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265:(GIDS) at its satellite site in Leeds. The suit was brought by "Mrs. A", the mother of a 15-year-old patient on the GIDS waiting list, and Sue Evans, a former nurse at the Leeds GIDS satellite site. It alleged that advice around hormone therapy was "potentially misleading" and that true informed consent could not be given under such circumstances. The suit described hormone therapy as "experimental" and stated that there was "robust evidence" to show long-lasting medical effects of hormone therapy. The lawyer representing the claimants said the lawsuit would be "pressing the
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whether to consent to the use of puberty blocking medication. It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.
411:, one of the appellants against the original ruling, expressed delight with the appeal judgment and said "By confirming that clinicians are able to use their professional judgement to evaluate an individual young person's capacity to consent to the use of puberty blockers, today's judgment crucially upholds the principle of
446:. If this is right, a clinical negligence claim is just a matter of time. Unlike proceedings for judicial review, that will provide a forum where the court is required to make factual findings, form judgments about clinical practice, and resolve disputes between experts. On that occasion, the judges will have to decide."
470:
is a separate case involving the
Tavistock & Portman NHS Foundation Trust, on the related matter of whether parents can give legal consent to their child receiving puberty blockers. In a judgment issued on 26 March 2021, the High Court ruled that parents are able to give such consent "save where
299:
available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life changing consequences for a child. There will be enormous difficulties in a child under 16 understanding and weighing up this information and deciding
284:
In the judgment delivered on 1 December 2020, which has now been quashed on appeal, the judges said that it was highly unlikely that a child aged 13 or under would be competent enough to give consent to puberty blockers, and that it was doubtful that 14 or 15 year olds could understand the long-term
272:
Some time after
January 2020, Evans passed on her role as complainant to Keira Bell. Bell (referred to in court documents as Quincy Bell) began puberty blockers when she was 16, 1 year and 9 months after being referred to GIDS, with the hope of progressing on to testosterone later - which she did at
418:
Describing the appeal judgment, Sandra Duffy of Irish Legal News said "The Court of Appeal disagreed profoundly with the findings of the
Divisional Court on both evidentiary and legal bases. Its decision to overturn found that the Divisional Court had relied on flawed expert evidence (Bell 2, 38),
351:
Alistair
Robertson, a solicitor who advised Tavistock and Portman NHS Foundation Trust in the appeal said "We were disappointed with the Divisional Court's judgment. Despite making no finding of unlawfulness, the court still made a declaration of what, precisely, a child had to be able to weigh up
347:
Sandra Duffy, writing in Irish Legal News said "Through the declaration and guidance issued in the judgment, it set a near-impossibly high standard for competence to consent, including a requirement to understand the effects of cross-sex hormones – a treatment which is only prescribed to adults."
339:
issued a joint statement expressing disappointment in the judgment and concern "not only for what this means for the health and well-being of trans young people, but the wider implications this will have on the rights of children and young people of all genders, particularly on consent and bodily
303:
In respect of young persons aged 16 and over, the legal position is that there is a 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
403:
Alistair
Robertson, a solicitor who advised the Tavistock and Portman NHS Foundation Trust, said going into the appeal "Our strategy had to be to focus the courts on the specific legal issues raised and away from the moral controversy around the treatment of children for gender dysphoria."
235:
competent to consent to puberty blocking treatment. The court also said that " respect of young persons aged 16 and over… we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment".
419:'implied factual findings that the Divisional Court was not equipped to make' (65), and was incorrect in issuing both its declaration of law and its guidance on the application (84 and 89)" and highlighted the importance of "the Court of Appeal's finding that
294:
A child under 16 may only consent to the use of medication intended to suppress puberty where he or she is competent to understand the nature of the treatment. That includes an understanding of the immediate and long-term consequences of the treatment, the
387:
test and puberty blockers because that court should have dismissed the case when it ruled that the
Tavistock guidance was lawful. The Court of Appeal found that it was "for clinicians to exercise their judgement" in relation to puberty blocking treatment.
285:
risks and consequences associated with them. Where the young person is 16 or over, "we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment."
219:, the legal principle governing under what circumstances under-16s can consent to medical treatment in their own right. By contrast, people aged 16 or older were presumed to have the ability to consent to medical treatment (
343:
In the immediate aftermath of the judgment, there were many reports of existing patients at GIDS having their treatment abruptly cut off, and that even care for patients over the age of 16 was being affected.
