Starting on the first of May, the Karolinska University Hospital in Sweden halted the prescription of puberty blockers and cross-sex hormones to treat gender dysphoric children under the age of eighteen. In announcing its policy change, it pointed to the potential “extensive and irreversible adverse consequences” of transgender treatments, including “cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis.” The hospital expressly cited a ruling by the high court’s ruling in of Justice in Bell v. The Tavistock and Portman NHS Foundation Trust.
These are the first glimmers of hope that the ideologically-driven haste to “affirm” the gender identity of children by pumping them full of hormones and performing mutilating surgery may be slowed by the brakes of actual scientific research.
The court expressed surprise and dismay that so little sound data had been gathered by Tavistock before its headlong rush into treating even pre-adolescents, “given the young age of the patient group, the experimental nature of the treatment and the profound impact it has.” This research is forming a consensus that “gender-affirming” treatment of youth fails to address the causes of gender dysphoria (almost always accompanied by other comorbidities) and renders extraordinarily high — and permanent — negative outcomes.
The “Bell” of the U.K. case is Keira Bell, a female who at age sixteen began to “transition” to male at the Tavistock Center. Bell admits that, as a depressed and anxious fifteen-year-old, she was adamant that she wanted to transition. The Center was quick to affirm her insistence and, after “superficial conversations with social workers,” she began her life-altering therapy. At sixteen she was put on puberty blockers, at seventeen she started receiving testosterone injections, and at twenty, she had a double mastectomy.
But Bell was still miserable. She eventually realized that her “gender dysphoria was a symptom of her overall misery, not its cause.” As she explains it, “I was a girl insecure in my body who had experienced parental abandonment, felt alienated from my peers, suffered from anxiety and depression, and struggled with my sexual orientation.”
The dysphoria was a symptom. Rather than to treat the underlying psychological causes, Tavistock ignored her real clinical conditions and treated the symptom. “[I]t was the job of the professionals to consider all my co-morbidities,” she says now, “not just to affirm my naïve hope that everything could be solved with hormones and surgery.” As the court found, those professionals failed her miserably.
This is not to say that the High Court’s decision is wholly satisfying. Rather than to draw a bright line holding that children under sixteen are not capable of giving consent to gender-transitioning treatment, the court established a very strong — but rebuttable — presumption. Few if any children under the age of sixteen could possibly give consent to he court’s list of eight factors to be met. The typical fifteen-year-old could not even understand, much less agree to, some of them.
For example, the Court stated that children “may understand the concept of the loss of fertility,” but not how that will affect their life as adults. Many will not be able “to conceptualise what not being able to give birth to children . . . would mean in adult life.” The court sets the bar high for rebutting the presumption against transition procedures for pre-sixteen-year-olds, but not high enough.
It would have done better to rule that children cannot consent as a matter of law, akin to statutory rape laws. Why can a child consent to permanent, irreversible surgery, but cannot consent to sexual intercourse?
The court also determined that, as a matter of law, such treatment is “experimental.” In using these treatments, the clinic is necessarily relying on “little or no” data for the long-term efficacy of the treatment or well-being of the patient. The clinic doesn’t know it will turn well.
In doing this, the Court has established a possible cause of action by such a patient against the clinic, and thus cautioned the clinician against racing into treatment. In other words, the clinic exposes itself to costly litigation when unhappy patients come to the same realization to which Keira Bell arrived.
For Keira Bell, the implications are not academic or theoretical. She will forever live with the consequences of “possible infertility, loss of my breasts and inability to breastfeed, atrophied genitals, a permanently changed voice, [and] facial hair.”
Bell, like many similarly situated adolescents and teenagers, suffered from real clinical morbidities, of which gender confusion was a symptom. But rather than to diagnose and treat these morbidities, those who were responsible for her care practiced ideology instead of medicine. “I was an unhappy girl who needed help. Instead, I was treated like an experiment.”
Kenneth Craycraft is a licensed attorney and the James J. Gardner Family Chair of Moral Theology at Mount St. Mary’s Seminary and School of Theology, the seminary for the Archdiocese of Cincinnati. He holds the Ph.D. in theology from Boston College, and the J.D. from Duke University School of Law. His previous article for Chapter House was The Grand Inquisitor and Independence Day: A Catholic Question About the 4th of July.
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