The Supreme Court decision in the Keira Bell case is not a loss

supreme court

The decision by the Supreme Court to deny Keira Bell and Mrs A permission to appeal the Court of Appeal judgment is disappointing. But it is not a loss. Keira Bell has already won. The evidence in the judgment made in the original judicial review has been vindicated again and again both in the UK and across the world. The influence of the case has been far-reaching and has effected real change globally. This decision does not change that.

The original Divisional Court judgment that it is doubtful that children are able to give informed consent to treatment with puberty blockers was based on a thorough examination and assessment of all the evidence presented by both sides. We believe this should also have been the criteria used by the Appeal Court and the Supreme Court. It is disappointing that the Supreme Court, like the Court of Appeal, has failed to see the protection of children from medical experimentation as their responsibility.

However, it is the results of the original judicial review that matter. The judgment in Keira Bell’s case reverberated across the world and continues to do so. The case woke the world up to the reality of the medical transition of children, the dangers of the ‘gender affirmative’ model and the scandal of treating children according to ideology rather than clinical evidence. Keira Bell kick-started a global conversation that has not abated.

The subject of detransitioners has entered public awareness and attracted continued press interest. As greater numbers of young people who regret their transition feel more confident to speak out, accusations of ‘transphobia’ towards people who express concerns about the transition of children ring hollow.

What we wanted was real change on the ground and that is what the judicial review achieved. The Tavistock GIDS’ win on appeal has made no difference to that, and neither will this judgment. The decision of the Supreme Court does not diminish Keira Bell’s tremendous achievement in exposing a scandal the world can no longer ignore. We were proud to support Keira in her case as intervenors.  

The changes we have seen since the judicial review, both in the UK and worldwide, are testament to its global influence. Facts and evidence are powerful; the exposure of the facts in Keira’s case made the world sit up and take notice. There is no going back now. The re-evaluation of gender clinics for children will continue as more and more countries recognise the harms to children that Keira’s case exposed.

The edifice of unquestioning “gender affirming” care is crumbling worldwide and for that we have to thank the courage of Keira Bell.

As a direct result of the judicial review, the NHS swiftly implemented changes, which are ongoing and have led to government action:

The NHS corrected its guidance, no longer claiming that puberty blockers are ‘reversible.’

The National Institute for Health and Care Excellence (NICE) published two evidence reviews in 2021 on treatments for children and adolescents with gender dysphoria.

The conclusion of the evidence review of gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria was:

“The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning) in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.”

The conclusion of the review of ‘gender-affirming’ hormones for children and adolescents with gender dysphoria was:

“This evidence review found limited evidence for the effectiveness and safety of gender affirming hormones in children and adolescents with gender dysphoria, with all studies being uncontrolled, observational studies, and all outcomes of very low certainty. Any potential benefits of treatment must be weighed against the largely unknown long-term safety profile of these treatments.”

Having rated the same service as ‘good’ in 2016, in 2021 GIDS was rated “inadequate” by the Care Quality Commission, the regulator for health and social care in England. The inspectors documented concerns about clinical practice, safeguarding procedures, and assessments of capacity and consent to treatment. They also noted poor record keeping at the clinic.

The NHS commissioned a review of the Tavistock GIDS, led by Dr Hilary Cass, a retired paediatrician. The Cass Review interim report was published in March this year.

The report found that children referred to the Tavistock GIDS were not being offered the same standard of care as other paediatric services, and detailed shocking failings. The report concluded:

“A fundamentally different service model is needed which is more in line with other paediatric provision, to provide timely and appropriate care for children and young people needing support around their gender identity. This must include support for any other clinical presentations that they may have.

“It is essential that these children and young people can access the same level of psychological and social support as any other child or young person in distress, from their first encounter with the NHS and at every level within the service.”

