Schedule 3: Children and Young Persons (Care and Protection) Act 1998
Understanding the Proposed Amendments
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What is the Current Legal Framework in NSW for Consent to Medical Treatment of Minors?
In NSW, the care and protection of minors are governed by the Children and Young Persons (Care and Protection) Act 1998, which, along with the Gillick competence test at common law, prioritizes the best interests of the child. Gillick competency evaluates a minor's ability to consent to medical treatment based on their understanding of the treatment's nature and implications.
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For minors under 16, the law requires an assessment of Gillick competence or parental/guardian consent for medical treatments, ensuring protection for children who might not fully grasp long-term implications. Generally, the law presumes that minors aged 16 and 17 can consent to their medical treatment, aligning with the understanding that they can weigh the implications against their well-being. This presumption can be rebutted with evidence.
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What is the Current Legal Framework in NSW for Consent to ‘Gender’ Medical Treatment of Minors?
The consent process for minors seeking ‘gender’ medical procedures is distinctly regulated. The Family Court of Australia may intervene due to the irreversible nature of such interventions. Court involvement is required when either the child, one parent, or the treating medical practitioner does not consent to the procedure. If all four parties agree, court intervention is not required.
How do the Amendments in Schedule 3 Propose to Change the Current Framework in NSW?
Schedule 3 of the Equality Bill proposes radical and unnecessary changes to the current legal framework in NSW.
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Schedule 3 allows children aged 16 and over to make decisions regarding their medical treatment with the same authority as an adult. For children under 16, Schedule 3 suggests that one parent's consent is sufficient for medical treatment OR that a child between 0-15 years of age can consent on their own if deemed capable by a medical practitioner.
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This amendment is reckless and represents a significant departure from the current legal requirements and potentially lowers the threshold of Gillick competence due to the absence of the requirement that the child fully understands the nature and implications of the treatment sought.
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Informed consent cannot be achieved if a child does not “fully” understand the implications. In any case, a child cannot “fully” understand the implications of lifelong sterility, lack of sexual function, increased risk of cancer, brittle bones, among many other severe long-term health outcomes caused by ‘gender affirming’ medicine.
What is the Affirmation Model in Gender Affirming Care?
The affirmation model – used in Australia - is a clinical approach to gender medicine that prioritises affirming an individual's self-identified gender without critically examining the underlying psychological, social, or developmental factors. Treatment often involves the use of puberty blockers, cross-sex hormones, and surgical interventions, often without thorough, long-term assessments.
In practice, this means that if a child – of any age - expresses that they feel as though they were born in the wrong body and wishes to ‘transition’, their self-identification is not challenged or explored. Instead, it is accepted, affirmed and acted upon. Medical professionals follow the child's expressed wishes, and the process is child-led, as outlined in the Royal Children's Hospital Melbourne treatment guidelines.
Australian gender clinics use the affirmation model. The inherent flaw in this model is its one-way pathway that facilitates vulnerable individuals, especially minors, into irreversible medical treatments without adequately considering the complexities of gender dysphoria. This approach can lead to significant physical and psychological harm, as it reinforces the child's self-declared identity to the extent that they may feel unable to change their mind with everyone involved compelled to “affirm” them in their self-declared identity.
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UK Approach to Gender Affirming Care and the Cass Review
The UK also adopts the affirmation model in its approach to gender affirming care. The Cass Review, an independent, systematic review of gender identity services for children and young people, was released on April 9, 2024. Commissioned by the UK’s National Health Service, the review was led by Dr. Hilary Cass, a respected paediatrician. The Cass Review was initiated due to growing concerns about the rapid increase in referrals to the UK’s children’s Gender Clinic – The Tavistock, as well as concerns about the safety and efficacy of existing treatments, and the need for a more evidence-based approach to care.
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Cass Findings
Cass systematically reviewed all research world-wide (including Australia's research and AusPATH guidelines), and provided critical recommendations to ensure that gender identity services are safe, effective, and centred on the best interests of children. The full final Cass report found:
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Significant Evidence Gaps
The review uncovered major deficiencies in the evidence base for current clinical practices, particularly regarding the use of puberty blockers and hormone therapies, raising serious doubts about their justification.
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Lack of Long-Term Data
There is a glaring absence of high-quality research and long-term follow-up data on the effects of gender-affirming treatments, leaving the long-term outcomes for patients largely unknown.
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Concerns About Social Transition
The review highlighted the potential dangers of social transition in children, noting the limited evidence on its long-term effects and recommending a more cautious approach.
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Individualised Care Emphasis
The findings stress the need for a significantly more cautious, individualised approach to gender identity care, suggesting that the affirmation process is too generalised and potentially harmful.
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Mental Health Oversight
The review underscored the critical importance of addressing co-occurring mental health issues, indicating that these are overlooked and dismissed in the rush to administer irreversible gender medicine.
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Inadequate Clinician Training
The call for improved training and support for clinicians involved in gender identity services suggests that many healthcare providers are currently ill-equipped to offer the best care.
