The High Court Decision
A step in the right direction that proves children cannot consent to puberty blockers.
On December 1st, 2020, the High Court in London ruled that children are unlikely to be able to give informed consent to undergo treatment with puberty-blocking drugs. All children under 16 years of age had to immediately come off of puberty blockers, and clinicians were instructed to seek court approval to treat children aged 16 and 17.
Keira Bell, 23, had been referred to the Tavistock — the UK’s only gender-identity development service (GIDS) — and was prescribed puberty blockers at age 16.
She argued that the Tavistock should have challenged her more as a teen — not just gone ahead with an affirmation-only approach. She went on to take cross-sex hormones (testosterone) — as almost all children do once they start puberty blockers — and got a double mastectomy.
In its ruling, the High Court laid out the following reasons why children cannot consent to puberty blockers:
The court held that in order for a child to be competent to give valid consent, the child would have to understand, retain and weigh the following information:
(i) The immediate consequences of the treatment in physical and psychological terms;
(ii) the fact that the vast majority of patients taking puberty blocking drugs proceed to taking cross-sex hormones and are, therefore, a pathway to much greater medical interventions;
(iii) the relationship between taking cross-sex hormones and subsequent surgery, with the implications of such surgery;
(iv) the fact that cross-sex hormones may well lead to a loss of fertility;
(v) the impact of cross-sex hormones on sexual function;
(vi) the impact that taking this step on this treatment pathway may have on future and life-long relationships;
(vii) the unknown physical consequences of taking puberty blocking drugs, and
(viii) the fact that the evidence base for this treatment is as yet highly uncertain.
The court considered that it was highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It was also doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blocking drugs.
In respect of young persons aged 16 and over, the legal position is that there is a statutory presumption that they have the ability to consent to medical treatment. Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, the court recognized that clinicians may well regard these as cases where the authorisation of the court should be sought before starting treatment with puberty blocking drugs.