In April Boris Johnson announced that the government’s proposed conversion therapy ban would not include transgender people. It is clear that the government is listening to Cass rather than to activists, recognising that there may be unintended consequences for therapists who are helping children with issues relating to gender distress. The Cass interim report highlighted the concerns of therapists who already feel under pressure to adopt an unquestioning affirmative approach, and that

“From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations”

The UK health secretary, Sajid Javid, is now preparing to launch an urgent inquiry into gender hormone treatment for children amidst concerns that the system is “failing children” and that the approach is “ideological.” The Times reported that Javid is also preparing legal changes that would give Hilary Cass access to an NHS database of children treated by the service to see how many later regretted taking puberty-blockers and cross-sex hormones.

Calls have now been made for the Scottish government to launch a similar inquiry into the Sandyford Clinic in Glasgow following revelations that 559 children were referred to the clinic in 2019, a 1,411% increase on 37 children in 2013.

We have since seen a cascade of consequences across the world.

In 2021 Dr Thomas Steensma, lead researcher at the Amsterdam clinic that pioneered the use of puberty blockers for gender dysphoric children, issued a warning about the lack of research in this area and cautioned healthcare providers about blindly following the Dutch research:

“Little research has been done so far on treatment with puberty blockers and hormones in young people. That’s why it’s also seen as experimental. We are one of the few countries in the world that conducts ongoing research about this. In the United Kingdom, for example, only now, for the first time in all these years, a study of a small group of transgender people has been published. This makes it so difficult, almost all research comes from ourselves.”

Also in 2021 a group of paediatricians and health professionals in Australia published a study of children presenting to a multidisciplinary Gender Service in New South Wales, which referenced the Keira Bell case. The study emphasised the high incidence of co-morbidities among these children and concluded:

“Our findings indicate that engagement with families, a trauma-informed model of mental health care, and ongoing discourse pertaining to the effects of unresolved trauma and loss need to be part of all gender dysphoria clinics and the services with which they collaborate.”

Following a review of children’s gender services, the Swedish Board of Health and Welfare issued new guidelines this year that treatment with hormones should be given only within the framework of research:

“Based on the results that have emerged, the National Board of Health and Welfare’s overall conclusion is that the risks of anti-puberty and sex-confirming hormone treatment for those under 18 currently outweigh the possible benefits for the group as a whole.”

The French Academy of Medicine also issued guidance this year advising “psychological support as long as possible for children and adolescents expressing a desire to transition” and stressed that caution must be exercised in the prescription of blockers and hormones:

“However, a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.”

The Council for Choices in Healthcare in Finland had already issued strict new guidelines in 2020:

“Based on thorough, case-by-case consideration, the initiation of hormonal interventions that alter sex characteristics may be considered before the person is 18 years of age only if it can be ascertained that their identity as the other sex is of a permanent nature and causes severe dysphoria. In addition, it must be confirmed that the young person is able to understand the significance of irreversible treatments and the benefits and disadvantages associated with lifelong hormone therapy, and that no contraindications are present.

In April this year the Florida Department of Health fact-checked evidence, including the Cass interim report, and published new Department guidance, concluding:

“Social gender transition should not be a treatment option for children or adolescents. Anyone under 18 should not be prescribed puberty blockers or hormone therapy. Gender reassignment surgery should not be a treatment option for children or adolescents.”

Perhaps the most significant development in the US this year is that even the most prominent ‘gender doctors,’ the pioneers of the “gender affirmative” approach and the use of blockers and hormones, have begun to voice their concerns.

Marci Bowers, MD, president-elect of the World Professional Association for Transgender Health (WPATH), and Erica Anderson, PhD, president of the US Professional Association for Transgender Health (USPATH) and USPATH representative to the WPATH board have spoken out about the risk that many children going through this treatment will live to regret it.

At a recent talk at Duke University, surgeon Marci Bowers admitted that children who undergo transition at Tanner stage 2 of puberty (as at the Tavistock GIDS) will never have adult sexual function or experience orgasm:

“This raises huge and glaring red flags about the concept of “informed consent” for children and teens who are ushered into transition.”

Our thanks to Keira Bell, Mrs A and Susan Evans for their courage in bringing the case.

There are still outstanding legal fees to be paid. Please share Keira’s crowdfunder and donate here:

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