1200:
383:
The original decision was overturned by the Court of Appeal and the guidance on puberty blockers was quashed. The Court of Appeal ruled that the High Court should not have issued guidance on the
288:
The Court said (126) "Where the decision is significant and life changing then there is a greater onus to ensure that the child understands and is able to weigh the information" and concluded:
442:
among children is increasing: in 2009 there were 97 referrals to the
Tavistock clinic; in 2019 there were 2,519. Given these figures, Ms Bell is unlikely to be the only young person who has
434:, reacting to the appeal, said "In essence, the Court of Appeal found that the judges below had stepped into the shoes of clinicians: it is 'for doctors to decide on competence not judges
276:
Bell in hindsight described her transition as being related to her mother's alcoholism, struggling with puberty, struggling with being a lesbian, social isolation, and depression.
449:
In July 2022, the NHS decided to close GIDS (the
Tavistock Clinic) and replace it with regional healthcare centres in 2023, following the release of an interim version of the
1391:
304:
experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.
352:
before consenting to treatment with puberty blockers, and gave very strong 'guidance' on whether children in particular age groups would be able to give such consent."
325:, a UK charity for gender-variant and trans youth, described the ruling as a "potentially devastating blow to trans under-16s", and a "betrayal of trans young people".
1264:
1155:
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1406:
249:), the High Court ruled that parents are allowed to give consent on behalf of their children to receive puberty blockers without having to gain a judge's approval.
1238:
30:
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319:(the defendant in the suit) said it was disappointed in the decision and intended to appeal. Bell, one of the claimants, expressed approval of the judgment.
328:
The
Bayswater Support Group, which describes itself as supporting "the parents of children with adolescent-onset gender dysphoria", welcomed the ruling.
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53:
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test and puberty blockers, because that court should have dismissed the case when it ruled that the
Tavistock guidance was lawful. In a separate case (
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In September 2021, the Court of Appeal overturned the High Court judgment, and ruled that the High Court should not have issued guidance on the
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209:. The Court of Appeal said that "it was for clinicians rather than the court to decide on competence" to consent to receive puberty blockers.
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the parents are seeking to override the decision of the child" . The case does not overrule, nor have any legal effect on, the judgment in
41:
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refused Bell's application for permission to appeal on 28 April 2022, with the reason that it did "not raise an arguable point of law".
392:
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475:; the ruling reads "Nothing that is said below is intended to depart, to even the smallest extent, from anything that was said in
360:
Leave to appeal against the decision of the High Court was granted in January 2021. The appeal was heard on 23 and 24 June 2021 by
273:
17. At age 20 Bell had a double mastectomy. In 2019, she stopped taking testosterone. Bell describes regretting her transition.
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893:"Trans kids must understand risks of hormone therapy to receive life-saving puberty blockers, judge rules in landmark case"
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231:) ruling, which was overturned on appeal, said that it was unlikely that a child under the age of 16 could be
1182:
296:
572:
408:
1201:"Brook response to the ruling of Quincy Bell and Mrs A v The Tavistock and Portman NHS Foundation Trust"
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224:
997:"Treatment plans at gender clinics have 'effectively stopped' for young trans people, warns clinician"
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which underpins practice across health, social care and many other areas of work with young people."
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709:"R (on the application of) Quincy Bell and A -v- Tavistock and Portman NHS Trust and others"
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871:"Puberty blockers: Under-16s unlikely to be able to give informed consent 1 December 2020"
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applies to puberty blockers in the same way that it would to any other medical decision."
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R (on the application of Quincy Bell and A) v Tavistock and Portman NHS Trust and others
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1291:
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1001:
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921:"Keira Bell lawyer warns on internet coverage of transgender issues 6 December 2020"
1239:"'A contentious place': the inside story of Tavistock's NHS gender identity clinic"
831:"Why I was right to blow the whistle on the Tavistock Clinic over puberty blockers"
770:
677:"Appeal court overturns UK puberty blockers ruling for under-16s 17 September 2021"
591:
443:
172:
High Court judgment quashed: The High Court should not have issued guidance on the
1102:"High court ruling on puberty blockers 'based on partisan evidence' 23 June 2021"
1076:"High court grants leave to appeal to UK gender identity service 19 January 2021"
1371:
976:"Families of trans children 'broken' after sudden puberty blockers rule changes"
454:
450:
361:
137:
631:
Bell and another -v- The Tavistock and Portman NHS Foundation Trust and others
808:
947:"Amnesty International UK and Liberty joint statement on puberty blockers"
897:
380:(Lady Justice of Appeal), and judgment was given on Friday 17 September.
