The courts are right to warn against making an individual child part of an attack on a wider ideology - but I think they are wrong to deny medical transition as a 'special category' of treatment.
The Federal judge criticised the approach of gender clinics, cited the risks to the child of being a lifelong patient and of later regret, also said:
"even if there were only a 33.33 per cent chance of the child being harmed by puberty blockers, I consider that no sensible person would take the risk of putting the child in that situation because, even though the prospect of harm would only be possible, as opposed to probable, the risk is too high to tolerate and is, therefore, unacceptable."
The risk is too high to tolerate. Therefore, unacceptable.
Oh for such clear thinking, in our courts.
Question: the judge was guided (amongst a lot of other evidence!) by the Cass Review: is there any cross-fertilization of jurisprudence between jurisdictions, which share a lot in common? (Australian law has obviously diverged, but it began as Brittish.)
Thank you for sharing your thoughts, here and on Twitter.
Thank you for your Devin write-up, more detailed than earlier ones I read. More clarity to this troubling clash/crossover of medicine & law.
Still hoping, with you, that "this judgment heralds the return of Family Courts all over the world to their fundamental values; to identify and protect the welfare of the child as its paramount concern."
Re the age difference: judges in criminal courts, in Scotland certainly, not sure about England & Wales, take age (youth) of convicted people into account when sentencing, up to the age of 25 (I think). If criminal judges/court system are aware that we don't fully mature until well beyond legal adulthood, why hasn't this influenced Family Court judges to extend the protective umbrella to older children appearing in their courts?
Thank you for clarifying the distinction between competence and capacity. He’s not enough to purchase alcohol but old enough to “consent” to extreme body modification as treatment for a mental health condition.
Oh, my bad! I took you to mean that competence is assumed as a default for any adult (or minor over 16). While capacity only comes into play when a medical professional or the court wants to challenge a patient’s ability to understand and articulate the consequences of their decision. But I obviously over-interpreted what you actually said. I guess the terms are (legally) synonymous then?
I don't know but I can't see a distinction. A child is presumed competent or capacitous at 16 via the Family Law Reform Act. You would to prove he is incompetent/incapacitous to rebut that presumption. My issue is that I don't see how ANY person is competent/capacitious in this field given all the unknowns and the ideological gloop covering it all.
I agree wholeheartedly. The HHS review ethics chapter is very strong on the idea that “informed consent” shouldn’t even enter the picture when there is no good evidence of benefit and likelihood of significant harm. Unfortunately TRAs and “gender affirming” clinicians have completely derailed the concept of respect for autonomy - which is supposed to help people refuse treatment, but not to demand unproven and dangerous treatments.
If I had been in a position to discuss this case with 'B's' parents, I would have suggested a completely different approach. The belief that one is or could ever become the opposite sex is delusional. It is not a 'choice' that is possible to make, any more than we can choose to become a mermaid, or Jesus.
Some transgender people have enough insight to recognise that they are delusional, while others do not. (The DSM-5-TR section on body dysmorphia states something similar, but thanks to activists, has an exception for patients with gender dysphoria).
Therefore a psychiatric evaluation is necessary to establish whether the patient is fully delusional, or retains some insight. If the patient is insulted by the idea that they need psychiatric evaluation, that's of no consequence, because a fully delusional person may well consider having their beliefs tested insulting.
And gender dysphoria, the medical justification for cross-sex hormone use, remains a psychiatric condition in any country that uses the DSM, so it is completely appropriate for the family court to hear a psychiatric expert opinion.
If the patient maintains that they do not have gender dysphoria, are not delusional and wish to take cross-sex hormones as a matter of bodily autonomy, that is outside the scope of the healthcare system, and so no hormone can be prescribed. Otherwise recreational drug users would be queuing at the hospital to get all manner of fixes.
Besides the subject: It's great that a 17-year-old gets to instruct his own legal team, but a taxpaying adult has to act as a LiP because there's no legal aid for employment or defamation matters. Hope he's paying for it.
Further to my comments/questions about re Devin, ie outside of England & Wales jurisdiction, do you follow SEGM (@segm_ebm on twitter)? They have just posted about a new SEGM Digest, which includes "Legal Assessment of the Dutch Protocol (2025)"
SEGM comment: "Although this article focuses on the Dutch medical and legal situation, it is likely to have considerable cross-over relevance to other countries."
The Legal Assessment says "A key legal issue will be the interpretation of the standard of care... Legal science and case law suggest that courts consider medical protocols as a reference point only if they meet certain criteria: they must be evidence-based, have limited ethical implications and be established through a proper procedural process."
It concludes "This article has argued that it is highly questionable whether the first criterion is met and that the second and third criteria are not fulfilled. Consequently, courts should not rely on the Dutch Protocol as a guiding standard.”
Sorry if this is approaching spam level with your article, but I just can't get over my initial outrage & incredulity that medically transitioning children, especially, could ever be morally, ethically or legally justifiable.
Yes I do. The problem appears to be that the courts are very slow to recognise the truth - that this area of medicine and surgery has been hijacked and the courts cannot simply trust medical practitioners to be safe and reliable in this field. Even after the Cass Review. I suppose I feel some sympathy - this is for Parliament to clean up this mess and they are taking some sensible steps regarding banning puberty blockers and now examining provision of CSH to children.
Compare and contrast with recent Australian case, Re Devin, judgment here:
https://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/FedCFamC1F/2025/211.html
The Federal judge criticised the approach of gender clinics, cited the risks to the child of being a lifelong patient and of later regret, also said:
"even if there were only a 33.33 per cent chance of the child being harmed by puberty blockers, I consider that no sensible person would take the risk of putting the child in that situation because, even though the prospect of harm would only be possible, as opposed to probable, the risk is too high to tolerate and is, therefore, unacceptable."
