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Informed consent: the decision-making capacity of children in relation to gender-affirming treatment

Massey, Olivia LU (2021) LAGF03 20211
Department of Law
Faculty of Law
Abstract (Swedish)
När High Court of Justice avkunnade dom i målet Bell v Tavistock konstaterade domstolen att barn under 16 års ålder som lider av könsdysfori högst troligen inte kan ge ett giltigt samtycke till pubertetsbromsande hormonbehandling eller könskonträr hormonbehandling. Världen fick då ta del av berättelsen om en ung flicka som genomgått identitetsbekräftande vård och sedan ångrat sitt beslut. Denna uppsats har undersökt barns medicinska självbestämmanderätt och mer specifikt dess förmåga att samtycka till de vårdinsatser som kan tänkas ingå i identitetsbekräftande vård, först enligt nationell rätt och därefter enligt Barnkonventionen. Det har funnits få nationella bestämmelser att luta sig på
och rättsläget förefaller osäkert. Gällande rätt... (More)
När High Court of Justice avkunnade dom i målet Bell v Tavistock konstaterade domstolen att barn under 16 års ålder som lider av könsdysfori högst troligen inte kan ge ett giltigt samtycke till pubertetsbromsande hormonbehandling eller könskonträr hormonbehandling. Världen fick då ta del av berättelsen om en ung flicka som genomgått identitetsbekräftande vård och sedan ångrat sitt beslut. Denna uppsats har undersökt barns medicinska självbestämmanderätt och mer specifikt dess förmåga att samtycka till de vårdinsatser som kan tänkas ingå i identitetsbekräftande vård, först enligt nationell rätt och därefter enligt Barnkonventionen. Det har funnits få nationella bestämmelser att luta sig på
och rättsläget förefaller osäkert. Gällande rätt består till största del av principer som inte förekommer i lagstiftning och endast i svag utsträckning i praxis. Principerna innebär en långtgående självbestämmanderätt för barn i medicinska ärenden som enligt en huvudregel alltid ska avgöras genom individuell bedömning. Barnets vårdnadshavare har både rätten och skyldigheten att bestämma i barnets personliga ärenden enligt 6 kap. 11 § FB tills han eller hon fyller 18 år. Små barn kan behandlas med en vårdinsats efteratt proxy-samtycke ges av vårdnadshavarna. De har ingen egen självbestämmanderätt. Allt eftersom barnet
mognar, ökar förmågan att fatta egna beslut. Först inträder negativ självbestämmanderätt (förmågan att avböja behandling) och successivt även positiv självbestämmanderätt (förmågan att godta eller söka behandling). Det finns inga lagstadgade bestämmelser som reglerar hormonbehandling eller de ingrepp som inte
behandlas i lagen (1972:119) om fastställande av könstillhörighet i vissa fall. I stället gäller Socialstyrelsens rekommendationer som för närvarande är under revidering. Efter att ha informerats i enlighet med Patientlagen (2014:821) och beslutat i samråd med vårdnadshavarna får barnet behandlas med pubertetsbromsande hormonbehandling. Då könskonträr hormonbehandling och kirurgi blir aktuellt har barnet ofta tillträtt en ålder i vilken han eller hon tillerkänns positiv självbestämmanderätt. Vårdnadshavarnas inflytande minskar väsentligt, om inte helt och hållet. Denna utveckling finner generellt stöd i Barnkonventionen, som möjligen eller möjligen inte ger barnet en rätt till identitetsbekräftande behandling. Denna alltmer uppmärksammade fråga är mycket privat till sin natur och innebär sammandrabbningar mellan barnet, vårdnadshavaren och vårdgivaren. Den
innehåller flera etiska överväganden för lagstiftaren och samhället i stort. (Less)
Abstract
When the High Court of Justice ruled in Bell v Tavistock that children under the age of 16 suffering from gender dysphoria most likely could not consent to being treated with puberty blockers or cross-sex hormones, the verdict told the story of a young girl who underwent gender-affirming treatment and later came to regret her decision. This essay studied the decision-making capacity of children and their ability to consent to medical treatment and more specifically to gender-affirming treatment, examining first domestic provisions and subsequently the UN Convention on the Rights of the Child. It concludes that domestic statutory provisions are few and that the legal area is prone to uncertainty. This is largely because of a
custom under... (More)
When the High Court of Justice ruled in Bell v Tavistock that children under the age of 16 suffering from gender dysphoria most likely could not consent to being treated with puberty blockers or cross-sex hormones, the verdict told the story of a young girl who underwent gender-affirming treatment and later came to regret her decision. This essay studied the decision-making capacity of children and their ability to consent to medical treatment and more specifically to gender-affirming treatment, examining first domestic provisions and subsequently the UN Convention on the Rights of the Child. It concludes that domestic statutory provisions are few and that the legal area is prone to uncertainty. This is largely because of a
custom under which children have been granted far-reaching decision-making capacity and autonomy in medical matters, heavily dependent on individual assessments as a rule. The parental right and duty to decide on behalf of the child in his or her personal matters is established in Chapter 6, Section 11 of the Parental Code and it persists until he or she turns 18 years old. Young
children may receive treatment by parental proxy-consent as they have no decision-making capacity of their own. As the child matures, the capacity to make his or her own decisions progresses. This initially manifestsas a negative decision-making capacity (the ability to decline treatment) and gradually expands to a positive decision-making capacity (the ability to accept or request treatment).