1129:
558:
510:
1028:"Analysis: Gillick competence wins the day in puberty blockers appeal"
1265:"UK court rules in favour of parental consent in trans treatment row"
766:"High court to decide if children can consent to gender reassignment"
1347:"Bell & Anor v The Tavistock and Portman NHS Foundation Trust"
1325:"Bell & Anor v The Tavistock And Portman NHS Foundation Trust"
565:
517:
1156:"Appeal court overturns UK puberty blockers ruling for under-16s"
737:"Bell & Anor v The Tavistock And Portman NHS Foundation Trust
656:
Bell & Anor v The Tavistock and Portman NHS Foundation Trust
1183:"Permission to Appeal April & May 2022 - The Supreme Court"
797:"Mother sues Tavistock child gender clinic over treatments"
438:" adding "As figures before the Court show, treatment for
1049:"Lawyer in the news: Alistair Robertson, DAC Beachcroft"
407:
Following the appeal Helen Marshall, Chief Executive of
1130:"Ruling limiting under-16s puberty blockers overturned"
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257:In October 2019, a legal complaint (a request for
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658:[2021] EWCA Civ 1363 (17 September 2021)"
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1349:. British and Irish Legal Information Institute
1327:. British and Irish Legal Information Institute
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54:The Tavistock and Portman NHS Foundation Trust
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88:EWHC 3274 (Admin), judgment 1 December 2020
1392:Transgender case law in the United Kingdom
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317:Tavistock and Portman NHS Foundation Trust
29:
20:
119:(President of the Queen's Bench Division)
995:Andersson, Jasmine (21 December 2020).
829:Bartosch, Josephine (5 December 2020).
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263:NHS Gender Identity Development Service
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113:Original action before the High Court:
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16:2021 UK case regarding puberty blockers
1407:History of women in the United Kingdom
1074:Topping, Alexandra (19 January 2021).
974:Andersson, Jasmine (9 December 2020).
865:
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675:Siddique, Haroon (17 September 2021).
453:, a report conducted by paediatrician
1218:Wheeler, Marina (27 September 2021).
1124:
1122:
7:
311:Reactions to the High Court judgment
42:Court of Appeal of England and Wales
1026:Duffy, Sandra (24 September 2021).
393:Supreme Court of the United Kingdom
199:Court of Appeal (England and Wales)
1263:Greenhalgh, Hugo (26 March 2021).
444:changed their mind about treatment
14:
1237:Brooks, Libby (19 January 2023).
1100:Siddique, Haroon (23 June 2021).
919:Doward, Jamie (6 December 2020).
1300:) [2021] EWHC 741 (Fam)"
891:Parsons, Vic (1 December 2020).
833:. Telegraph Media Group Limited.
764:Doward, Jamie (5 January 2020).
564:
557:
516:
509:
795:Hurst, Greg (12 October 2019).
207:under-16s with gender dysphoria
1304:Courts and Tribunals Judiciary
714:Courts and Tribunals Judiciary
638:Courts and Tribunals Judiciary
1:
1290:High Court (26 March 2021).
844:Bell, Keira (7 April 2021).
1387:High Court of Justice cases
331:The UK human rights groups
201:on the question of whether
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176:test and puberty blockers.
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530:Under-16s cannot consent
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261:) was lodged against the
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1397:Transgender and medicine
1220:"Let the Doctors Decide"
269:to its breaking point".
212:The case was related to
160:(Lady Justice of Appeal)
1412:2021 in women's history
1053:The Law Society Gazette
399:Reactions to the appeal
315:A spokesperson for the
205:could be prescribed to
846:"Keira Bell: My Story"
582:Under-16s can consent
573:Lord Burnett of Maldon
362:Lord Burnett of Maldon
308:
197:was a case before the
138:Lord Burnett of Maldon
952:Amnesty International
333:Amnesty International
1402:2021 in LGBT history
1298:AB v CD & others
1294:AC v CD & others
1224:UK Human Rights Blog
1207:. 20 September 2021.
483:Summary of judgments
229:Administrative Court
223:did not apply). The
1187:www.supremecourt.uk
1181:The Supreme Court.
1162:. 17 September 2021
1136:. 17 September 2021
641:. 17 September 2021
525:Dame Victoria Sharp
374:Master of the Rolls
280:High Court judgment
152:Master of the Rolls
117:Dame Victoria Sharp
52:Bell and another v
747:. 1 December 2020.
739:EWHC 3274 (Admin)"
585:17 September 2021
546:Mrs Justice Lieven
539:Lord Justice Lewis
468:AB v CD and others
462:AB v CD and others
421:Gillick competence
413:Gillick competence
366:Lord Chief Justice
246:AB v CD and others
142:Lord Chief Justice
128:Mrs Justice Lieven
123:Lord Justice Lewis
98:AB v CD and others
1055:. 11 October 2021
955:. 3 December 2020
717:. 1 December 2020
609:
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604:Lady Justice King
496:Puberty blockers?
378:Dame Eleanor King
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158:Dame Eleanor King
64:17 September 2021
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877:. December 2020.
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