Family Court Chief Justice Diana Bryant says she would like to see the court’s jurisdiction tested in cases involving medical treatment for transgender children.
“I’d like to see the High Court have the opportunity to examine these kinds of cases, these gender identity cases and to decide whether or not the court has to be involved at all,” she told the ABC’s Four Corners program.
As it now stands, a child wishing to change gender needs to apply to the Family Court for the second stage of treatment involving gender-changing hormones.
For that to change, there would have to be a test case to the full bench of the Family Court, and then to the High Court.
The judge was responding to issues raised in tonight’s Four Corners program, which tells the story of transgender children and their struggle socially and legally to be the person they believe they are.
As one child reveals, without support and medical intervention, her life might have been in real danger.
“It would be very dark, very bleak and very short,” she said.
Chief Justice Bryant made it clear the court and legal system needs to respond.
“I think society is changing about these issues as well, and I think it is important to remember that,” she said.
“I think from what we’ve seen, it’s completely innate and when you read all the psychiatric reports and all the reports about how it affects young people, it is undoubtedly innate.”
The views expressed by Chief Justice Bryant come as the numbers of transgender children presenting at clinics around Australia skyrocket.
The Royal Children’s Hospital in Melbourne has had 100 new referrals this year.
Isabelle is one of the children being treated at the hospital and she told Four Corners that without support and access to treatment, she would have been deeply unhappy.
“If you don’t be yourself, you’re going to be miserable for your whole life,” she said.
Transgender children requesting treatment much earlier: doctor
Michelle Telfer, a paediatrician at the gender clinic at Melbourne’s Royal Children’s Hospital, believes there are no more transgender kids than 10 years ago, but rather they are just coming out and requesting treatment much earlier.
“So we’ve had a huge increase in new referrals to the Royal Children’s Hospital from one in 2003, to 100 new referrals just this year,” she said.
“And this is replicated across the western world, so the same numbers are being seen across America, across Europe.”
The internet had also helped show children and families what services are available.
“What’s changed is that people are feeling safer to come forward because of social change, but they are becoming aware that we have treatments that can help them,” Dr Telfer said.
“And that’s something that’s only been around for about 15 years around the world, and probably only 10 years in Australia.”
Transgender children can now be treated with puberty blockers, which delay the onset of puberty.
Associate Professor Dr Campbell Paul, a psychiatrist at the the Royal Children’s Hospital, said this is a good thing.
“It means the inexorable unchangeable effects of pubertal development can be delayed, while the young person works out, am I really at core a boy or a girl?” he said.
Before a child is given treatment, they are assessed by at least five doctors.
“The process for the assessment is very rigorous,” Dr Paul said.
“There is a team of us that are involved and in the first instance it’s a psychiatrist and an adolescent physician or an endocrinologist and we get a detailed assessment from the family.”
Studies show that 30 per cent of adolescents who do not get treatment attempt suicide and 50 per cent self harm.
“As doctors, every decision we make on a clinical basis is about weighing up the risks versus the benefits,” Dr Telfer said.
“And in this case what we have is a risk of self harm and suicide that is extremely high, and yet a risk of regret that is very small.”
Doctors meet with Chief Justice over court cost concerns
The regret rate after surgery is less than 0.5 per cent and included regret around hormone treatment, surgical treatment and poor surgical outcomes.
At 16 years of age, teenagers can also get the second stage of treatment – irreversible cross-changing hormones – but before they can access this, the Family Court has to assess if they have capacity to consent, known as being Gillick competent.
“It relates to the child’s capacity in a holistic and psychosocial way to give informed consent to the treatment, so in these kind of cases you’d want to be satisfied that the child concerned was aware of all of the problems, the risks, dangers; you would want to know that the child was psychologically in a position where they could make these decisions,” Chief Justice Bryant said.
Many doctors and families are not happy that young people, at the relatively young age of 16, must go to court to establish their ability to consent to treatment.
“I don’t think going back to court is a good thing at all. I don’t think it is necessary to be honest,” Dr Telfer said.
Jamie, a 14-year-old transgender girl, agreed.
“I don’t think it’s necessary that we have to go back to the court so they can decide if I’m Gillick competent, ’cause that’s just up to the parents and doctors I think,” she said.
“They will make just as good a decision as anybody, even better because they’re the experts.”
Due to concerns about courts costs, doctors from the Royal Children’s Hospital met recently with Chief Justice Bryant.
She said that even before any High Court ruling on the issue, other steps could be taken to help transgender children access treatment.
“I am confident that we can put in place a process which will be easily manageable and will not be expensive for parties to be able to come to court and get a decision about capacity to consent,” she said.
In a recent New Zealand study, 1.2 per cent of secondary schools students identified as transgender.
If these numbers were reflected in Australia, it would mean almost 18,000 Australian students.
Four Corners’ Being Me airs at 8.30pm on ABC TV.
If you or anyone you know is in need of support, contact Lifeline Australia on 13 11 14, Kids Helpline on 1800 55 1800 or visit BeyondBlue.