This case concerned a mother, AB, of a child, XY, who was 15 at time of judgement, seeking a declaration that herself and the father of XY, CD, were able to consent to the administration of ‘puberty blockers’. This is a form of hormone treatment designed to supress the onset of puberty. XY had already started this hormone therapy.
After the landmark judgment in Bell v Tavistock, the NHS amended its guidelines so that patients undergoing hormone therapy needed a ‘best interests’ application to the court before treatment could continue. This is on the finding in Bell that a child would need to have Gillick competence to consent to the administration of puberty blockers. The first key question was therefore:
- Do the parents still have the legal ability to consent to treatment for their children undergoing hormone therapy?
It was held that it was irrelevant whether XY was Gillick competent or not. If they were, they could consent on their own behalf. If they were not, then their parents would be able to do so. Where the child does not make the decision themselves, then the parents have their right to provide consent for their child if they deem it to be in the child’s best interests.
Lieven J therefore held that the parents did have the right to consent to that treatment.
With that decided, the next key questions were:
- Is the administration of puberty blockers a special category of medical treatment which requires the consent of Court on application before they can be prescribed? And;
- Even if the answer to the above is ‘no’, it is a matter of good practice that an application should be made to the court?
With regards to b), Lieven J looked at other cases and treatment could fall under ‘special category’ and determined that these were largely fact-specific and in any case very limited. Puberty blockers did not fall into this definition.
Lieven J continued that, while Bell case doubt on the medical basis of puberty blockers, AB and CD would have weighed up the considerations prior to allowing XY to begin treatment. XY was not found to have overly pressurised their parents to consent to treatment, although it was admitted this may not be the case in all other situations. Where the parents are under pressure, or the child’s treatment team are conflicted as to how to proceed, then the matter should be referred to the court.
This case addresses the fallout from Bell for parents and their children already undergoing treatment at the time of the Bell decision. The aim of the court appears to be a mix between enabling parental rights and allowing parents to act in what they see as the child’s best interests while not giving carte blanche approval of puberty blockers.
Until assessments are completed of all patients currently undergoing treatment as to whether they are Gillick competent, AB v CD & Ors is likely to continue to have significant relevance going forward. With new patients, the case will remain applicable for the interim period between a child expressing the desire to commence treatment and being assessed as Gillick competent.