UK court overturns ruling in Keira Bell case limiting use of puberty blockers in children

The UK court of appeal has overturned a controversial judgment in the Keira Bell case that children under the age of 16 who are considering gender reassignment are not able to give informed consent to be prescribed puberty-blocking drugs.

Keira Bell, 24, sued Tavistock and Portman NHS foundation trust, which runs NHS England's only gender identity development service (GIDS) for children, after they had prescribed her puberty blockers at the age of 16. Later, she regretted taking them and detransitioned. In her lawsuit, she claimed she had not been made aware of the potential damage puberty blockers could cause her.  

In the original ruling, found in Bell's favor, the three high court judges said medical professionals working with children under 18 may need to consult the courts for authorization for medical intervention.

In Friday's judgment, the high court said it had been "inappropriate" for them to issue such guidance: "The effect of the guidance was to require applications to the court in circumstances where the divisional court (a branch of the high court) itself had recognised that there was no legal obligation to do so. It placed patients, parents and clinicians in a very difficult position.

"In practice the guidance would have the effect of denying treatment in many circumstances for want of resources to make such an application coupled with inevitable delay through court involvement."

A spokesperson for Tavistock applauded the decision saying, "The judgment upholds established legal principles which respect the ability of our clinicians to engage actively and thoughtfully with our patients in decisions about their care and futures. It affirms that it is for doctors, not judges, to decide on the capacity of under-16s to consent to medical treatment."

Transgender proponents applauded this ruling as well.

"We are delighted that the Court of Appeal, as expected, has overturned the High Court ruling in Bell v Tavistock."

"The Court of Appeal accepts that children can have the capacity to consent to puberty blockers and an approach to treatment that centres on the consent of the child is lawful."

"We're overjoyed to hear that the Tavistock has won its appeal in the Bell v Tavistock case. Today's outcome will be a huge relief for trans young people and their families, as well as the wider trans community!!"

While the ruling has opened the doors again to the use of puberty blockers on children under 18 years old, the ruling in no way minimizes Keira Bell's actual lawsuit, wherein she revealed that she did not know what puberty blockers would do to her and how they eventually harmed her and was able to prove as such.

Just because the High Court does not want to step into the medical space in the UK and determine what medical treatments are appropriate and wise for children under 18 years old does not suddenly mean that puberty blockers for that age group are no longer damaging or that children are suddenly aware of the damage that can occur when they're taken, as the original ruling said.

While much of the medical community seems to be taken up with the use of puberty blockers on children, not everyone supports this. In a 2021 interview with London-based Channel 4 News, Dr. David Bell revealed that he faced disciplinary action after raising concerns about procedures at Tavistock in an internal 2018 memo. Bell retired after working with Tavistock for over two decades as a consultant psychiatrist. He told reporter Cathy Newman that in addition to adults voicing concerns that their children were not "able to consent to the treatment," he thought Tavistock was too aggressive in pushing children towards transition.

"Then there were concerns of children being inappropriately pushed through to transition, where they had a lot of complex problems that really needed thinking about. The whole attitude of what's called 'affirmation' instead of neutrality and inquiry caused considerable damage to the capacity of the service and clinicians to take on the full complexities of the cases they were dealing with. As a result, children have been very seriously damaged."