There are no legislative provisions concerning the administration of puberty blockers, cross-sex hormones, or the surgical procedures which the Gender Classification Act (1972:119) does not regulate. Treatment is instead administered according to recommendations issued by the National Board of Health and Welfare, currently under revision. These assert that the child may receive puberty
blockers after having received appropriate and adequate degree of information according to the Patient’s Act (2014:821), together with the parent(s) or legal guardian, jointly making the decision. When cross-sex hormones and surgery might come into question, the child is usually of an age where he or she is in possession of positive decision-making capacity, leaving the parents with less influence in the matter, if any at all. This development of maturity in relation to autonomy finds general support by the provisions of the UNCRC, which may or may not give a right to gender-affirming treatment. This increasingly observed issue is of a considerably private nature and constitutes a clash between the
child, the parent, and the caregiver. It contains several ethical considerations for the legislator and society. (Less)
Please use this url to cite or link to this publication:
author
Massey, Olivia LU
supervisor
organization
course
LAGF03 20211
year
type
M2 - Bachelor Degree
subject
keywords
informed consent, medical law, social law, child law, gender-affirming treatment
language
English
id
9045967
date added to LUP
2021-06-29 16:40:06
date last changed
2021-06-29 16:40:06
@misc{9045967,
  abstract     = {{When the High Court of Justice ruled in Bell v Tavistock that children under the age of 16 suffering from gender dysphoria most likely could not consent to being treated with puberty blockers or cross-sex hormones, the verdict told the story of a young girl who underwent gender-affirming treatment and later came to regret her decision. This essay studied the decision-making capacity of children and their ability to consent to medical treatment and more specifically to gender-affirming treatment, examining first domestic provisions and subsequently the UN Convention on the Rights of the Child. It concludes that domestic statutory provisions are few and that the legal area is prone to uncertainty. This is largely because of a
custom under which children have been granted far-reaching decision-making capacity and autonomy in medical matters, heavily dependent on individual assessments as a rule. The parental right and duty to decide on behalf of the child in his or her personal matters is established in Chapter 6, Section 11 of the Parental Code and it persists until he or she turns 18 years old. Young
children may receive treatment by parental proxy-consent as they have no decision-making capacity of their own. As the child matures, the capacity to make his or her own decisions progresses. This initially manifestsas a negative decision-making capacity (the ability to decline treatment) and gradually expands to a positive decision-making capacity (the ability to accept or request treatment).
There are no legislative provisions concerning the administration of puberty blockers, cross-sex hormones, or the surgical procedures which the Gender Classification Act (1972:119) does not regulate. Treatment is instead administered according to recommendations issued by the National Board of Health and Welfare, currently under revision. These assert that the child may receive puberty
blockers after having received appropriate and adequate degree of information according to the Patient’s Act (2014:821), together with the parent(s) or legal guardian, jointly making the decision. When cross-sex hormones and surgery might come into question, the child is usually of an age where he or she is in possession of positive decision-making capacity, leaving the parents with less influence in the matter, if any at all. This development of maturity in relation to autonomy finds general support by the provisions of the UNCRC, which may or may not give a right to gender-affirming treatment. This increasingly observed issue is of a considerably private nature and constitutes a clash between the
child, the parent, and the caregiver. It contains several ethical considerations for the legislator and society.}},
  author       = {{Massey, Olivia}},
  language     = {{eng}},
  note         = {{Student Paper}},
  title        = {{Informed consent: the decision-making capacity of children in relation to gender-affirming treatment}},
  year         = {{2021}},
}