A prominent medical journal has published an article arguing that parents should not have “veto power” in decisions around their children wanting to embark on medical treatment to change gender.

Writing in the Journal of Medical Ethics last month, bioethics professor Maura Priest (who is a philosopher and not a medical doctor) said that in relation to “transition-related pediatric care” she believed that “parents should lose veto power” over most decisions. She also argued that it was “no longer the job” of doctors to weigh the costs and benefits of care related to changing gender, and that this should only be the purview of the”informed and competent patient”.

“If the medical community is to take LGBT testimony seriously (as they should) then 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,” Priest wrote.

“Moreover, taking LGBT patient testimony seriously also means that parents should lose veto power over most transition-related pediatric care,” she added.

Her intervention comes at a time when the debate over whether children should be allowed to undergo gender transition treatment has become controversial and hotly debated globally, with Sinn Féin in this country saying they would allow children under the age of 16 take their parents to court in order to change their legal gender without the parents’ consent.

In the US, some public schools have adopted policies which direct teachers to affirm self-identified trans school children by changing their name and sex in school records without parents being notified.

In Britain, however, growing concerns about the rush to facilitate sex changes for young adults and children came under the spotlight recently when the Tavistock clinic, the country’s only clinic providing gender transitioning for children, was investigated after clinicians reported that some children were being referred onto a gender transitioning pathway too quickly.

That investigation, carried out by the Care Quality Commission (CQC) , reported that Tavistock – a NHS facility – put vulnerable children on a pathway which used medicines that were not fully tested and led to life-changing interventions. The CQC noted that “staff had not consistently recorded the competency, capacity and consent of patients referred for medical treatment before January 2020”.

In what many saw as a reluctance of clinicians to be seen to oppose ‘trans rights’, it was alleged that children would sometimes be referred for treatment with puberty blockers after only one or two appointments. Puberty blockers stop a young person’s body developing breasts, periods, facial hair or a deeper voice.

The NHS has now updated its advice on the use of puberty blockers to acknowledge that little is known about long-term effects of this medication, or what impact their use might have on children’s brains and bones.

In December 2020, the British High Court ruled that children under-16 were unlikely to be able to give informed consent to what it described as “experimental” treatment, such as the use of puberty blockers. Keira Bell, one of the claimants in the case, told the court that she attended the Tavistock clinic and started taking puberty blockers at the age of 16. Now in her mid-20s, she says she regrets her decision to undergo a sex change to a male, and believes that the clinic should have challenged her more.

The controversy around when or how children should make decisions for themselves regarding changing gender is clearly very much a live issue, then.

Irish expert, Prof Dónal O’Shea has repeatedly expressed concern about the speed with which children are being prescribed puberty-blocking drugs in this country, claiming, with the backing of other medical experts, that underlying mental health issues in young patients are sometimes not being addressed beforehand.

He was one of a group of senior medical professionals who recently called for the suspension of puberty-blocking services for children with alleged gender dysphoria at Crumlin Children’s Hospital. Prof O’Shea, with consultant psychiatrists Paul Moran and Ian Schneider, said practices were “unsafe” but their concerns seemed to be largely ignored.

US media platform, The Blaze, said they reached out to Ms Priest for “clarification about her views”, saying they wished to ascertain at what age she believes children should be able to make decisions for themselves about transitioning.

They say that Priest replied that in a perfect scenario, “Children’s desires about transition-related medical care should be followed when those desires line up with the recommendations of a physician who is an expert in transgender medicine, and ideally, one who has been treating the child and communicating with both the child and parent for many years.”

But they noted that, “in a fuller explanation, she maintained that a child as young as 12 years old could — and perhaps should — be considered an “equal party” to discussions about their health care, specifically as it relates to their gender

“The child should at first begin to sit in on the discussions between parent and pediatrician about their health. Once the child reaches a certain level of maturity, the child should become an equal part of the now 3-way discussion about their health care. While the way to determine the correct age for maturity is not something I have a conclusive thought on at the moment, my guess would be around age 12 they become an equal party to the discussion,” Priest told them.

Kiera Bell might disagree.

Irish therapist Stella O’Malley has noted that: “Historically, until the last decade or so, it was mostly middle-aged men who transitioned. Suddenly there has been a flip in the statistics and there has been a 3,000pc rise in the numbers of girls presenting at gender clinics, a high number of whom have been diagnosed with autism”.

“More importantly, how can doctors and clinicians hope to ‘first, do no harm’ if doctors and clinicians are not allowed to freely discuss different treatment paths for vulnerable children?” she asks.

If children are allowed to veto their parents and medical advisers, who have their best interests at heart, regarding enormously important, life-changing treatments, serious questions need to be asked about what the outcomes will be for some of the most vulnerable children in society.

 


 

Máirín de Barra