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When it comes to transgender healthcare, time and time again we see the concept of safeguarding used to try and help support our patients, but we also see it used in an attempt to seemingly restrict their options.

‘Gillick competence’ is a term originating in England and is used in medical law to decide whether a young person (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge. It helps people who work with children and adolescents to balance the need to listen to the wishes of a youngster, with the responsibility for keeping them safe.

Yet when the concept is applied to whether or not a young person is capable of making a decision about their gender, it leads to polarised and politicised debate.

 

We often hear the following narratives from those coming to our service and we would like to openly address them as they provide some interesting insights into how young (trans) people are viewed in this country:

 

How can you be sure that the young person has the consent of their parent or legal guardian?

The implication is that if they don’t have consent, they shouldn’t have access to care. This is incredibly problematic – we know how devastating and dangerous it can be to have a parent or guardian who doesn’t support their young person. The truth is that the reasons for this lack of support can be multifactorial, including because they are actively against the concept or belief that their child is trans.

 

How can you be sure that the adult with them is truly their parent or guardian, and is not just pretending to be such?

The objective in this instance is to demonstrate that the young person in question has adult support. Someone who knows and can vouch for the youngster. If we feel compelled to secure that additional endorsement, if we feel the need for the perspective of the trans youth to be corroborated, then we believe the important factor is that the adult in question is able to give support, rather than whether they are acting in the official capacity as parent or guardian to the young person.

 

How do you know that they have the capacity to consent to their own treatment?

Well – we talk to them, and listen to them and understand them. They can’t just ‘tick this box’ and be prescribed medication. We don’t work that way. Good Medical Practice is to start from the standpoint that people have the capacity to understand the options being presented to them. It will soon become clear to an experienced practitioner if the capacity to understand is lacking.

 

How can you be sure they won’t change their mind?

Because they don’t. That is the fear of every cisgender person when presented with a transgender person. It is time to start from a position of belief and listen to the thousands of trans people who have been willing to share their experiences. Personal fear is not a legitimate reason to deny someone else the care that they need.

 

Safeguarding trans youth – best practice according to GenderGP

  • Young people need to be listened to and believed from the outset.
  • The aim should be to support them in the exploration of their gender, not to limit their choices simply because they are young.
  • In line with Gillick Competency, young trans people are legally able to be involved in decisions about their healthcare.
  • Not every young person has the support of their family, that is indeed a safeguarding risk, but should not be used as a reason to deny access to care.
  • Young people should be encouraged to seek help from another responsible adult if their legal guardians are unable to provide that support.
  • Young people who are not believed and who are denied access to supportive healthcare options are suffering, this puts their mental and physical health at risk.

 

We would like to send out a very clear message to those who are worried about the safety of trans youth:

 

GenderGP has the experience of listening to, caring for and looking after hundreds of trans youth. It is vital that they have access to healthcare options. To deny them access to care on the basis of a restrictive tick box list of safeguarding issues is a safeguarding threat in itself. The real threat to them comes from the lack of autonomous gender-affirming care.

 

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