Bell v Tavistock

On 1 December 2020, the British High Court handed down its judgment in the case of Bell v Tavistock. Keira Bell had received puberty blockers as a teenager and testosterone later on at the Tavistock and Portman NHS Trust gender clinic in London, and came to regret this as a young adult. Together with the mother of another patient, she asked the court to consider whether minors can give valid consent to puberty blockers.

The 2020 judgment

The three judges ruled that it is highly unlikely that a child aged thirteen or younger can understand the consequences of puberty blockers, and questionable whether young people aged fourteen and fifteen can do so. They pointed out that almost all young people who start blockers subsequently go on to take sex hormones, meaning that choosing blockers is effectively also a decision about fertility and sexual function. Where there was doubt, doctors would have to seek the court’s permission. The clinic subsequently suspended new referrals for blockers.

The 2021 appeal

On 17 September 2021, the Court of Appeal overturned the judgment. According to the court, the lower court should not have issued general guidance based on age. Whether a minor can consent is an assessment for doctors, not the courts. In 2022, the UK Supreme Court refused permission for a further appeal.

Who is Keira Bell

Keira Bell was referred to the gender clinic at the age of fifteen. After a few consultations, she was given puberty blockers at sixteen and testosterone a year later. At twenty, she underwent a mastectomy. She stopped treatment shortly afterwards. In the legal proceedings, she argued that the clinic should have questioned her more critically as a teenager. Her story made detransition a subject of public debate in the United Kingdom.

The legal framework: Gillick competence

The case centred on a concept in English law known as Gillick competence. In 1985, the highest British court ruled that a child under sixteen can consent to medical treatment if they have sufficient understanding and intelligence to comprehend what the treatment involves. Whether this is the case is assessed by the doctor for each child and each treatment. In 2020, the High Court found that the consequences of puberty blockers are so significant and uncertain that young teenagers can almost never understand them. The Court of Appeal ruled that the lower court had overstepped its role by taking the place of doctors.

The months between the two judgments

In the meantime, clinical practice changed significantly. NHS England determined that young people under sixteen could only start puberty blockers after a separate assessment. In March 2021, another judge ruled, in a case brought by parents, that parents can consent on behalf of their child if the child is unable to do so themselves. Even after the appeal, the previous situation did not return: an independent group of experts continued to assess every new request, until prescribing was stopped altogether in 2024; see the UK ban.

Significance

Although the clinic won the legal case, it had major consequences. The treatment of minors came under intense scrutiny in the United Kingdom, and the independent review by paediatrician Hilary Cass, which had begun in 2020, gained additional significance. In 2022, the clinic itself was told that it had to close; see the closure of the Tavistock gender clinic. How the case relates to the other turning points in youth gender care is set out on transtijd.nl in the overview of turning points in transgender healthcare. The Cass investigation led to the Cass Review in 2024.