Originally a comment by Enzyme on Under the influence.

we should be able to give informed consent to our own treatment – just as any cisgender young person already can

Yeah, but no. It’s more complicated than that.

First of all, define “young person”. Since we’re talking about puberty-blockers, then that’s going to be someone who is at most in their early teens. So can – let’s say – a 12-year-old consent to treatment? Sometimes. it depends on the treatment, and on the child.

Importantly, though, consent doesn’t mean demand. Too many people think that it does. Consent is a negative thing: it’s about my being able to tell you what you not do to me, not about my being able to tell you what you should. Or, perhaps, we could say that the default is that treatment should not be given, but consent lifts the barrier.

In effect, it means that the doctor comes up with a suggestion that is expected to serve the child’s (or any other patient’s) best interests, and the child (or adult patient) agrees to it. Sometimes, there’ll be more than one option, because treatment modalities have up- and downsides. Sometimes there’ll be more than one option, because what counts as “best interests” is open to debate: medical, social, in keeping with the patient’s account of the kind of life they want to lead, and so on. To give a hackneyed example, the JW might sincerely believe that it is in her best interests not to have the blood transfusion, and given a sufficiently strong commitment about the kind of life she’d find tolerable, then that’s all fine and groovy.

That, in essence, is what Gillick v West Norfolk was all about. And I think that some people get misled by that because, superficially, it lends itself to the fallacy that consent is the same as request or demand. But presumably the doctor in that case thought that prescribing the pill was in the girl’s best interests; had he not thought that, he ought not to have been offering it. In a way, it was fortuitous that she asked for it; but her having asked for it wasn’t really the driving force behind its prescription being permissible.

And so: can these kids give consent? Possibly some can, though since PBs are most use to the very young, the more useful they are, the less likely it is that consent would be possible. But all that rides on there being a medical consensus that they should be offered to begin with. Keira Bell had argued that as a matter of fact, she could not give consent to gender-treatment because not enough was known about them. As we know, she lost. But post-Cass, I’m not sure that a parallel case would be lost, because we now know that there’s not really evidence that it serves anyone’s interests. Therefore they shouldn’t be offered. Therefore consent is neither here nor there.