The High Court has recently ruled that children under
sixteen are unlikely to be able to give informed consent to puberty blocking
treatment. There are of course lots of treatments that under sixteens cannot
understand. There are illnesses and treatments indeed that adults struggle to
understand. Faced with a serious illness no one can know exactly what the
result of treatment will be not even the doctors. What then should be so
problematic about puberty blocking?
The High Court is making the issue one of age, but it
is hard to see any major differences between the thought processes of a fifteen-year-old
and a twenty-five-year-old. School children have to make life changing decisions
when they choose which subjects to study at school. A decision to concentrate
on playing football may lead a twelve-year-old to a job where he earns
thousands a week or alternatively to unemployment, but we allow him to make it.
What is so particularly problematic about the decision to take puberty
blockers?
The reason the case came to the High Court at all is
that Keira Bell believed during her teens that she was a boy. She went to Tavistock
and Portman NHS Trust sought advice and treatment. She was prescribed puberty
blockers and later male hormones. She had surgery to remove her breasts. After
all this she decided that she was not after all a man and wanted to revert to
being a woman.
The problem with puberty blockers is that they can
only be prescribed to children and in some cases the effects of taking such
drugs is permanent. If a girl takes puberty blockers, she may be infertile. If
she takes testosterone she may be left with permanent physical changes to her
voice, her hair and her body. If she has parts of her body such as breasts removed,
they can no more be replaced than if she had a leg removed. If she decides to
have surgery on her genitals, it may not be possible to reverse this process.
The reason such treatment was problematic in Keira
Bell’s case was fundamentally not because she was too young to make the
decision, but that she changed her mind. If she had been happy with her male
identity there would have been no need to worry when she had the puberty
blockers.
Keira Bell did not have an illness like cancer, where
there was no real alternative to treatment. Her treatment was not because she
was in a conventional sense ill at all. Doctors looking at her body would have found
nothing malfunctioning and no illness that would lead to death if untreated. If
there was an illness it was psychological.
But this is our problem. We normally treat psychological
problems with therapy and drugs. We don’t treat them with surgery anymore. Indeed,
cutting out bits of people’s brains because of psychological problems is
considered barbaric today. Why then do we treat the problem that Keira Bell had
by hormones and mutilation of otherwise healthy body parts?
What is it for someone to believe that they are a boy?
Keira Bell believed she was a boy and sought treatment with puberty blockers.
She now believes that she was mistaken. But how do we discover the truth of her
belief?
In recognising the problem of someone changing their
mind, the High Court has implicitly said that someone who sincerely believes he
is a girl can be mistaken. It is for this reason that he cannot consent to the
treatment. But what can this mistake consist in?
One hundred years ago if Keira Bell had gone to a
doctor and seriously claimed that she was a boy, the doctor would have examined
her and would have told her, I’m sorry but you are mistaken. You are a girl
because you have a female body. It is not possible to change this. This is how
you were born, and this is how you will remain.
But now what is it that makes someone a girl or a boy.
How do we distinguish between the one and the other? If a girl’s belief that
she is a boy is enough to justify puberty blockers though this belief contradicts
her having a female body, then how can it be that she could later be mistaken? To
suppose that Keira Bell was mistaken about her being a boy is to suppose that
there is a truth that she really was a girl and really is a woman, based not
merely on how she feels or what she believes, but about what she actually is.
To suppose that it is problematic to give children
puberty blockers is to suppose that a girl might make a mistake in supposing that
she is a boy. But to suppose this is to suppose that there is a way of
objectively determining that someone is a girl and a boy otherwise there can be
no question of making a mistake and likewise no question of regret.
If it were true that Keira Bell now really is a man
then there would be no reason for her to regret the treatment which attempted
to change her body from that of a girl to that of a boy. The problem is that Keira
Bell thought she was a boy, but really was a girl. If that is not the case the
High Court has no reason to prevent children receiving puberty blockers.
But once we accept that there is a reality to someone
being a boy or a girl and that this is determined objectively, the
justification for transgender treatment like puberty blockers collapses. The
problem of transgender becomes a problem of mind requiring the person to accept
the reality of what he is, rather than a problem of body requiring parts to be
added or subtracted.
Once we accept that a girl can be mistaken about being
a boy, then logically we must realise that a man can be mistaken when he thinks
that he is a woman. But how are we to discover the truth? We cannot look into people’s
minds and anyway if a mind can be mistaken about whether it belongs to a man or
a woman, we are not going to find the answer there. How can we adjudicate the
mistake?
The only answer is to accept that being a man or a woman
has nothing whatsoever to do with someone’s mind. We adjudicate who is a boy
and who is a girl by the body of each. Once we accept this then the problem of transgender
dissolves. Doctors must simply tell adults and children that there is no such
thing as transgender. They can mutilate their bodies as much as they please.
They can pump themselves with male or female hormones. They can have male or
female genital mutilation. But none of these things will change what they are.
Once people learn that there really is no changing who
they are there is the first stage of accepting it. At this point it may be
possible to develop therapies that alleviate the problem. But having a true and
realistic belief is the foundation of all psychological wellbeing.
The High Court has destroyed the intellectual
foundation of Transgenderism. Once you accept that Keira Bell thought she was a
boy, but she was mistaken, then the idea that being a girl or a boy is a matter
of belief collapses. It is a matter of reality.
At some point in the future Transgenderism will be looked on like phrenology except that phrenology despite being mere pseudoscience and quackery was more plausible.