very soon after the GIDS was opened in 1989. The late Colette Chiland, a renowned French psychotherapist who was an expert on transsexualism, recounts in her book Transsexualism: Illusion and Reality (first published in French in 1997) a very disturbing conversation at the international conference on Gender Identity and Development in Childhood and Adolescence in London in 1992. Some Dutch delegates told the conference that they were now giving cross-sex hormones to teenage boys aged 16 upwards. Richard Green responded by asking “Why not at 12, before the growth of facial hair?” Chiland comments that “other medical practitioners, including myself, were astonished to hear what these people were saying.” [Page 71 of English translation, published in 2003]

Trans charities supported puberty blockers before 2005

The press reports that Susan Evans’ complaints in the GIDS led to an internal inquiry as early as 2004. This is extremely important and requires thorough independent investigation because the Gender Recognition Act was being pushed through Parliament at the time. However, there is no record in the documents of the Parliamentary Forum on Transsexualism, which was formed in 1994 to lobby MPs to support the Act, of any interest in gender reassignment for children. Back then, nobody was publicly suspecting this could lead to children being put on puberty blockers or given cross-sex hormones.

However, the online archives of transgender charity GIRES, which campaigned for the Act and which has historically had close links with Mermaids (which is opposed to the current case being brought against the GIDS), show that it was interested in treatment for children even before the Act was tabled in December 2003. GIRES awarded its Research Award in August 2003 to Professor Dr Peggy T Cohen-Kettenis, of the Free University of Amsterdam, and Professor Dr Friedemann Pfafflin of the University of Ulm in Germany, for their book “Transgenderism and Intersexuality in Childhood and Adolescence – Making Choices”. Chapter 7 on ‘Clinical Management of Gender Problems in Adolescents’ includes a section entitled ‘Effects of Sex Reassignment’. In a discussion on the appropriate age limits for physical treatments, the authors cite the 1998 guidelines of the Royal College of Psychiatrists, authored by Domenico Di Ceglie the founder of the GIDS in 1989, as follows:

“Moving from one stage to another should not occur until there has been adequate time for the young person fully to assimilate the effects of intervention to date.”
[Royal College of Psychiatrists guidelines, page 5, cited on page 172 of Cohen-Kettenis and Pfafflin]

The authors note that the guidelines do not actually give age limits for these physical interventions except for gender reassignment surgery, which they think should only be available at age 18 due to being irreversible. On the very next page the authors dismiss the legal age of maturity as ‘arbitrary’, noting that it does not exist in some countries such as Saudi Arabia and Oman, where ‘legal maturity is reached with sexual maturity’. They then argue that other forms of sex reassignment than surgery would have to be allowed before the age of legal maturity in order to prepare teenagers. These ‘other forms’ include name changes, school enrolment as a member of the opposite sex, and use of puberty blockers and cross-sex hormones (page 173).

Time to challenge GIDS philosophy

It should be clear by now that the very philosophy that animates the GIDS, one that refuses absolute prohibition of gender reassignment, is the problem. The application of ‘Gillick Competence’ and going beyond even that, is dependent upon this idea that gender reassignment is somehow appropriate medical treatment for what are psychological problems. The problem lies with the clinicians themselves, the ‘authorities’ who have published papers and trained an entire generation of colleagues. Even the ‘moderates’ who urge caution are part of the problem. They have been in cahoots with the transgender groups all along, as even a cursory glance of the academic and online archive material reveals. Ultimately therefore this is a problem of culture and therefore a spiritual worldview problem.

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