Over the past year, you may have seen the discussion about gender care for young trans people debated. You may feel as though the media has been bombarded with sides for and against the case but showing no clear details of the facts at hand. This article will present the facts of the 'Bell V Tavistock' clearly and without bias.
The High Court Puberty blockers case, or 'Bell V Tavistock', refers to a recent court case brought by Keira Bell and a 'Mrs. A' against the Tavistock and Portman NHS Foundation Trust regarding the approval and distribution of puberty-blocking prescriptions to individuals under 16 who are experiencing gender dysphoria - a discomfort because of a mismatch between assigned sex at birth and their gender.
The Tavistock and Portman NHS Foundation Trust, located in London, is the only clinic in England and Wales to currently provide services tailored to patients under the age of eighteen with gender dysphoria through its Gender Identity Development Service (GIDS). The service utilises psychosocial assessments, counselling and prescription drugs, and depending on circumstances, puberty (hormone) blockers.
Before the High Court's recent ruling, individuals from the age of ten years old, experiencing gender dysphoria, could seek out puberty blockers from the clinic as a form of treatment. However, the case has since questioned if and how individuals of a young age can adequately and legally consent to this form of medical treatment, and if they're aware of the long-term side effects the prescription drugs can have.
What are puberty blockers?
Puberty Blockers are drugs which are a physically reversible intervention to inhibit the release of sex hormones, which begin physical puberty changes. For young trans people, these drugs stop unwanted physical changes that may cause discomfort such as deeper voices and facial hair, or the growth of breasts and starting of periods. Puberty blockers are also often used for children who experience puberty too early, to treat prostate cancer and sometimes used for uterine disorders. Once the use of puberty blockers is stopped, the release of hormones continues as usual and, according to current evidence, children will experience physical puberty as if it was never inhibited.
The use of puberty blockers for Trans children gives them beneficial time to ease physical discomfort from Gender Identity Dysphoria. This also allows time for the young people to consider options and explore their gender identity before making decisions to have more irreversible changes, such as Hormone Replacement Therapy and Surgeries.
Who were the main parties in the case?
When the case was first lodged against the Tavistock clinic in October 2019, the claimants consisted of a 'Mrs A', the mother of an autistic child who was diagnosed with gender dysphoria, and Susan Evans, a former psychiatric nurse for the GIDS programme. Their initial complaint labelled Tavistock's treatment approach as illegal. It was claimed that the clinic provided misleading and insufficient information to patients suffering from gender dysphoria, meaning a young person could not properly consent to treatment. They also argued that not enough constructive counselling was provided beforehand to young people suffering from gender dysphoria.
By January 2020, however, Susan Evans passed her role in the case onto Keira Bell, a former patient of the clinic who was initially meant to serve as a witness to Susan Evans. Keira Bell had undergone treatment as a teenager and opposed Tavistock's provision of prescription drugs to individuals under 16.
In conjunction with the defendant, the Tavistock clinic, and the claimants' Mrs A' and Keira Bell, interested parties in the case also included the University College London Hospitals NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, and Transgender Trend LTD. Still, the interested parties did not formally appear or partake in the case's judgment, which could cause some to ask if the court case and final judgment was entirely assessed and free of bias.
What were the primary arguments and the final ruling?
During the trial, Bell gave testimony describing her experiences with the Tavistock clinic and said that, had she had more in-depth care and personalised treatment, she would not have transitioned so quickly and felt that the drugs left behind long-term effects that she can't reverse, especially since she's de-transitioned.
The defendants then argued that the treatments provided were fully reversible and that extensive care was given to individual patients before prescribing the drugs. Professor Butler, one of the clinic's administrators, said the clinic works closely with its patients to ensure the decision to seek treatment comes directly from the individual and is not a result of environmental pressures, which was particularly true of Bell's case.
What was the final ruling?
In coming to the final ruling, the High Court relied on the concept of 'Gillick Competence', which helps determine whether or not children under 16 have the capacity to consent to such medical treatment or if they require parental consent. When a child is intelligent enough, well-informed, and educated on the anticipated treatment, they are considered Gillick competent and can give consent. Children that are not found to be Gillick competent must still rely on parental consent for their medical treatment.
The High Court found that those under 16 likely weren’t Gillick competent and didn't have the capacity to agree to puberty blockers, or understand the long-term risks and consequences of treatment. They ruled, in order to receive puberty blockers, court approval would be required.
Additionally, the High Court was also perplexed by the lack of statistics and information provided by the defendants. The Court labelled the drugs as experimental and innovative, meaning that the efficiency of the treatments and their long-term effects were not yet known, and young individuals could, therefore, not give full consent to treatment with unknown side effects.
What has been said about the ruling?
The ruling was met with divided views. Some, including Keira Bell, praised the Court's decision to take action against the clinic. Other campaigners, such as the World Professional Association for Transgender Health and European Association for Transgender Health, amongst others, have condemned the decision, noting that it will inevitably marginalise young trans people even further.
Stonewall UK, a non-profit that advocates for the rights and equalities of the LGBT+ community, also states that young trans people are already disproportionately disadvantaged and regularly experience discrimination. This judgement, therefore, can further these disadvantages because of the new obstacles made to access treatment.
How does this ruling affect young trans people?
Although the ruling doesn't entirely ban puberty-blockers as a potential treatment for those suffering from gender dysphoria, it does mean that anyone under 16 looking to receive the drugs will now have to obtain approval from the Court or parental consent, which can make accessing treatment even an even longer wait, than was experienced beforehand.
Ultimately, until those suffering from gender dysphoria can freely seek comprehensive treatments that help them navigate their gender identity, they will continue to face a range of obstacles that could hinder them from leading happy and healthy lives.
For more resources and articles on Trans rights, head to our dedicated LGBTQ+ Rights & Issues section.