PATHSA welcomes the UK’s Appeal Court’s ruling overturning the controversial judgement of 1 December 2020 that children under 16 are highly unlikely to be able to give consent to taking hormone blockers. The previous ruling said that a court would have to give authorization for puberty blockers or cross sex hormones for any gender diverse children under 16 years old. In a judgement on Friday the 17th September 2021, the Appeal Court said it had been inappropriate for the Divisional Court to issue this guidance and acknowledged that “it was for clinicians rather than the court to decide on competence [to consent].”
The Divisional Court judgment caused the Tavistock clinic to stop accepting all new referrals of gender diverse youth to be considered for puberty blockers from December 2020. This further added to a waiting list that was already 22-24 months for a first appointment. This will have a permanent negative impact on the mental health and future prognosis of many of these youth, whose puberty will have progressed further before accessing puberty blockers. In addition, the Divisional Court ruling created confusion and anxiety in the minds of parents, health care professionals and people all over the world around the crucial evidenced based need for puberty blockers for transgender youth. The ruling was used by right wing organisations, usually with religious motivations, as evidence that the current best practice guidelines were not appropriate.
We are relieved to learn that UK Appeal Court has looked at the evidence in more detail and set aside the High Court ruling. According to the appeal judgment, “The evidence of Tavistock and the Trusts was that the treatment was safe, internationally endorsed, reversible and subject to a rigorous assessment process at each stage.”
The appeal judgement recognises “the difficulties and complexities associated with the question of whether children are competent to consent to the prescription of puberty blockers and cross-sex hormones” and says: “Clinicians will inevitably take great care before recommending treatment to a child and be astute to ensure that the consent obtained from both child and parents is properly informed by the advantages and disadvantages of the proposed course of treatment and in the light of evolving research and understanding of the implications and long-term consequences of such treatment. Great care is needed to ensure that the necessary consents are properly obtained.” PATHSA supports this approach of informed consent which is in line with international guidelines and best practice in gender-affirming healthcare.