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Disingenuous Attempts to Distance Cass from the Australian Model
Trans lobby groups in Australia who are invariably staunch advocates of the affirmation model, continue to attempt to distance Australia from the findings of the Cass Review by claiming that Australia already follows its advice and that our multidisciplinary approach is different from the UK's system. However, this assertion is misleading. Both the Australian and UK systems fundamentally rely on the same model of care: the affirmation model. The Cass Review highlighted significant flaws in this approach.
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The review examined international evidence and gender-affirming medicine guidelines, including those in Australia. The Royal Children's Hospital (RCH) guidelines, were written by a gender-affirming clinician at RCH and became known as the Australian Standards of Care and Treatment Guidelines. These guidelines are endorsed by the Australian Professional Association for Trans Health and are modelled on the World Professional Association for Transgender Health (WPATH) standards of care.
In the University of York’s examination of international guidelines, the RCH Standards of Care ranked very poorly. Australia's guidelines received a very low score of 19% for "rigour of development" and 14% for "editorial independence". The Cass report found that various national guidelines often referenced each other in a "circular" manner to support their methods, despite the objectively poor evidence underpinning the gender-affirming medical approach.
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The similarities between the UK and Australian systems are striking:
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Affirmation Model: Both systems use the affirmation model as the primary approach to treating gender dysphoria.
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Lack of Rigorous Assessment: Both countries lack comprehensive, long-term assessments before starting medical interventions.
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Child-Led Process: The process in both systems is led by the child’s expressed wishes rather than long-term, thorough clinical evaluation, with no exploration of co-morbidities or past trauma to understand the underlying drivers of a child’s deep discomfort with their own body.
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Multidisciplinary Claims: Despite claims of a multidisciplinary approach, both systems primarily affirm the child's self-identified gender without sufficient psychological evaluation.
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The Cass Review's findings are highly pertinent to Australia, underscoring the urgent need for a critical reassessment of our current practices. Any claim that Australia's system is fundamentally different from the UK's is a fallacy, propagated by those seeking to avoid scrutiny of a system that, in practice, facilitates permanent changes to a child’s life. The review’s evidence clearly demonstrates that the quality and independence of Australia's guidelines are seriously lacking, necessitating immediate and thorough reconsideration of these practices to ensure the safety and well-being of children and adolescents.
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Further Material Regarding Gender Medicine and the Affirmation Model
WPATH
The WPATH Files, released in March 2024, exposed that WPATH—the peak health body influencing global gender medicine practices, including AUSPATH in Australia—highlighted a troubling disregard for the informed consent process, with minors provided with puberty blockers, cross-sex hormones without adequate understanding of long-term risks. The files revealed that youth do not have the capacity to make informed decisions about gender medicine
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Global Shift Away from Gender Medicine
In the past two years, countries around the world as well as individual states within the USA and Canada, have recoiled from gender-affirming care and the affirmation model. They have reversed their policies, with governments intervening in many states, due to concerns about the lack of robust evidence supporting the long-term safety and efficacy of these treatments, the potential for significant physical and psychological harm, and the need for thorough psychological assessments before medical interventions. Countries that have either banned, restricted or pulled back from gender medicine include Sweden, Finland, the UK, Scotland, France, Norway, Denmark, approximately half of USA states, and Alberta, Canada. In light of this global shift and mounting evidence against the affirmation model, it is perplexing why Australia, and particularly the Greens Party and the Labor government, continues to support and forge ahead with these practices.
Recommendation:
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Withdraw the proposed amendments.
Removal of Schedule 3 and Further Points to Contemplate:
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Alex Greenwich stated during the Equality Bill Inquiry that he has agreed to remove Schedule 3 from the Equality Bill.
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We urge Members of Parliament to be cognizant of the information in Schedule 3 and ensure it is removed from the bill.
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We urge Members of Parliament to be aware that, despite the Schedule’s removal, the affirmation model remains the model used in NSW and is embedded in policy.
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Speaking out against the affirmation model, including by clinicians, results in silencing, threats, and job loss.
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Trans lobbyists vehemently oppose any public scrutiny or government inquiry into the affirmation model, which is based on a child’s self-identification and leads to a one-way, irreversible medical pathway.
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It is perplexing why lobbyists and supporters of this model, including the NSW Labor government, continue to champion it, despite the irrefutable evidence against it.
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We urge all Members of Parliament to understand that NSW Labor’s recently passed conversion laws further entrench the affirmation model into law by ensuring that no one can counter the self-declared identity of another without facing civil and/or criminal penalties.
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We urge Members of NSW Parliament to be aware that the average cost made from transitioning a child is approximately $500,000 to $1 million over the course of the child’s lifetime. Gender medicine – and the affirmation model - is an extremely profitable business
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Medical treatment will be needed for life, and there is no undoing what is done.
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Click on the table, to see the differences of the gender affirming care model
versus the normal medical model of care.
