Against a backdrop of disproportionate morbidity and mortality from COVID-19, the need to prioritise and protect ethnic and religious minorities as part of the UK’s new vaccine programme has been the focus of recent media, public health and government attention. My question iswhois considered a ‘priority’ andhow can public health bodies engage productively and sensitively with ethnic and religious minorities.(more…)
The Supreme Court has refused permission for Shamima Begum, who left the UK as a 15-year-old British schoolgirl for Syria in 2015, to come back to the UK so that she can effectively challenge the removal of her citizenship (decision dated 26th February 2021;  UKSC 7). Begum was found in a camp in Syria two years back. The Home Secretary removed her British citizenship soon thereafter, arguing that she has eligibility for Bangladeshi citizenship, and would not be left stateless without British citizenship. (more…)
Prof. Xinyu Wang (China University of Political Science and Law) and He Xiao (a law PhD student at the University of Bristol)
Since October 2020, a “Stop Period Shaming” campaign has been quietly taking place within universities in China. It all started in early 2020, during China’s fight against the COVID-19, with various socially sponsored donations of medical supplies and an extreme shortage of feminine period products. The female doctors and nurses, who made up more than half of the medical team that went to Wuhan, overcame their cycles’ fragility and fought like the male doctors. (more…)
by Sandra Duffy, Law School, University of Bristol
On December 1st, the High Court handed down its decision in the case of Bell and A v Tavistock and Portman NHS Trust. This ruling concerned a judicial review of the practice of the Tavistock Gender Identity Development Service in prescribing puberty-blocking hormonal treatments to children under 16 years of age.
Puberty blockers are given to transgender children with a diagnosis of gender dysphoria. They are used to spare these children from going through the puberty associated with their assigned sex and to give them time to reflect on their gender identity without the pressures associated with puberty. Puberty blockers have an inverse correlation rate with suicidal ideation in transgender persons and can sometimes be a life-saving treatment for these children. Most young persons who take puberty-blocking treatments will go on to take adult hormonal interventions (CSH) also (approx 98%, per Bell). However, this is neither automatic nor inevitable. Puberty blockers are fully reversible as they pertain to pubertal developments and the individual is given the choice at 16 as to whether they wish to continue on to adult medical services.
The standard used to assess competence to receive medical treatment in children under 16 is known as Gillick competence. Children are considered competent to give consent to treatment without their parents’ consent if they have “sufficient understanding and intelligence” to understand the “nature and implications of the proposed treatment.” (Bell, 105)
The interested party in this case is Keira Quincy Bell, who identified as a trans boy as a teenager and young adult, but now identifies as a woman. She does not believe that she was fully competent to make transition-related decisions as a minor, alleging that she could not understand the consequences of those decisions, nor that they would entrain the later decisions she made as an adult (such as a mastectomy).
The High Court’s conclusion in this decision is that “it is highly unlikely that a child aged 13 or under would ever be Gillick competent to give consent to being treated with [puberty blockers]… In respect of children aged 14 and 15, we are also very doubtful that a child of this age could understand the long-term risks and consequences of treatment in such a way as to have sufficient understanding to give consent.” (Bell, 145) Within the list of “long-term… consequences” the Court believes it is necessary to understand are the effects of CSH on sexual function and fertility. CSH are voluntary treatments undertaken after the age of 16, in a separate decision to that which is involved in consenting to puberty blockers. The Court here uses the high correlation rate between puberty blockers and CSH as destiny, conflating the two decisions into one – which is not the case in reality.
In making the above-quoted statement, the Court refines Gillick competence as it relates to trans children as a class. As Ruth Fletcher has pointed out, this is antithetical to the usual way in which capacity decisions are made – on a decision- and person-specific basis. It also singles out trans children and applies stricter standards on them than on other children when consenting to healthcare. Asking trans children to understand the consequences for sexual and other health matters of taking CSH (Bell, 138) – which is a treatment they will not encounter until later in their teenage/early adult years – involves a leap of the imagination which will render this standard difficult to meet.
Puberty blockers are characterised as an experimental treatment with unknown consequences in the decision. This impacts strongly on the Court’s holding that it would not be possible for young teenagers to understand the consequences of their decision to take them. However, this has been denied in the medical literature.
