Keira Bell | Read Time 10-12 Minutes.
In December 2020, London’s High Court ruled that transgender children under the age of 16 can no longer decide to take puberty blockers. It also advised doctors to first seek court approval before prescribing these drugs to children below the age of 16.
The reason for these changes? Keira Bell.
Bell’s case sparked a heated debate on children suffering gender dysphoria. It raised questions of how far medical professionals should challenge children, and whether children have the capability to understand the consequences of their own decisions.
So what actually happened?
Who is Keira Bell?
Before diving into the case, it’s important to know the background behind the main parties. Keira Bell is a 23-year old woman who, at the age of 16, felt she was experiencing gender dysphoria.
During her childhood, Bell described herself at the time as a tom boy struggling with the onset of puberty as a young woman and everything that entailed. This progressed into depression alongside Bell’s conflicted views on her attraction to other women.
However, it was only when Bell’s mother if she wanted to be a man that she started to research the possibility of transitioning. Following her research, Bell eventually went on to attend the GIDS at the Tavistock clinic for counselling. And finally, after that Keira Bell was finally prescribed puberty blockers and began her journey to becoming Quincy Bell.
But some time into her transition, at the age of 20, Bell realised she didn’t want to be a man. And so she began the process of detransitioning to become Keira Bell once more.
Can you really detransition?
Keira Bell comes under the 1% of transgender people who have detransitioned.
Detransitioning is the reversal of transition, back to the individual’s birth gender. It can leave significant psychological and physical impressions on an individual, beyond the original gender dysphoria they suffered from.
Whether or not people can fully detransition is subject to the debate around the effect of puberty blockers and cross-sex hormones.
What is the Tavistock Clinic?
The Tavistock and Portman Clinic as it’s officially known is an NHS trust specialising in talking therapies. It began a specialised Gender Identity Development Service (GIDS) in 1989 focusing on young people who have issues with their gender identity.
Like Keira Bell, most children under the age of 18 with gender dysphoria are referred to the Tavistock Clinic’s London or Leeds branches. The clinic and GIDS offers a range of psychological services and counselling that aim to qualify whether a child’s gender dysphoria is permanent. This is because it’s common for gender identity issues to resolve themselves at the onset of puberty.
The theory is that the counselling helps children with 2 main areas:
- To understand where conflicts over their gender come from
- To allow children going through puberty the chance to see if their gender dysphoria resolves itself over time
If the gender dysphoria is permanent, GIDS may recommend these children go on to take puberty blockers and cross-sex hormones. This is to allow their body begin the transition to match their gender identity.
So why did Keira Bell bring legal action if she had been through all of this with the GIDS?
Puberty Blockers and How They Work
Puberty blockers are an experimental treatment in the UK. In theory, they put puberty ‘on pause’ until a child can decide whether they wish to transition. By taking them, children can age free of physical changes.
This allows them the time to understand the impacts of the drugs and make a more informed decision.
However, currently there is little evidence on the benefits of puberty blockers on both gender dysphoria and the long term physiological and psychological effects.
Some medical experts say puberty blockers actually prohibit a child’s understanding of, and development in their birth gender.
Bell v Tavistock: The Case
Bell v Tavistock didn’t include Keira Bell at the start. Instead, in late 2020, the mother of a 15-year old child (known as Mrs A) who was on the GIDS waiting list made a legal complaint against the GIDS. This was alongside a former nurse at the GIDS office in Leeds. The complaint came in the form of a judicial review, which is a request to review the law.
As the complaint progressed, Keira Bell eventually took the nurse’s place in the complaint.
The complaint against the Tavistock clinic centred on the argument of whether children below the age of 18 have the knowledge to consent to complex medical treatment.
Keira Bell’s personal experience was that there were a large variety of factors that affected her decision to transition. She argued that she was a stubborn teenager who wanted what she wanted. She said that gender dysphoria was a symptom of her depression, but that transitioning was ultimately not the cure. And most notably, she believed that as a 16-year old, she simply didn’t have the life experience and understanding that enabled her to really understand concepts like infertility or being in a relationship.
In short, she felt that, as a child, medical experts hadn’t challenged her enough in why she was experiencing gender dysphoria.
The judge in Bell v Tavistock examined a wide range of evidence presented by both sides. In their judgment, the judge expressed concerns over the lifelong and life changing effects of puberty blockers on children and their ability to appreciate these.
