News of a troubling case reaches Steerpike. Earlier this month the Administrative Court handed down judgment in the case of R (AI) -v- London Borough of Wandsworth and Secretary of State for Education [2023] EWHC 2088 (Admin). It’s a complex ruling on a complex case, not likely to catch the attention of the public. But that judgment does contain details that raise some striking questions about medical treatment as it relates to issues of sex and gender.
This relates to the claimant in the case, a 22-year-old with a heart-rending personal history and a string of serious problems. The claimant, named only as AI, was born female and now identifies as a transgender man. The judgment uses male pronouns for AI.
Here’s the court on AI’s background:
The circumstances of his early life are significantly distressing and can only provoke profound sympathy. Although he cannot yet read or write he has been able to make a statement through his solicitor. He records that his childhood was chaotic. His mother was a recovering drug addict, he saw her subjected to domestic violence and witnessed her taking drugs. He would go back and forth between her and his grandmother and when around 11 or 12 years old, AI went into his grandmother’s care. He records moving all the time, living in numerous different places in the South East and spending a lot of time with his grandmother, who is disabled, whom he cared for, and with whom he is in fact, once again, currently living, although he reports difficulties with that relationship. At about 13 or 14 AI went into the care system.
Here’s a summary of AI’s conditions:
He has a total of 14 diagnoses and continues to have complex needs. His difficulties have been medically described as Mild Mental Retardation, Attachment Disorder, Emotion Dysregulation, Attention Deficit Hyperactivity Disorder (“ADHD”), Oppositional Defiant Disorder (“ODD”) and (Autism Spectrum Disorder (“ASD”), dyslexia, severe anxiety, Post Traumatic Stress Disorder (“PTSD”) and low self-esteem. In 2021, he was diagnosed with disturbance of activity and attention, minimal impairment of behaviour and reactive attachment disorder of childhood.
The combined impact of those conditions is that AI is unlikely to be able to live unsupported. The judgment says: ‘Mental health professionals have previously advised he may likely need 24-hour support in the foreseeable future.’ In sum, AI is deeply troubled and faces multiple psychological, behavioural and emotional challenges. AI cannot read or write.
AI cannot function as an independent adult, meaning the State must provide additional support: Wandsworth Council duly provides an Extended Health and Care Plan, a legally binding plan to help meet those additional needs. In that context, consider these words from that court judgment:
The Claimant was assigned female gender at birth, but identifies as male. He was referred to the Gender Identity Clinic (“GIC”) at the Tavistock and Portman NHS Foundation Trust (“the Tavistock”), when he was about 14… He has been approved for testosterone treatment with gender affirming surgery known as a Subcutaneous Mastectomy.”
Here, it seems appropriate to summarise the facts set out in that court judgment as they relate to the person known as AI. This is a 22-year-old with more than a dozen diagnosed clinical conditions, who cannot read or write, who cannot function independently and who may well require 24-hour support in order to live. This person has been approved for surgery to remove healthy breast tissue, as well as for hormone treatment that the NHS says can lead to blood clots, gallstones and infertility.
The matters of administrative law involved in the case of AI vs Wandsworth are unlikely to trouble many people beyond a few corners of the law and the public sector. But you don’t need to understand the legal details to look at the story of AI and ask how on earth we have created a system that means a struggling and vulnerable young person who cannot live independently can give consent to life-changing but physically unnecessary surgery and medical treatments, in the name of ‘gender identity’?
Don’t expect an answer to that question anytime soon…
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