VfJUK’s reply to the Government’s rejection of call to ban gender reassignment treatment for under 18s.

The Government has responded to Voice for Justice UK’s campaign calling for the prohibition of all medical treatment for gender reassignment under the age of 18 (read full response here: https://www.gov.uk/government/news/voice-for-justice-uks-campaign-about-gender-reassignment).

We respectfully suggest that the Secretary of State for Health and Social Care and his Department have failed entirely to understand the nature of the problem or the extreme risk posed to children.   The policy, as expressed, is no more than a thinly disguised ideological attempt to normalise—and even promote—transgenderism within the wider population, displaying a total disregard for the safeguarding and wellbeing of the nation’s young.

We note the statement:

“If children have the capacity to give consent for themselves, then consent should be sought direct from them. Once young people reach the age of 16, they are presumed in law to be competent to give consent for themselves for their own surgical, medical or dental treatment, and any associated procedures, such as investigations, anaesthesia or nursing care.

Those under 16 are not automatically presumed to be legally competent to make decisions about their healthcare. However, the courts have stated that a person under 16 will be competent to give valid consent to a particular intervention if they have “sufficient understanding and intelligence to enable him or her to understand fully what is proposed”.
This would appear to be unequivocal endorsement for gender reassignment treatment, when and where requested by what the Government deems a ‘competent’ child. We would respectfully point out, however, that as a general principle it is recognised that children lack the intellectual and emotional maturity necessary to make potentially harmful decisions that will affect their future development and wellbeing. In particular, the fact that children below the age of 16 may sometimes be adjudged competent to consent to some procedures does not relieve adults from their general duty to protect children from procedures that are unnecessary, harmful, largely irreversible and a likely source of subsequent regret.

It is recognised that childhood, and especially adolescence, is a period when young people have yet to discover who and what they really are, and so ‘push the boundaries’.   This is a normal and healthy part of growing up. As part of this process/transition, however, adolescent brains are recognised as prone to making ‘suboptimal decisions’ resulting from, among other things, immaturity of the prefrontal cortex and inability to control or delay ‘impulses of gratification for optimization of outcomes’(see The Adolescent Brain, B.J. Casey, Rebecca M. Jones, Todd A. Hare, (PMC The US National Library for Medicine 2008,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475802/).

The NHS guidance on recommended treatment for children with gender dysphoria impliedly recognises the instability of adolescent decision-making when it states:

“Most treatments offered at this stage are psychological, rather than medical or surgical. This is because the majority of children with suspected gender dysphoria don’t have the condition once they reach puberty.” https://www.nhs.uk/conditions/gender-dysphoria/treatment/#treatment-for-children-and-young-people

As pointed out in our petition, as a general principle we seek as a society to protect children and young people from harm, in particular attempting to protect them from the consequences of decisions they are too young to make. Thus, children cannot legally consent to sex below the age of 16; the sale of both alcohol and tobacco is banned to children under the age of 18; children under the age of 16 are not allowed to work full time, etc.

The Government response states that once children reach the age of sixteen they are presumed by law to be competent to give consent for their own medical, surgical or dental treatment.

As stated above, adolescent brains are noted for making suboptimal and highly risky decisions. Children also go through phases, included within which are same sex attraction and gender confusion. It is medically well documented that expression of such feelings are frequently both normal and transient, and, without intervention, naturally dissipate over time.  On the other hand, where feelings of gender dysphoria persist, it is medically recognised that they are more often an expression, rather than the cause, of an underlying and primary mental health problem, which may well be exacerbated by invasive gender reassignment treatment. We concur therefore with the NHS guidance, which recommends that under the age of 18 treatment should be psychological, in the form of psychotherapy and counselling, and that puberty blockers, sex change hormones, and surgery should not be given.

There is growing evidence the NHS guidance is being ignored. There is evidence of children as young as 10 regularly being prescribed not just so-called puberty blockers, but sex change hormones (e.g. http://www.dailymail.co.uk/news/article-4743036/800-children-young-10-puberty-blockers.html ).   There are other reports of children, who have received such therapy, subsequently seeking help to detransition (e.g. http://www.independent.co.uk/life-style/12-year-old-boy-trans-female-cha…).

This situation is scandalous. There can be no certainty at a young age that a child’s expressed wish permanently and irrevocably to change gender will persist. Neither can a child expressing the desire to transition fully appreciate the consequences – namely that for the rest of their lives they will be dependent on potentially damaging medication, and that they will be rendered infertile as result of treatment. As a young teenager a child may well feel such things are irrelevant – but age 30, both facts may cause severe distress.

We therefore call again for an urgent review of policy, and for all medical intervention to change gender, whether by the administration of sex changing hormones or surgery, to be banned below the age of 18.