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UK court overturns puberty blocker restrictions – The Straits Times (17 September 2021)
TLDR: Keira Bell is a young British woman who was born a girl, started a medical gender transition at the age of 16 years old to become male and then subsequently transitioned back to female. Read her story here.
In 2020, she brought a judicial review claim against the public clinic that first provided her with the hormone treatment to block puberty, essentially arguing that the clinic should not have allowed such a treatment to a teenager. The question presented to the High Court was whether youths could truly consent to such medical interventions.
The judges expressed serious doubts that those below 16 years old could understand the implications of such treatments. The outcome was that the clinic should only permit puberty-blockers for under-16s if specifically authorised by a court.
However, the clinic appealed against this ruling and the Court of Appeal decided to overturn the previous decision of the High Court.
The revised and current position is that court permission is not necessary for treatment of under-16s. Therefore, instead of the court deciding whether a child is capable of consenting to puberty-blockers, this should be the doctors’ role. This decision means that doctors would no longer need to seek approval from the courts to treat under-16s.
Keira Bell and her team intend to appeal to the Supreme Court in the hopes of restoring the previous decision.
More thoughts: This case raises interesting issues for discussion in the areas of kids’ capacity and consent for medical treatment, as well as legal procedure and court structure.
There is no legislation in Singapore stipulating the age of capacity to consent to medical treatment. Generally, parents’ consent is needed for the medical treatment of anyone below 21 years old.
However, in certain cases, a doctor may consider a child below 21 years old to be capable of giving his or her consent independently of his or her parents. This concept is known as Gillick Competence. It originated in the UK and is well-recognised in common law countries including Singapore.
The Keira Bell case actually attempted to add another level of safeguards in situations of UK gender transitions, namely, to require court approval for all cases below the age of 16 years old. This effort failed in the Court of Appeal and it remains to be seen if the Supreme Court appeal will ultimately succeed.
On a separate note, what is judicial review? It’s a process where courts may review legislation and acts of public bodies to determine whether they are valid. An individual who is personally affected by a public law or action may bring such a case before the courts for judicial review. This is another role that judges play outside of deciding criminal and civil cases. For judicial reviews, the court may make various orders to make a public body either do or not do something.
The last point that is worth talking about is court structure in the UK and Singapore. Notice that this case was first heard in the UK High Court, then appealed in the Court of Appeal. In certain cases, it may then be further appealed to the Supreme Court.
In Singapore, an appeal that has been heard by the Appellate Division of the High Court may in certain cases be further appealed in the Court of Appeal.