It’s against the law for children to purchase alcohol or cigarettes in almost every country on Earth. And for good reason. We know these substances can be harmful and we protect them from exposure to them. This is hardly controversial: not even the most ardent libertarians would campaign for the rights of five-year-olds to get drunk.
Yet, when it comes to handing out puberty-blocking hormones – medication that prevents the biological changes that come with adolescence – the debate never seems to stop. Some argue it should be down to children themselves to decide whether they want to take body-altering medication. But this would be a reckless abdication of adult responsibility.
Late last year, a young British woman, Keira Bell, won a major victory in the UK’s High Court. As a child, Bell did not like being a girl and “hated the idea of growing into a woman”. She thought this meant she wasn’t actually female. When she sought medical advice, doctors did not question her assumptions or her underlying feelings, but agreed that she was indeed male and set her on the path to transition. Aged just 16 and after only three appointments, Bell was prescribed puberty blockers. A year later, she was taking cross-sex hormones, and had a double mastectomy when she was 20.
It was only then that Bell began to realise her problems were not caused by her body. She took the clinic that treated her to court and three judges ruled that children under the age of 16 were “unlikely to be able to give informed consent” to hormone ‘treatments’ because they were unable to “understand and weigh the long-term risks and consequences of the administration of puberty blockers”.
Bell’s victory was more than just a personal triumph. It provided important legal protections for vulnerable children. But, incredibly, the High Court ruling has not marked the end of the debate. In both Britain and the US, some still argue that youngsters who are struggling with their gender identity should be given puberty blockers.
Last month, a leading British publication, the Journal of Medical Ethics, published an article by bioethicist Dr Maura Priest, of Arizona State University, on the topic of “ongoing puberty suppression”. Priest argues that medical practitioners should take LGBT “testimony” seriously – that is, that LGBT people should be believed when they describe their feelings about their gender. Few would disagree. LGBT adults should be treated the same way, and afforded the same respect and dignity as every patient.
But Priest concludes from this that, “it is no longer the job of physicians to do their own weighing of the costs and benefits of transition-related care. Assuming the patient is informed and competent, then only the patient can make this assessment, because only the patient has access to the true weight of transition-related benefits.” This is a far more controversial claim.
It’s true that only those concerned can know the extent to which they are struggling with their gender identity. But “first do no harm” is an important principle of medical ethics. Using surgery or medication to alter a perfectly healthy body is not without risk. It is very different to treating a diseased body to help return a patient to health.
Even more controversially, Priest goes on to conclude that, “taking LGBT patient testimony seriously also means that parents should lose veto power over most transition-related paediatric care.” In other words, doctors should uncritically accept the beliefs and feelings of children who present as transgender and prescribe medication to suppress puberty, even if this goes against the parents’ wishes.
Priest is arguing that parents should not have authority over their children in medical decisions. Clearly, there are times when this may be appropriate. If a child’s life is at risk, it would be wrong to delay surgery until parental consent can be obtained. But the ‘do no harm’ principle remains. Intervening without parental consent in order to treat a youngster who is sick or at risk is quite different to ‘treating’ an otherwise healthy young body. She suggests that children as young as 12 should be an “equal party” to discussions about their healthcare as it relates to gender.
This ignores the fact that parents love their children and have a strong sense of what is in their best interests. Parents know their child’s life history. They know if they have been struggling with mental ill health or have a developmental disorder, or are, quite simply, ‘going through a phase’. As the growing number of adult ‘detransitioners’ shows, no matter how certain they may sound at the time, children can be easily led and make mistakes.
Incredibly, the Court of Appeal is now reviewing the decision made in Bell’s case. The Tavistock and Portman NHS Foundation Trust, which oversees the UK’s only gender identity clinic for children, in London, claims puberty blockers give those distressed by their birth sex “time to consider their options”.
Let’s hope the Court of Appeal sees sense and rejects such ridiculous claims. Adults have a responsibility to protect young people and safeguard them from harm. There are very good reasons why we do not let children smoke or drink alcohol. Neither should we let them take puberty blockers.
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