Keira Bell speaks to reporters outside the Royal Courts of Justice in London in 2020. Trans children's charity claims the ruling is a victory for common sense and young people’s bodily autonomy but campaigners vow to fight on
Children under 16 will be allowed to take puberty blockers without parental consent, the Court of Appeal has ruled.

Last year, the High Court concluded it was "highly unlikely" that a child aged 13 or under would be able to consent to the hormone-blocking treatment which used to treat children with gender dysphoria, and that it was "very doubtful" a child of 14 or 15 would understand the long-term consequences.

The Tavistock and Portman NHS Foundation Trust, which runs the UK's only gender identity development service (GIDS) for children, brought an appeal against the ruling in June.

Comment: Numerous healthcare staff at the trust have quit their jobs accusing it of malpractice over the issue: Trans-identified children need therapy, not just 'affirmation' and drugs: Why I resigned from Tavistock

In a judgment on Friday, the Court of Appeal said it was inappropriate for the High Court to give the guidance - which will impact thousands of children with gender dysphoria - and instead, finding it is for doctors to exercise their judgment about whether their patients can properly consent.

Comment: This isn't about whether doctors are capable of making judgements, this is about protecting children, and whether children with verifiable psychological disorders are capable of making life changing decisions to take drugs that will, ultimately, cause them harm.

In their ruling, the Lord Chief Justice Lord Burnett, with Sir Geoffrey Vos and Lady Justice King, said: "The court was not in a position to generalise about the capability of persons of different ages to understand what is necessary for them to be competent to consent to the administration of puberty blockers."

Comment: Interesting turn of phrase: 'persons of different ages'; these are children. Adults are already legally allowed to take hormone disrupting drugs. Further, courts generalise all the time, why would this issue be treated any differently?

They added: "It placed patients, parents and clinicians in a very difficult position."

The decision reverses a 2020 landmark ruling that under-16s lacked capacity to give informed consent to the drugs, which delay the onset of puberty. The Trust is now liaising with NHS England to consider how this ruling will impact on its practice.

Comment: This statement is quite misleading, because these drugs do not simply 'delay the onset of puberty', they disrupt a critical biological process, the consequences of which we have yet to fully understand. Although what is becoming clear is that those participating in these experiments, because of the drugs involved, are more susceptible to illness, live shorter lives, and suffer greater rates of other psychological disorders, such as depression.

The original case was brought by Keira Bell - a 24-year-old woman who began taking puberty blockers when she was 16 before later "detransitioning" - and the mother of a teenager who is on the waiting list for treatment, referred to as "Mrs A". They are seeking permission to appeal to the Supreme Court.

'Victory for common sense'

Following the ruling, Mermaids, a charity representing trans children, claimed it as "a victory for common sense and young people's bodily autonomy" amid calls for the NHS to urgently publish updated guidance for the 5,000 young people seeking treatment.

Susie Green, the chief executive of Mermaids, told The Telegraph that the ruling is expected to cause a surge in the number of trans children coming forward for treatment.

"How many more children forward will be influenced by the judgment," she said, adding: "Prior to this appeal verdict, families may have decided there was no point seeking help".

Comment: Indeed. It would appear that, like anorexia, transgenderism is a new social contagion amongst young people. Except, in this instance, there's a significant profit motive for corporations to encourage this disorder: The rich, white men institutionalizing transgender ideology

During a two-day appeal earlier this year, the Tavistock's lawyers argued the ruling was "inconsistent" with a long-standing concept that young people may be able to consent to their own medical treatment, following an appeal over access to the contraceptive pill for under 16s in the 1980s.

Comment: The two issues are not comparable.

However, Jeremy Hyam QC, representing Ms Bell and Mrs A, argued policies and procedures at the Tavistock "as a whole failed to ensure, or were insufficient to ensure, proper consent was being given by children who commenced on puberty blockers".

The Court of Appeal heard the Tavistock does not provide puberty blockers itself but instead makes referrals to two other NHS trusts - University College London Hospitals and Leeds Teaching Hospitals - who then prescribe the treatments. The court heard that the median age for consenting to puberty blockers is 14.6 for UCL and 15.9 for Leeds.

'It is for doctors to decide, not judges'

Following the ruling, a Tavistock and Portman spokesperson said: "We welcome the Court of Appeal's judgment on behalf of the young people who require the GIDS and our dedicated staff.

"The judgment upholds established legal principles which respect the ability of our clinicians to engage actively and thoughtfully with our patients in decisions about their care and futures.

"It affirms that it is for doctors, not judges, to decide on the capacity of under-16s to consent to medical treatment.

Comment: Since when did doctors become the arbiters of morality? The courts intervene in all manner of issues, and for good reason. Because decisions like these require input from diverse fields of expertise.

"We recognise the work we do is complex and, working with our partners, we are committed to continue to improve the quality of care and decision making for our patients and to strengthen the evidence base in this developing area of care."

Nancy Kelley, chief executive of LGBT charity, Stonewall, also welcomed the ruling, describing it as "a huge relief for trans young people and their families, as well as the wider trans community".

Comment: Stonewall is another charity mired in controversy.

"This deeply unsettling case has caused many trans young people and their families enormous distress by adding to waiting lists that were already out of control and leaving young people in limbo without vital healthcare support.

Comment: This is hardly an issue just for the vanishingly small number of children with gender dysphoria, backlogged waiting lists are a critical problem throughout the NHS. And the situation is getting even worse amidst the ongoing lockdowns.

"Now the NHS must publish updated guidance for young people relying on these services with as much urgency as they suspended treatment access after the previous ruling.

"This judgment must be a turning point for NHS and the Government in addressing trans people's healthcare."

Ms Kelley added: "It is 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."

Seeking permission to appeal to the Supreme Court

Following the ruling, Ms Bell said she was "surprised and disappointed" by the decision but said she had no regrets in bringing the case.

"It has shone a light into the dark corners of a medical scandal that is harming children and harmed me," she said.

Adding that she believed the medical service had become "politicised", Ms Bell said she will be seeking permission to appeal to the Supreme Court.

However, Bayswater Support Group, which represents 350 families across the UK, advocating for evidence-based care for our trans-identified adolescents and young people, said it does not share the Court of Appeal's "confidence in GIDS clinicians - whose service their own regulators have deemed to be 'inadequate' - to offer appropriate care to our children when there is no clear evidence to guide them".

"Whether the appeal is overturned at the Supreme Court or not, this case has ignited a long-overdue conversation about the direction of care for a highly vulnerable group of young people."

An NHS spokesperson said: "The NHS commissioned Dr Hilary Cass to review gender identity services prior to the original High Court ruling to ensure the best model of safe and effective care is delivered - this will set out wide-ranging recommendations, including on the use of puberty blockers and the many contested clinical issues identified by the court.

"An independent multi-professional review group will continue to confirm whether clinical decision making has followed a robust consent process now that the endocrine pathway has been reopened by the Tavistock."