As part of their overall conclusions, the judge made 4 key findings around children using puberty blockers:
- Children under the age of 16 can only consent to puberty blockers if they understand the nature of the treatment, but;
- Those aged 13 and under are highly unlikely to understand the long-term impacts of the treatment
- It’s doubtful that those aged 14 and 15 can understand the implications
- 16 and 17-year olds legally can understand, however medical practitioners might want to seek court approval before making any prescriptions
Effectively, this means doctors won’t prescribe puberty blockers to anyone under the age of 16.
Has Bell v Tavistock Changed Anything In Reality?
Back in 2011, the age at which children could be given puberty blockers lowered from 16 to 11.
Before the ruling, children wishing to transition went through a process of assessment by a medical professional. Legal intervention was not required, but a medical review was compulsory before prescribing any medication, such as puberty blockers.
The new legislation means that “cross-sex hormone therapies” cannot be given to children without applying to the court. Whatsmore, even after applying to the court, the assessment process will be more rigorous than ever.
The court’s ruling comes as a blessing to some and a curse to others. The decision is devastating for the many thousands of child patients who are waiting for treatment.
Response to the ruling
The reaction among the transgender community and relevant charities is extremely mixed: appreciated by some and damned by others.
GIDS has over 3,000 patients, with a waiting list of 5,000. The ruling to suspend hormone therapy for all under 16 year old’s has a devastating effect on current patients. Furthermore, it means that many transitions, for now, will have to come to a halt.
Many parents of transgender children have come out as saying that their children do not have the choice to transition. Additionally, many think that it is not an active decision, but a right, and to deny children of this is “barbaric.”
“I did not imagine for one moment that the outcome of this case would be the effective withdrawal of medical care from children in dire need of it.”
Some argue that it is “not proportionate” to take away services. Furthermore, they say it is because of “a very small number” of people who regretted undergoing medical intervention.
Popular transgender charity Mermaids released their response statement to the decision, stating that the ruling was “a dangerous betrayal of trans youth.” Interestingly, the High Court denied both Mermaids and LGBT charity Stonewall permission to intervene on the case.
Mermaids claim that the ruling will negatively impact the mental health and sense of identity in all those undergoing their transition. Whatsmore, charities like this are seeing a rapid incline in people phoning their helplines in a state of panic and suicidal thoughts. People who have been on a two-year waiting list to receive hormone therapy have now had that ripped away from them.
DYSPHORIA AND THE FUTURE FOR TRANSGENDER CHILDREN
Only time will tell if the legislation sufficiently protects transgender children. This includes both those who wish to transition and those who have already begun.
The new ruling comes under a much broader line of questioning about gender dysphoria and gender-critical therapy’s transphobic nature.
“Children must be treated as children, not as political mascots for an ideology” (transgender trend)
However, the future is looking bright for the victorious Kiera Bell, whose journey of identity discovery is taking her back to the beginning. Bell stated to the press that she was “delighted by the ruling and its protection of young people.”
Whatsmore, Bell also argued that medical professionals have a duty to “convince gender dysphoric youth to reconcile with their birth gender.”
The fundamental question that comes out of the case is: is a child capable of consenting to such a life-altering decision?
4 months later: An update on the Keira Bell Case
On initial publication of this article back in December 2020, the Keira Bell case was certainly a controversial topic. On December 1 2020, the court ruled in favour of Keira Bell, winning her case against The Tavistock Centre. 4 months later, in April 2021, LGBT Lawyers has returned to review the case and comment on any action since Bell’s victory.
- The Tavistock Centre began the appeals process later in December 2020, to undo the new ruling that under 16’s would need a court order to begin the transition. The court’s judgement paused until January 18, when the Tavistock Centre began their appeal. The appeals process is still ongoing, and a full inquiry will begin on June 23 2021.
- At the end of January 2021, The High Court allowed 3 prominent transgender charities to comment on the ruling. Gendered Intelligence (GI), Brook Charity and The Endocrine Society we’re all granted permission to comment on the case and give their opinion.
- On March 26 2021, The High Court ruled that parents are now able to give consent on behalf of their children when it comes to taking puberty blockers and undergoing hormone therapy. Justice Nathalie Lieven agreed that children under the age of 16 are not “fully competent” to consent to a full gender transition. However, Lieven stated that “parents are, in general, in a position to understand and weigh up these matters and consider what is in the long and short term best interests of their child.”