Session 12.2 Changing Approaches to Paediatric Gender Dysphoria / Incongruence: Different Strategies for Regulation of Medical Treatment and Requirements for Informed Consent
Tracks
Track 2: Room LG18
| Wednesday, July 30, 2025 |
| 4:00 PM - 5:30 PM |
| LG18 - The David Li Kwok Po Lecture Theatre |
Overview
Panel Session
Chair: The Honourable Diana Bryant AO KC, Chair of the World Congress
Moderator: Ms Belle Lane, Victorian Bar, Australia
Panellists:
- Professor Sallie Baxendale, UCL Queen Square Institute of Neurology, UK
- Professor Lodewijk Smeehuijzen, VU Amsterdam
Details
Overview
The treatment of paediatric gender identification is a controversial area of medicine, despite assertions of a medical consensus. In the last 10 years, the medical transition of children has been a dominant treatment for gender dysphoric children in many Western countries. When parents can’t agree on the medical transition of their children, the family and children’s courts must decide.
In Australia and other countries, the WPATH Standards of Care have been interpreted to mean that if a child identifies as TGD, wishes to have medical treatment and believes that they will not be ok without it, they should have access to medical treatment. The Australian Courts are told that the treatment is not recommended by the doctor, but is requested by the child.
However, in Northern Europe some early adopters of this model have changed course due to the lack of evidence base of the treatment approach and concerns about significant impacts and children’s capacity to understand the impacts.
Countries such as Finland, Sweden, Norway and the United Kingdom have had to develop regulations for access hormonal and surgical interventions by children. They have also reconsidered what information should be provided to parents and children in light of a shifting complex evidence base and what level of understanding a child should have before treatment should be authorised.
The session will address:
1. Different strategies for the regulation of access to Puberty blockers, Cross-sex hormones and surgery for children with gender identity or gender Dysphoria.
2. Different views about what the following mean in this context:
a.Informed consent
b.Gillick competence / child’s understanding.
In Australia and other countries, the WPATH Standards of Care have been interpreted to mean that if a child identifies as TGD, wishes to have medical treatment and believes that they will not be ok without it, they should have access to medical treatment. The Australian Courts are told that the treatment is not recommended by the doctor, but is requested by the child.
However, in Northern Europe some early adopters of this model have changed course due to the lack of evidence base of the treatment approach and concerns about significant impacts and children’s capacity to understand the impacts.
Countries such as Finland, Sweden, Norway and the United Kingdom have had to develop regulations for access hormonal and surgical interventions by children. They have also reconsidered what information should be provided to parents and children in light of a shifting complex evidence base and what level of understanding a child should have before treatment should be authorised.
The session will address:
1. Different strategies for the regulation of access to Puberty blockers, Cross-sex hormones and surgery for children with gender identity or gender Dysphoria.
2. Different views about what the following mean in this context:
a.Informed consent
b.Gillick competence / child’s understanding.
Speaker
Ms Belle Lane
Barrister and Mediator
Victorian Bar
Changing Approaches to Paediatric Gender Dysphoria / Incongruence: Different Strategies for Regulation of Medical Treatment and Requirements for Informed Consent
Biography
Professor Sallie Baxendale
Professor Of Clinical Neuropsychology
UCL Queen Square Institute of Neurology
Changing Approaches to Paediatric Gender Dysphoria / Incongruence: Different Strategies for Regulation of Medical Treatment and Requirements for Informed Consent
Abstract
Informed consent for elective medical treatments relies upon four elements: correct diagnosis, accurate information regarding the potential benefits of the proposed treatment, accurate information regarding the potential harms and the neuropsychological capacity of the patient to understand this information and weigh it up to make a decision.
Prof Baxendale will explore each of these areas with a particular focus on the neuropsychological capacity of children and adolescents to make decisions and the neurobiological underpinnings of decision-making during this dynamic stage of brain development. Teenagers are able to make decisions but they assess risk differently to adults. Adolescence is a time of increased risk taking when social acceptance by one’s peers becomes a key motivator. Adolescents also spend more time in more emotionally charged (“hot”) situations, where strong feelings like excitement, fear and stress are present; these strong emotions can lead to greater impulsivity and risk taking in decision-making. The implications of the scientific literature on decision making in teenagers with respect to their capacity to give informed consent for elective medical treatments with irreversible impacts will be discussed.
Prof Baxendale will explore each of these areas with a particular focus on the neuropsychological capacity of children and adolescents to make decisions and the neurobiological underpinnings of decision-making during this dynamic stage of brain development. Teenagers are able to make decisions but they assess risk differently to adults. Adolescence is a time of increased risk taking when social acceptance by one’s peers becomes a key motivator. Adolescents also spend more time in more emotionally charged (“hot”) situations, where strong feelings like excitement, fear and stress are present; these strong emotions can lead to greater impulsivity and risk taking in decision-making. The implications of the scientific literature on decision making in teenagers with respect to their capacity to give informed consent for elective medical treatments with irreversible impacts will be discussed.
