Ruling in Keira Bell case means UK gender clinicians will have to think again before prescribing puberty blockers

Miles of text has been written about the effect of the appeal in Keira Bell's case, and some commentators appear not to have read—or understood—the judgment.

It is worth noting that the appeal—which was supported by nine interested parties, including the US Endocrine Society—was a win for child safeguarding.

On September 17, the English Court of Appeal upheld the Tavistock gender clinic’s appeal against the lower court’s decision in Bell & Mrs A v. Tavistock and Portman NHS Foundation Trust.

Keira Bell was transitioned in childhood by the Tavistock but came to regret the procedures and to desist in her cross-sex identification. She, and the mother of a girl awaiting puberty blockers, applied for a judicial review of the clinic’s policies. The court found their concerns about administering the experimental drugs to children more than justified.

Bell said: "I should have been challenged on the proposals or the claims that I was making for myself…And I think that would have made a big difference as well. If I was just challenged on the things I was saying."

The appeal was presented by transgender activists as a direct blow to the hopes of parents and detransitioners opposed to the transitioning of children with puberty blockers—as though critics do not have the long-term best interests of children at heart.

However, dig a little deeper and opponents of pediatric transitioning can find much to reassure. The decision was confined to the issue of Gillick competence, ie. whether or not a child has the capacity to consent to medical treatment. The court has bounced this question back to the clinicians, with a clear warning of legal action if they get it wrong.

The judgment said:

"…clinicians will be alive to the possibility of regulatory or civil action where, in individual cases, the issue can be tested."

This was clearly a note of warning, and potentially a green light to those considering suing the gender clinic in medical negligence.

Keira Bell and Mrs A have thus succeeded in tightening up safeguards around this form of ideologically-motivated medical experimentation. If a clinician makes the wrong call—by peering into their crystal ball to guess the child's future feelings—and prescribes puberty blockers to a child who later desists in their cross-sex identification, and regrets the procedures, they will be at risk of legal action.

The reality is that no clinician has a crystal ball that enables them to predict whether or not a child will be in the small percentage who persist, past puberty, in their transexual identity. Children change their minds about things all the time as they develop, and have no sense of the long-term future or how they will feel about parenthood aged 25, or 35.

In the UK, then, it will be quite a professional gamble for a clinician to put a child on puberty blockers.

Can it ever be worth the risk to prescribe these experimental drugs (off label prostate cancer treatments), when the cost of making the wrong call is that the child will never reproduce?

What seems obvious to observers may still be opaque to professionals working within the cult mentality demanded by gender identity ideologues. Perhaps litigation risk will serve as a "golden bridge" for some of those with unvoiced doubts to retreat over. Clinicians risk becoming uninsurable.

The Tavistock's appeal reinforces the finding of the lower court that blanket consent to puberty blockers cannot be assumed—each child, with their clinician, must fully explore what pediatric transitioning involves, including the risks of infertility and iatrogenic disease, and what that will mean when the child grows up.

There will be no more "one size fits all" approach to doling out puberty blockers to any child who attends the clinic, regardless of highly relevant comorbidities such as autism, and regardless of social pressures such as homophobia.

This is unlikely to be the end of the matter, as Bell may decide to take the case to the Supreme Court. Other detransitioners may proceed with medical negligence claims against the NHS trust, as well. Watch this space.

The recent decision should be viewed alongside the outcome of the claim made by Tavistock safeguarding lead, Sonia Appleby. The court found that she was vilified for raising safeguarding concerns over the number of children automatically prescribed puberty blockers. She was awarded damages in the sum of £20,000.

The clinic accused Appleby of "transphobia" for raising the very concerns that it was her job remit to raise—the standard tactic of gender identity ideologues to shut down debate, and deter criticism and accountability.

It should be apparent, by now, that critics of these medical experiments on children are not motivated by prejudice, but by reasonable concern. It should no longer wash to simply silence and shame critics, when it is abundantly clear that pediatric transitioning is a medical scandal unfolding in plain sight.

It is long past time for the gender identity clinics to engage in self-scrutiny, and evaluate whether their insurers will be willing to carry the cost of clinicians’ counterfactual—and, in the US, profit-motivated—decisions.