NHS gender clinic sued over transition

A recent article[1] highlights a potential new area of clinical negligence for those who feel that they could not, or did not, give fully informed consent to transition from male to female, or vice versa.

Keira Bell has been given the go-ahead by a Judge to sue the Tavistock and Portman NHS Foundation Trust. This NHS Trust runs the UK’s only gender identity development service (GIDS).

Keira was referred to GIDS[2] at the age of 16. She said that after only 3 one-hour appointments she was prescribed puberty blockers (drugs which stop the sexual development known as puberty). About a year later she was prescribed testosterone, the male sex hormone. This meant that she developed male (secondary sexual) characteristics, like facial hair and a deeper voice. Within a few years she stopped taking the drugs.

Her legal case is that she did not give fully informed consent, partially because she was too young at the time and partially because she was not given all the information necessary to way up the benefits of the transition treatment and also its risks. Former staff of the clinic have raised additional concerns about the clinic. This included about its assessment process and psychological considerations.

The Guardian newspaper quotes[3] the director of GIDS, Dr Polly Carmichael, as saying “The pausing of a puberty they do not want, in a birth-assigned sex they do not associate with, can be hugely beneficial in alleviating distress and can allow the young person to consider more widely what they may want for themselves without the pressure of further changes to their bodies.”

However, the NHS guidance[4] for GIDS for children and adolescents says in relation to informed consent “The Service will facilitate the careful consideration by clients and their family or carers of the meaning of informed consent, as it is an important aspect of ethical assessment and intervention, including the emotional, social and factual issues, so as to enable them to make informed decisions about the treatment options, benefits, risks, and the alternatives to the treatments proposed (including the option of no treatment). The consequences of treatment decisions can be significant and life-changing.”

This means that potentially if the NHS service breached their duty of care to any of these patients, and those patients consequently chose a treatment (eg transitioning) option that they would not have done, which results in long-term changes and consequences then those patients may have a claim for clinical negligence.

*the photograph used in this blog was obtained from the Gender Spectrum Collection

[1] https://www.bbc.co.uk/news/health-51676020

[2] https://gids.nhs.uk/

[3] https://www.theguardian.com/society/2020/mar/01/families-divided-tavistock-nhs-gender-clinic-judicial-review-goes-ahead

[4] https://www.england.nhs.uk/wp-content/uploads/2017/04/gender-development-service-children-adolescents.pdf