Royal Children’s board must not ignore judge’s trans case findings
Justice Andrew Strum, who recently decided the case of Re Devin, was so concerned about the evidence he heard from a clinician at the Royal Children’s Hospital in Melbourne he prohibited a mother from taking her son back to its gender service unless the father agreed.
Justice Strum also considered it in the public interest to name one of the experts, the hospital’s chief of medicine, Michelle Telfer, who has been Australia’s foremost leader in promoting what some call “gender-affirming care”.
In the way the best judges do, he delivered a carefully reasoned explanation about why he found the RCH’s practices so disturbing, based on the trial evidence that had lasted four weeks.
At the heart of his concerns was that Telfer – and the other expert witness who was identified only as a “senior clinical psychologist” – did not offer the court a coherent justification for their clinical practice. Telfer and the senior clinical psychologist, the judge noted, believe gender identity is “internal and immutable” and not open to external influence. But he observed “neither of those experts were able to point to any empirical or substantive basis for their opinion but, rather, only to anecdotal reports from transgender adults”.
According to Justice Strum, Telfer made assertions that seemed to contradict the idea that a child’s gender identity is immutable. Neither clinician could say at what age children have the capacity to know their “true” gender identity, but both were confident that in this case the child could do so when he was only six years old.
The questions raised by Justice Strum are important. At the heart of the issue is whether a young person’s gender identity is innate and immutable. The RCH’s own published data shows 25 per cent of its young patients have had eating disorders and 45 per cent have autistic traits. This is consistent with research elsewhere. Many of these young people seeking medical treatment from gender clinics have had adverse childhood experiences, including child abuse and family breakdown. Insisting these factors are quite independent of the young person’s identification as “trans” seems to fly in the face of all the evidence.
Judges are sometimes critical of expert witnesses, but this was much more than criticism about some details. Justice Strum expressed concern about the basis of the RCH’s practices. If gender identity in children is not immutable – and the overwhelming evidence from research is that it is not – why would we put primary school children on a pathway to irreversible modifications of their sex characteristics?
We might do that if the evidence of benefit is overwhelming and the risks of not treating are grave. But one systematic review after another across the world has been unable to find such evidence. The consensus is, the evidence to support the benefits of prescribing puberty blockers and cross-sex hormones to minors is very weak. Without puberty blockers, the majority of children seen at specialist gender clinics have resolved their gender incongruence before, or during, puberty.
This month a high-profile study in the US, led by a well-known proponent of gender-affirming care, Jo Olson-Kennedy, found no mental health benefits from puberty blockers. Yet at the time they entered the study, before receiving puberty blockers, 28.6 per cent of these children reported elevated depression symptoms and 22 per cent had clinically significant anxiety.
After an experienced and highly respected judge has so strongly criticised the hospital’s chief of medicine, and called into question the clinical practices at its gender service, one might expect the chief executive or the board to announce the hospital was treating the issues raised with the utmost seriousness. In a similar situation, other hospital boards might well have announced a formal independent inquiry.
Instead, the hospital released a statement saying its gender service delivers a “world-leading, multidisciplinary model of care”.
Really? The RCH did not go on to explain which countries are following its lead. In Britain, after the landmark Cass review, the Labour government has banned the use of puberty blockers for the treatment of gender dysphoria outside a clinical trial. In Scandinavia and elsewhere, governments have taken a restrictive approach to puberty blockers and cross-sex hormones for minors, preferring a psychotherapeutic approach in the first instance. The treatment is banned or restricted in 25 US states and, this month, these laws were upheld as constiutional by the US Supreme Court in US v Skrmetti.
Last month, this newspaper revealed that the gender service’s treatment protocol had not been approved by the RCH’s new technology and clinical practice committee in the normal way. A prerequisite for approval by that committee is that “evidence of efficacy and clinical effectiveness must exist”.
The Australian’s report indicates the committee was not provided with such evidence.
The RCH’s reputation is on the line. The situation in Victoria is no doubt complicated by the position of its government, which has championed the practices of the RCH gender service and incorporated the underlying beliefs of the transgender movement into its educational policies and programs.
But this is an issue about whether the RCH is practising evidence-based medicine. It is also a child protection issue, for the consequences of providing unnecessary and irreversible treatments to children, with such adverse and lifelong effects, could be grave. This is a board responsibility now. It must not shirk it.
Patrick Parkinson is emeritus professor of law at the University of Queensland.
Building a future on guesses and gambles
There are many subtle ways in which the budget figures can be manipulated to show the NSW government’s fiscal approach in the best possible light.
Treasurer borrows from state Labor’s playbook in debt shuffle
Queensland Treasurer David Janetzki is clearly of the view that hypocrisy can be a virtue in politics. It’s how you spin it that matters.