An assessment of the Keira Bell case

Written by Genspect parent Lynn Chadwick.

In an editorial for the Journal of Clinical Nursing dated 09 December 2021, Helyer, Jackson, Hill, and Ion summarize the developments of the UK case brought by Keira Bell and Mrs. A. The court initially ruled in favor of the plaintiffs, resulting in the halting of the use of puberty blockers in the treatment of adolescents with gender dysphoria in the UK. This ruling was later overturned on appeal. As the authors explain:

“We hope to stimulate engagement with this most difficult of topics by exploring the implications for clinical staff of a recent legal case in the United Kingdom, which considered the issue of consent to puberty blockers by children and young people experiencing gender dysphoria.”

As the new cohort of patients referred for treatment has soared, approaches to care have been uneven and vary internationally and, in the United States and Canada, between states and provinces. As new observations and evidence of harm have come to light, interventions such as puberty blockers have been suspended in Sweden and Finland. Evidence brought to light during the UK trial has been critical as the calls for evidence-based, clinically sound research has increased:

“Evidence of benefit was not established and the potential for harm was determined to be substantial. Effects of puberty blockers followed by cross-sex hormones include reduction in bone density, loss of sexual function and sterility. Effect of suppression of normal puberty on child brain development and long-term outcomes remains unknown, and the medical interventions on offer were deemed experimental. In addition, instead of providing a reversible ‘pause’ for exploration of gender identity, puberty blockers now appear to serve as a direct pathway to full medical transition as almost all (98%) of children prescribed puberty blockers progress to cross-sex hormones. (Carmichael et al., 2021). As such, consent to puberty blockers cannot, in effect, be separated from consent to cross-sex hormones.” (emphasis mine)

Upon repeal, the court declined to consider the appropriateness of medical interventions, stating the clinicians are responsible for being aware of their ethical duties, leaving themselves open to regulatory consequences or civil action. This has broad implications for clinical practice, as the authors note:

“The judgment informing regulatory or civil action for clinicians in cases of failure to ensure informed consent is particularly important for clinical practice. While reversing the original ruling, it effectively puts the onus on clinical staff to determine Gillick competence and capacity. This has significant implications for those involved in the care and treatment of children and young people seeking puberty blockers. Medical interventions must be evidence based with known and unknown outcomes, safety and effectiveness clearly communicated to all concerned, including the patient.”

After pointing out that systematic review has shown that 61-98% of children and young people will naturally desist from opposite sex identification if not offered medical intervention, the authors conclude:

“It is essential that clinicians offer patients who present with gender dysphoria usual norms of evidence-based care. Children and young people have the right to high standards of individualized care that best support their developmental and healthcare needs and long-term outcomes. Clinicians must ensure the history, needs, and causes of presenting distress of the individual child is centered to their care and not influenced by political or ideological positions. This will help safeguard and ensure high standards of therapeutic care for children and young people who present with gender dysphoria, and enable the many who would naturally desist, to do so, without medical interventions and long-term harms.”

You can read the entire piece here.

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