The care and treatment of children and adolescents in relation to their gender identity in the UK (2021)

Background Paper

Exploratory project

A transfeminine non binary person and transmasculine gender nonconforming person looking at a phone and laughing

Project update - November 2021

In autumn 2019, we spoke to a wide range of people about the challenges involved in providing care and treatment for young people in relation to their gender identity. From those meetings, we found that there are many areas of consensus, but also a number of unresolved ethical questions that deserve further consideration. We, along with many of the stakeholders involved in the initial meetings, felt that there was a clear role for the Council to play in facilitating further discussion about the ethical challenges in this area, and that we could make a positive contribution to the care and treatment of gender diverse young people in the UK.

In early 2021, we began gathering more evidence to inform a further exploratory project, and we are very grateful to those who contributed and engaged with us. Since then, there have been a number of external developments - for example, the recent Court of Appeal ruling in Bell v Tavistock, and the NHS’s ongoing independent review of services. In light of these developments we reflected carefully on the initial objectives of the project and whether and how we might still be able to make a helpful, constructive contribution to policy development in this area.

Following a number of discussions among the project working group and amongst our Council Members we came to a decision in November 2021 that this was not the right moment for us to take forward this work in its current form, therefore we made the decision not to continue with the project at this time.

We do not rule out either returning to this project at a later date or taking on a more substantial project as part of our future programme of work. We are enormously grateful to everyone who engaged with us during the consultation and engagement to help us with our exploration of the ethical issues.

About the project

The aim of this project was to explore the ethical issues which arise in the care and treatment of children and adolescents in relation to their gender identity. This is an area in which there are deeply held scientific and moral disagreements about how we as a society should care for, treat, and support gender diverse children and adolescents. We aimed to explore some of the issues which underline those disagreements, including:

  • different understandings of gender dysphoria and how this affects approaches to care and treatment;
  • differing interpretations of the existing evidence base and what this means for clinical practice;
  • current approaches to care and treatment, including pharmacological interventions, gender affirmation, and social transition;
  • the balancing of different types of benefits and harms in treatment and non-treatment; and
  • ideas about autonomy, choice, and the decision-making capacity of children and young people.

The focus of this work was on wide and comprehensive engagement and consultation with individuals and groups in order to ensure we hear a range of perspectives and experiences, for example through an open call for evidence, followed by more focused and targeted engagement with relevant groups and individuals through meetings, interviews, and other events and activities.