In a major win for trans rights, a Court of Appeal in the United Kingdom has overturned a 2020 ruling, which had stated that under-16s were unable to give informed consent to puberty blocker treatment.  

The Tavistock and Portman NHS Trust, which runs NHS England’s only gender identity development service for children, had appealed against the 2020 ruling of the high court. The high court had then also said that doctors of children under-18s may need to consult courts before authorising a medical intervention.

Now, not even a year that order, the original ruling was overturned, meaning UK doctors can once again prescribe puberty blockers and cross-sex hormones to young trans teens .

Clinicians, Not Courts

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The appeals court bench of lord chief justice, Lord Burnett, Sir Geoffrey Vos and Lady Justice King on Friday said it had been “inappropriate” for the high court to issue the guidance.

The judges said that while they understood “the difficulties and complexities” of the issues involved, “it is for the clinicians to exercise their judgement knowing how important it is that consent is properly obtained according to the particular individual circumstances”.

The judges also recognised the potential difficulties faced by trans teens following the 2020 ruling.

“The effect of the guidance was to require applications to the court in circumstances where the divisional court (a branch of the high court) itself had recognised that there was no legal obligation to do so. It placed patients, parents and clinicians in a very difficult position,” the judges said.

“In practice the guidance would have the effect of denying treatment in many circumstances for want of resources to make such an application coupled with inevitable delay through court involvement,” added the judges.

A spokesperson from The Tavistock and Portman NHS Trust said to the BBC that “the judgement upholds established legal principles which respect the ability of our clinicians to engage actively and thoughtfully with our patients in decision about their care and futures”.

2020 Ruling Sparked Frustration Amongst Trans Groups 

At the age of 16, Keira Bell was prescribed puberty blockers as she wished to transition from female to male. Now in her mid-20s, she said she regretted her decision to transition to a male and says the clinic should have challenged her more.

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“I started to realise that the vision I had as a teenager of becoming male was strictly a fantasy and that it was not possible. I was being perceived as a man by society, but it was not enough. I felt like a fraud and I began to feel more lost, isolated and confused than I did when I was pre-transition”, she said in her testimony in December 2020.

For that reason, she had last year taken legal action against the London-based The Tavistock and Portman NHS Trust, which runs the only youth gender identity clinic in the UK, arguing that children cannot properly consent to take puberty blockers. She won the case when the UK’s High Court ruled that it was “very doubtful” that those aged 14 and 15 would have a sufficient understanding of the implications.”

 When the court in 2020 initially ruled in favour of Keira Bell, trans groups expressed concern about the decision calling it “shocking” and a “massive pause button”.

Action Sought On Unacceptable Waiting Lists

LGBTQI+ rights organisations welcomed the appeals court ruling. Stonewall UK said in a post on Twitter that the “judgement must be a turning point for NHS and the Government in addressing trans people’s healthcare. It’s for doctors – not courts – to decide if a young person can make an informed choice about their medical care.”

 

“This deeply unsettling case – which debated whether puberty blockers could be prescribed to under-18s with gender dysphoria – has caused many trans young people and their families enormous distress, and left young people in limbo without vital healthcare support,” said the organisation. 

“It’s time that the NHS and Department for Health take urgent action to address the unacceptable waiting lists facing trans young people, and ensure that all trans and questioning young people can get high quality care, when they need it,”they added.

For 24 hour crisis support and suicide prevention call Lifeline on 13 11 14

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