Bell v Tavistock: Why the assent model Is most appropriate for decisions regarding puberty suppression for transgender and gender diverse youth

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The decision of the High Court of England and Wales in Bell v Tavistock [2020] EWHC 3274 (Admin) raises important questions regarding best care for transgender and gender diverse (TGD) youth. In this section, I describe this case, its ruling, and its implications. The ruling is underpinned by the position that puberty suppression can only be ethically and legally permissible where the young person has not only provided their assent but has also been deemed capable to provide valid consent. I challenge this position on three grounds. First, it overlooks the key ethical question of whether puberty suppression is in the individual's best interests. Second, withholding puberty suppression until the young person can consent will likely result in harmful, irreversible consequences for them. Finally, puberty suppression is not sufficiently potentially harmful to justify the additional protection offered by requiring patient consent and court authorisation. For these reasons, I argue that an assent model should govern decisions about puberty suppression for TGD youth.

Original languageEnglish
Pages (from-to)632-644
Number of pages13
JournalJournal of Law and Medicine
Issue number3
Publication statusPublished - 1 Mar 2021
Externally publishedYes


  • assent
  • best interests
  • clinical ethics
  • consent
  • paediatrics
  • puberty suppression
  • transgender

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