A children’s hospital gender clinic is under review with responsibility for treatment decisions shifted to judges amid great secrecy and an international trend towards caution. New patients at the gender clinic, which cannot be named for legal reasons, have to get court approval before they can go ahead with life-altering hormonal treatments in high demand by teenagers who identify as transgender. The dramatic change followed concerns raised by a state solicitor’s office about the risk of government exposure to litigation akin to the successful case brought against the UK Tavistock clinic by Keira Bell, a young woman who came to regret her treatment with puberty blockers, testosterone and mastectomy.

After the English High Court handed down its Tavistock ruling that minors would struggle to give informed consent to experimental treatment, the parents of patients at the Australian gender clinic were sent a letter warning them the need for court approval would delay a start to blockers or hormones. University of Queensland legal academic Patrick Parkinson said it was a “very significant” turn in the gender clinic debate, likening it to the decision by the Tavistock clinic to halt new referrals for puberty blockers, and the recent policy of a Swedish clinic to limit all future hormonal treatment of minors to strictly supervised clinical trials. Professor Parkinson said the state government was “essentially saying they are going to use the court as a safeguard”, given the grave consequences of a mistaken decision to approve treatment with irreversible effects.

He said the government should be commended “for responding to the changing science on all of this and taking a precautionary approach” to the treatment of minors diagnosed with gender dysphoria, or a distressing sense of conflict between an inner “gender identity” and biological sex.  The judges in the Tavistock case expressed “surprise” about the lack of basic patient data at that UK clinic and the meagre evidence for treatment, concluding that puberty blockers were an experimental pathway to lifelong medicalisation. In recent years there has been an international surge in teens declaring a trans identity and telling parents they fear self-harm if unable to get blockers or hormones quickly, and clinics following the “gender affirmative” approach claim these treatments can be “life-saving”.

But the suicide narrative of affirmative clinicians as well as the evidence base and risks of their medical interventions are under intense international scrutiny, with concerns that a cultural fixation on gender stops exploration of crucial underlying issues such as trauma, autism or awkward same-sex attraction. The new policy at the unnamed Australian gender clinic was revealed in a recent decision by a state court exercising a family law jurisdiction, with Justice Susan Duncanson noting that the Tavistock ruling was “integral” to the change. The Tavistock, England’s only specialist gender clinic for children, has appealed. Justice Duncanson, noted the new policy of court approval for treatment would apply while the children’s hospital gender clinic underwent a review.

Even in cases where the child was 16 or older, able to give informed consent, and parents and clinicians all agreed on treatment, the hospital said it was likely to remain neutral, neither consenting nor opposing the application to the court. And the hospital suggested that in complex or disputed cases, the court might want to involve a “contravener” so the judges would have the benefit of hearing arguments against treatment. Unlike the Tavistock test case, Australia’s Family Court has had a string of gender dysphoria cases where only arguments in favour of medical treatment were heard.

Source: Compiled by APN from media reports

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