This decision is highly cisnormative. It positions cisgender (non-transgender) identity as normal and transition as a dangerous process to be avoided if possible. It is also heavily pathologised. There is no rights-based, affirming language used about trans youth. Trans identity itself is only referred to in terms of the psychological disorder ‘gender dysphoria,’ which people are said to “suffer from.” This adds to the othering of transgender persons and removes the perspective of the individuals concerned from the decision itself.
Lastly, the decision is likely to have an influence on other aspects of minors’ healthcare. Particularly troubling are the implications for reproductive healthcare decisions such as abortion which may also be said to have “lifelong consequences.” The tightening of Gillick competence in Bell is a worrying precedent for those seeking to protect minors’ reproductive autonomy.
The opinions expressed in this piece are solely those of the author, unless otherwise attributed.
The Human Rights Implementation Centre, along with the Centre for Health, Law and Society, are pleased to announce our seminar on the medico-legal consequences of the Bell v Tavistock judgment, which will be held on March 3rd at 1.15pm. Speakers include Robin White (Old Square Chambers), Professor Simona Giordano (University of Manchester), Dr Bianca Jackson (Coram Chambers), Dr Jay Stewart (Gendered Intelligence), and Dr Ruth Fletcher (QMUL). Please see further details at this Eventbrite link.
by Oliver Quick, Co-Director, Centre for Health, Law and Society, University of Bristol Law School
Healthcare harm is a global public health problem. The World Health Organisation estimates that adverse events account for more deaths than either lung cancer, diabetes or road injuries, and that around 80% are avoidable. In low- and middle- income countries,poor quality healthcare accounts for 10-15% of deaths annually. Such statistics are striking if slightly simplistic in that unsafe care combines with pre-existing health conditions and diseases, and avoidabilityassessments are likely based on ideal, rather than real world, conditions. However, in England alone, the additional annual financial costof providing further care to harmedpatientswould equate to employing over 2,000 salaried GPs and 3,500 hospital nurses, much needed given the high number of vacant positions in the NHS workforce.The annual cost of compensating and managing maternity negligence cases(£2.1 billion) now exceeds the amount spent on delivering babies (£1.9 billion.) Remarkably, there remains no coherent cross-government strategy and policy to address these spiralling costs. (more…)
In more ‘normal times’, the start of each new year marks the arrival of media coverage of the ‘divorce season’. Newspapers publish feature articles reporting that the stresses of Christmas prompt many couples to decide that enough is enough, and to make a new year’s resolution to get out of their marriage. Family solicitors duly issue press releases to advertise their services to assist them, both with getting the divorce itself and with sorting out the financial, property and child arrangements that will need to be made to deal with life going forward. In reality, this New Year ‘spike’ in divorce applications may not be much more than an urban myth. The divorce statistics show that in the years from 2011 up to and including 2019, there have only been three years when the first quarter of the year – January to March – has recorded the highest number of petitions (applications for a divorce) filed across the year. Rather, there tends to be a consistent flow of petitions across the year.
[This article is a follow-up to an earlier one by the same author]
Seven months after the removal of Bristol’s statue of Edward Colston in June 2020, the Secretary of State for the Ministry of Housing, Communities and Local Government is concerned. Writing in the Sunday Telegraph on January 18th, Robert Jenrick argued that “We will save Britain’s statues from the woke militants who want to censor our past”, claiming that “Latterly there has been an attempt to impose a single, often negative narrative which not so much recalls our national story, as seeks to erase part of it. This has been done at the hand of the flash mob, or by the decree of a ‘cultural committee’ of town hall militants and woke worthies”. (more…)
The National Audit Office’s Report on its ‘Investigation into government procurement during the COVID-19 pandemic’ found that the relaxation of the standard procurement rules to allow for extremely urgent acquisitions, mainly of PPE, resulted in alarmingly widespread levels of procedural impropriety in the award of up to £18bn in public contracts. Most notably, the NAO report revealed the existence of a ‘VIP procurement channel’ for those with political connections, which resulted in much higher chances of obtaining very lucrative contracts than for those retained under the ‘normal’ pool of potential suppliers. This adds to (and partly explains) earlier reports of very large PPE contracts awarded to companies with no proven track record in the PPE market. (more…)