The risk is too high to tolerate. Therefore, unacceptable.
Oh for such clear thinking, in our courts.
Question: the judge was guided (amongst a lot of other evidence!) by the Cass Review: is there any cross-fertilization of jurisprudence between jurisdictions, which share a lot in common? (Australian law has obviously diverged, but it began as Brittish.)
Thank you for sharing your thoughts, here and on Twitter.
thank you for that comment - I wrote about it here https://sarahphillimore.substack.com/p/good-news-from-down-under-re-childhood and should have included a reference to it in this piece as I think its a useful comparison. I will add it now!
But of course Devin was only 12 which I think does make a difference and makes it much easier for Judge's to be protective.
Thank you for your Devin write-up, more detailed than earlier ones I read. More clarity to this troubling clash/crossover of medicine & law.
Still hoping, with you, that "this judgment heralds the return of Family Courts all over the world to their fundamental values; to identify and protect the welfare of the child as its paramount concern."
Re the age difference: judges in criminal courts, in Scotland certainly, not sure about England & Wales, take age (youth) of convicted people into account when sentencing, up to the age of 25 (I think). If criminal judges/court system are aware that we don't fully mature until well beyond legal adulthood, why hasn't this influenced Family Court judges to extend the protective umbrella to older children appearing in their courts?
It’s a mystery. I argued this before Judd J in first OvP hearing - neither she nor Guardian were interested.
Thanks for this excellent report, Sarah.
The contrast with Re Devin is startling!
Have cross posted
https://dustymasterson.substack.com/p/are-you-for-womens-lib-dismantle
Dusty
I think the age is the key point. Although I think 16 year olds cannot possibly have the capacity the courts grant them
Noted, thanks
Thank you for clarifying the distinction between competence and capacity. He’s not enough to purchase alcohol but old enough to “consent” to extreme body modification as treatment for a mental health condition.
I am not sure how I did that given that I use the two terms interchangeably!
Oh, my bad! I took you to mean that competence is assumed as a default for any adult (or minor over 16). While capacity only comes into play when a medical professional or the court wants to challenge a patient’s ability to understand and articulate the consequences of their decision. But I obviously over-interpreted what you actually said. I guess the terms are (legally) synonymous then?
I don't know but I can't see a distinction. A child is presumed competent or capacitous at 16 via the Family Law Reform Act. You would to prove he is incompetent/incapacitous to rebut that presumption. My issue is that I don't see how ANY person is competent/capacitious in this field given all the unknowns and the ideological gloop covering it all.
I agree wholeheartedly. The HHS review ethics chapter is very strong on the idea that “informed consent” shouldn’t even enter the picture when there is no good evidence of benefit and likelihood of significant harm. Unfortunately TRAs and “gender affirming” clinicians have completely derailed the concept of respect for autonomy - which is supposed to help people refuse treatment, but not to demand unproven and dangerous treatments.
If I had been in a position to discuss this case with 'B's' parents, I would have suggested a completely different approach. The belief that one is or could ever become the opposite sex is delusional. It is not a 'choice' that is possible to make, any more than we can choose to become a mermaid, or Jesus.
Some transgender people have enough insight to recognise that they are delusional, while others do not. (The DSM-5-TR section on body dysmorphia states something similar, but thanks to activists, has an exception for patients with gender dysphoria).
Therefore a psychiatric evaluation is necessary to establish whether the patient is fully delusional, or retains some insight. If the patient is insulted by the idea that they need psychiatric evaluation, that's of no consequence, because a fully delusional person may well consider having their beliefs tested insulting.
And gender dysphoria, the medical justification for cross-sex hormone use, remains a psychiatric condition in any country that uses the DSM, so it is completely appropriate for the family court to hear a psychiatric expert opinion.
If the patient maintains that they do not have gender dysphoria, are not delusional and wish to take cross-sex hormones as a matter of bodily autonomy, that is outside the scope of the healthcare system, and so no hormone can be prescribed. Otherwise recreational drug users would be queuing at the hospital to get all manner of fixes.
Besides the subject: It's great that a 17-year-old gets to instruct his own legal team, but a taxpaying adult has to act as a LiP because there's no legal aid for employment or defamation matters. Hope he's paying for it.
Further to my comments/questions about re Devin, ie outside of England & Wales jurisdiction, do you follow SEGM (@segm_ebm on twitter)? They have just posted about a new SEGM Digest, which includes "Legal Assessment of the Dutch Protocol (2025)"
SEGM comment: "Although this article focuses on the Dutch medical and legal situation, it is likely to have considerable cross-over relevance to other countries."
The Legal Assessment says "A key legal issue will be the interpretation of the standard of care... Legal science and case law suggest that courts consider medical protocols as a reference point only if they meet certain criteria: they must be evidence-based, have limited ethical implications and be established through a proper procedural process."
It concludes "This article has argued that it is highly questionable whether the first criterion is met and that the second and third criteria are not fulfilled. Consequently, courts should not rely on the Dutch Protocol as a guiding standard.”
Sorry if this is approaching spam level with your article, but I just can't get over my initial outrage & incredulity that medically transitioning children, especially, could ever be morally, ethically or legally justifiable.
Yes I do. The problem appears to be that the courts are very slow to recognise the truth - that this area of medicine and surgery has been hijacked and the courts cannot simply trust medical practitioners to be safe and reliable in this field. Even after the Cass Review. I suppose I feel some sympathy - this is for Parliament to clean up this mess and they are taking some sensible steps regarding banning puberty blockers and now examining provision of CSH to children.