In a landmark ruling on Tuesday, a UK court has determined that children under the age of 16 will require court approval to access puberty blockers, igniting a global debate about the appropriate age for a child to make decisions regarding gender transition.
Three judges from the High Court stated that it was highly unlikely for children aged 13 or younger to be competent to give consent for puberty blockers, while also expressing doubts about the ability of 14- and 15-year-olds to weigh the long-term risks and consequences associated with such treatment.
Following the ruling, the National Health Service (NHS) England updated its guidelines, stipulating that a court order must be obtained for any new referral seeking medication related to puberty blockers.
The Tavistock and Portman NHS Foundation Trust, which operates England's sole youth gender identity clinic, has pledged to appeal the decision, setting the stage for a potential showdown in the Supreme Court.
Keira Bell, a 23-year-old woman who de-transitioned in her early twenties, initiated the legal action against the Tavistock and Portman NHS Foundation Trust. Bell, who regrets taking puberty blockers at the age of 16 and fears potential damage to her fertility, argued that such medications should only be prescribed to individuals under 18 with a court order.
The judges acknowledged that 16- and 17-year-olds are presumed to be capable of consenting to medical treatment. However, they suggested that doctors might consider seeking court orders before prescribing puberty blockers due to the experimental nature of the treatment.
Keira Bell expressed her satisfaction with the court's decision, stating, “I'm delighted at the judgment of the court today, a judgment that will protect vulnerable people. I wish it had been made for me before I embarked on the devastating experiment of puberty blockers.”
Paul Conrathe, Bell's lawyer, asserted that the ruling could lead to numerous expensive clinical negligence claims and called on the government to initiate a public inquiry.
NHS England promptly updated its guidelines following the court ruling. An NHS England spokesperson confirmed that new referrals for puberty blockers and cross-sex hormones for individuals under 16 would be suspended unless explicitly authorized by a court.
The Tavistock and Portman NHS Foundation Trust had argued that restricting access to these drugs would infringe upon the autonomy of young people and expressed concern about the potential anxiety it may cause for patients and their families. The Trust is currently engaging in discussions with lawyers.
Previously, under a 1985 court ruling in the UK known as the Gillick competence test, children under 16 could provide consent for medical treatment if they were deemed to fully understand and appreciate the implications.
Jolyon Maugham, a lawyer and director of the Good Law Project, a legal nonprofit organization that has been involved in trans rights cases, warned on Twitter that the ruling could lead families to seek treatment for their children abroad.
The ruling comes at a time when an increasing number of adolescents worldwide are seeking gender transitions, leading to debates over the cautiousness of doctors in prescribing puberty blockers and cross-sex hormones, as well as concerns about access to potentially life-saving medication.
The Tavistock has reported a nearly 30-fold increase in referrals of children to their clinic over the past decade, reaching approximately 2,560 referrals last year.
Courts and lawmakers in various countries, including Canada, the United States, Mexico, and Brazil, are grappling with issues surrounding parental rights and the age at which individuals can make medical decisions.
