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"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."
The United Kingdom's Court of Appeal has ruled that people under 16 can be prescribed puberty blockers without a parent's consent or a judge's approval.
The court Friday overturned a High Court ruling from December that said those under 16 were likely not mature enough to give informed consent to use of the drugs, which are often given to youths for gender transition, the Associated Press reports. The High Court had also ordered clinics to seek a judge's permission before prescribing puberty blockers to anyone under 18.
The High 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," the appeals court judges wrote.
"Moreover, the effect of the guidance was to require applications to the court in circumstances where the Divisional Court [a branch of the High Court] itself had recognised that there was no legal obligation to do so," they continued. "It placed patients, parents and clinicians in a very difficult position. In practice the guidance would have the effect of denying treatment in many circumstances for want of resources to make such an application coupled with inevitable delay through court involvement." Doctors should be the ones to decide if patients are mature enough to consent, the judges said.
The case originated from a lawsuit against the Tavistock and Portman NHS Trust, the primary provider of gender-affirming care for young people in the U.K. The suit was brought by Keira Bell, who started taking puberty blockers at 16 but later detransitioned, and the mother of an autistic girl who was seeking gender-affirming treatment.
Bell, now 24, "argued that the clinic should have challenged her more over her decision to transition," the AP reports. She and the other plaintiff, whose name was not made public, contended that young people going through puberty are not sufficiently mature to understand the effects of puberty blockers.
Because of the High Court decision, the Tavistock and Portman clinic "suspended new referrals for puberty blockers and cross-sex hormones for the under-16s," The Guardian reports, although it also notes that hormones are not generally prescribed for anyone under 16. In appealing the ruling, lawyers for the clinic said it was based on "partisan" evidence, and the Court of Appeal agreed. The clinic does not actually prescribe the drugs but assesses patients and makes referrals.
Tavistock and Portman praised the appeals court's ruling. "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," a spokesperson told The Guardian. "It affirms that it is for doctors, not judges, to decide on the capacity of under-16s to consent to medical treatment."
Bell expressed disappointment with the decision and said she plans to appeal to the U.K.'s Supreme Court. "A global conversation has begun and has been shaped by this case," she said, according to The Guardian. "There is more to be done. It is a fantasy and deeply concerning that any doctor could believe a 10-year-old could consent to the loss of their fertility." However, doctors say puberty blockers alone do not cause infertility, although cross-sex hormones can.
