Dr. Tush Wickramanayaka Chairperson, Stop Child Cruelty Trust

The global definition of a child is a person below the age of eighteen years. A child is the most vulnerable member of a community in any country and requires the attention and protection from adults. Any decision made relating to children must conform to the global principle of child protection, in the best interest of the child. Identifying one’s individuality can be confusing and challenging, especially during the teenage years. Gender identity for some can be daunting with the natural sexual curiosity that develops during adolescence. ‘Gillick Competence’ - is a recognized rule of medical practice when children under the age of sixteen can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent. Otherwise, someone with parental responsibility can consent for them. Whilst some decisions on medical treatment, such as contraceptive treatment, dental treatment, etc. can be made by a Gillick competent child, decisions that affect their lives permanently may not. Let’s be realistic, even adults find it difficult to make life changing decisions at the best of times. In a landmark case in UK in 2020, Kiera Bell, a twenty-year-old transgender won a case in the High Court against the NHS Gender Identity Development Service (GIDS) that offered Bell puberty blockers at the age of sixteen years. The court heard, “Bell had a double mastectomy aged twenty, and now regrets transitioning, which has left her with no breasts, a deep voice, body hair, a beard and affected sexual function. She may well be infertile as a side effect of the drugs.” Kiera was regretful of her decision and was convinced she was not appropriately counselled before receiving puberty blocking therapy. GIDS, the only NHS transgender service halted all treatment. However, the original decision was overturned by the Court of Appeal, UK in 2021 and the guidance on puberty blockers was quashed. The Court of Appeal ruled that the High Court should not have issued guidance on the Gillick test and puberty blockers because it was, “for clinicians to exercise their judgement,” in relation to puberty blocking treatment.

This historical landmark case has opened a wider debate across geographical borders by rights groups and law makers on gender transformation therapy. Whilst the debate on legal and moral ramifications of a minor making decisions is ongoing, a child experiencing gender distress needs time and support, not to be set on a medical pathway they may later regret. As a mother, physician, and human rights defender, I strongly believe that all decisions made relating to children must be in the best interest of the child.”