Biography
Professor of Clinical Neuropsychology at the UCL Queen Square Institute of Neurology and the Lead Consultant Neuropsychologist for the epilepsy surgery program at the National Hospital for Neurology, Queen Square. She has over 200 academic publications in neuropsychology, including books, book chapters and original research studies and was awarded the International Neuropsychological Society Arthur Benton Prize in 2018 in recognition of her outstanding scientific contributions to the field of neuropsychology and received the Distinguished Contribution Award from the British Psychological Society in 2023. She is a passionate advocate for the application of neuropsychological principles and knowledge in public policy and discourse. Her research and clinical interests focus on understanding the multi factorial nature of cognitive impairments in clinical populations. Her review of the impact of puberty blockers on neurodevelopment featured in The Cass Review.
Professor Lodewijk Smeehuijzen
Professor Of Private Law
Vrije Universiteit Amsterdam
Changing Approaches to Paediatric Gender Dysphoria / Incongruence: Different Strategies for Regulation of Medical Treatment and Requirements for Informed Consent
Abstract
In the Netherlands, care for children with gender dysphoria is provided on the basis of the Dutch Protocol (2018). This is a medical protocol. Normally, medical protocols are guiding in the interpretation of the medical-professional standard. For a protocol to indeed be guiding, it must (i) be evidence-based, (ii) have a limited medical-ethical dimension and (iii) be created in an appropriate process. In this presentation, these three requirements will be discussed.
Biography
Lodewijk Smeehuijzen holds a master’s in law from the University of Amsterdam (1996). He practiced law for five years at De Brauw Blackstone Westbroek and Houthoff Buruma (1996 – 2001), concentrating on litigation and commercial contracts. In 2008 he defended his Ph.D. thesis (cum laude) on limitation of actions. He currently is professor of private law at the VU law faculty and honorary judge in the Court of Appeal Arnhem-Leeuwarden. In 2016 he received the Frank van der Duijn Schouten award for best senior teacher of the VU-University. He is annotator of the leading journal on Dutch Supreme Court cases - de Nederlandse Jurisprudentie.
Lodewijk initiated a series of Master programmes over the years, the most recent being International Business Law: Climate Change and Corporations. He is also director of Ondernemingsrecht aan de Zuidas. He teaches Contract Law, Tort Law, Law of Obligations, Law & Governance, Climate Change Liability and Law and Circularity.
In his teaching he aims to take the law out of the books and demonstrate its real-life implications. He does this by involving students in his empirical research, by closely cooperating with legal practice (guest lectures at law firms, banks, regulators, NGO's) and by involving disciplines such as economics and psychology.
Lodewijk writes in the areas of contract law, tort law, climate litigation, corporate law, transgendercare for children, civil procedure and legal theory. About half his work is based on classical legal research methods, focusing on doctrinal issues. The other half is law-in-action oriented, inspired by empirical research and mostly in collaboration with others.
Professor Claire Fenton-Glynn
Professor of Law
Monash University
Changing Approaches to Paediatric Gender Dysphoria / Incongruence: Different Strategies for Regulation of Medical Treatment and Requirements for Informed Consent
Abstract
Adolescence is a time of significant physical, cognitive and emotional development. However, such development is not consistent or linear. The incidence of many mental disorders peak between ages 12 and 25. Severe mental disorders usually impair the completion of developmental tasks of adolescent and complicate identity development.
Children seeking gender services have higher rates of co-morbid mental health issues and neurodiversity than the general population. This makes the task of ensuring correct diagnosis and informed consent more complex. Prof Kaltiala will discuss Finland’s research and its subsequent move from the Dutch Protocol to noninvasive approaches and the sharp restricting of eligibility for hormonal interventions.
Children seeking gender services have higher rates of co-morbid mental health issues and neurodiversity than the general population. This makes the task of ensuring correct diagnosis and informed consent more complex. Prof Kaltiala will discuss Finland’s research and its subsequent move from the Dutch Protocol to noninvasive approaches and the sharp restricting of eligibility for hormonal interventions.
Biography
Claire Fenton-Glynn is a Professor of Law at the University of Monash, Australia. She was previously the Professor of Child and Family Law at the University of Cambridge, and Director of Cambridge Family Law.
Claire’s research lies in the field of children’s rights, comparative law and international human rights law. She has published on a wide range of issues including parenthood (especially international surrogacy), child trafficking and gender identity. Claire's work has been cited by the UK Supreme Court, the England and Wales Court of Appeal, the Law Commission of England and Wales, and the United Nations Special Rapporteur on the Sale of Children.
Claire is the Managing Editor of the Australian Journal of Family Law, and is on the Editorial Board of the International Journal of Law, Policy and the Family. She was an Academic Fellow of Inner Temple, and has worked with organisations such as UK Foreign, Commonwealth and Development Office and the Irish Department of Children, Equality, Disability, Integration and Youth, as well as the United Nations Office of the High Commissioner for Human Rights, the European Union, Save the Children, and Avocats Sans Frontieres on issues concerning child protection, human rights, and rule of law.
