Re: Andrea

[2017] FamCA 241

FAMILY COURT OF AUSTRALIA

RE: ANDREA [2017] FamCA 241

FAMILY LAW – CHILDREN – SPECIAL MEDICAL PROCEDURES – Where the applicants are the parents of a child diagnosed with Gender Dysphoria – where the applicants seek a finding that the child is Gillick competent to consent to stage two treatment for Gender Dysphoria – where the child’s treating medical experts and parents support the child commencing Stage Two treatment – assessment of whether 16½-year-old child is Gillick competent to consent to the medical treatment – finding that the child is competent to consent and authorised to make her own decision about Stage Two treatment.

Evidence Act 1995 (Cth), s 140
Family Law Act 1975 (Cth), ss 67ZC, 68L, 69H(1), 78, 97(2)(c), 100B(2), 121
Family Law Rules 2004 (Cth), rr 4.08(a), 4.09(3), 4.10

Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112
Re: Jamie [2013] FamCAFC 110; 50 Fam LR 369
Re K (1994) FLC 92-461
Re Kelvin [2017] FamCA 78
Secretary Department of Health and Community Services v JWB and SMB (1992) 175 CLR 218

FIRST APPLICANT: The Mother

SECOND APPLICANT: The Father

FILE NUMBER:  By Court Order File Number is suppressed

DATE DELIVERED: 21 April 2017

JUDGMENT OF: Thornton J

HEARING DATE: 30 March 2017

REPRESENTATION

By Court Order the name of Counsel and Solicitor have been suppressed

Orders made 30 March 2017

1. These proceedings be known by and referred to as ‘Re: Andrea’.

2. Pursuant to s 97(2)(c) of the Family Law Act 1975 (Cth) (“the Act”), leave be granted for the proceedings to be heard ‘in camera’.

3. Pursuant to s 121 of the Act, the full name of … born … 2000 – now known and referred to as ‘Andrea’ – Andrea’s family members and their occupations, any medical practitioner and hospitals, Andrea’s school and any staff at the school, the court file number, the State of Australia in which the proceedings were initiated, the names of the applicants’ legal representatives, any witnesses, and any other fact or matter that may identify Andrea shall not be published in any way and only anonymised reasons for judgment and orders (with cover sheets excluding the Registry, file number, lawyers’ names and details, as well as the parties’ real names) shall be released by the Court to non-parties without further contrary order of a Judge.

4. The applicants be granted leave to withdraw paragraphs 1, 2 and 4 of the Initiating Application filed 23 March 2017 and such paragraphs hereby stand withdrawn.

5. The Court is satisfied that … born … 2000 (“Andrea”) is competent to consent to the medical treatment described in the Initiating Application filed 23 March 2017 and the Court authorises Andrea to make her own decision in relation to that treatment.

6. The treatment described in the Initiating Application filed 23 March 2017 is the administration of oestrogen for the treatment of Gender Dysphoria (Stage Two Treatment) in such manner, in such dose and with such frequency as determined by and under the guidance of the child’s treating medical practitioners, including but not limited to Dr P and Dr H of the X Hospital.

7. Notwithstanding paragraph 3 of these orders, the applicants to these proceedings shall be at liberty to collect by hand, a full copy of the orders and any reasons for judgment published thereunder with all of the identifying details which are otherwise excluded by paragraph 3 of these orders and such documents may be provided to the treating medical practitioners.

8. The applicants be at liberty to provide a copy of the unanonymised orders and the unanonymised reasons for judgment to all persons involved with Andrea’s treatment.

9. No person shall be permitted to search the court file in this matter without first obtaining the leave of a Judge of the Court.

10. The applicants’ Initiating Application filed 23 March 2017 be otherwise dismissed.

11. The written reasons for judgment in this matter be delivered on a date to be fixed.

Note: The form of the order is subject to the entry of the order in the Court’s records.

IT IS NOTED that publication of this judgment by this Court under the pseudonym Re: Andrea has been approved by the Chief Justice pursuant to s 121(9)(g) of the Family Law Act 1975 (Cth).

Note: This copy of the Court’s Reasons for Judgment may be subject to review to remedy minor typographical or grammatical errors (r 17.02A(b) of the Family Law Rules 2004 (Cth)), or to record a variation to the order pursuant to r 17.02 Family Law Rules 2004 (Cth).

FAMILY COURT OF AUSTRALIA

FILE NUMBER: By Court Order File Number is suppressed

The Mother

First Applicant

And

The Father
Second Applicant

REASONS FOR JUDGMENT

Introduction

1. These are my reasons for making an order finding that Andrea, aged 16 years and six months, is competent to consent to her own medical treatment.

2. The treatment proposed is commonly known as Stage Two treatment for Gender Dysphoria in the form of the administration of oestrogen.

3. Andrea was born a male but now identifies as a female. She revealed to her parents that she was a female in or about the end of 2013 and publicly announced this to her friends in July 2015.  The child is receiving treatment for stage one with puberty blocking medication.

4. The child’s parents brought an urgent application for a finding that she is competent pursuant to the decision in Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112 (“Gillick competent”) to consent to her own Stage Two treatment.  As the parents of Andrea the applicants have standing to make this application.[1]

   [1] Family Law Rules 2004 (Cth), r 4.08(a).

5. Due to the sensitive nature of the subject matter of these proceedings, I made an order that the proceedings be conducted in camera pursuant to s 97(2)(c) of the Family Law Act 1975 (Cth) (“the Act”). I also made the usual orders preserving Andrea’s anonymity, which include not only protecting her given and chosen names, but also other information such as the names of the medical practitioners, lawyers and other professionals and entities involved.

6. There is no controversy about the child’s diagnosis of Gender Dysphoria, her wishes or her competence to provide informed consent for her own medical treatment. Andrea’s parents and her treating professionals, Dr P and Dr H, support the parent’s application.

7. The application is therefore essentially an application for determination by the Court as to whether Andrea is competent to consent to her own Stage Two medical treatment for Gender Dysphoria in circumstances where she is already receiving treatment for Stage One.

The Law: “Gillick” Competence

1. The term “Gillick” refers to the English case of Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112 (“the Gillick case”).

2. In Secretary Department of Health and Community Services v JWB and SMB (1992) 175 CLR 218 (“Marion’s case”) the High Court said that the view of the House of Lords in the Gillick case represented the common law in Australia. 

3. In the Gillick case, Lord Scarman recognised the underlying principle in the case law that parental right yields to the child’s right to make his/her own decisions when he/she reaches a sufficient understanding and intelligence to be capable of making up his/her own mind on the matter requiring decision.  Lord Scarman referred to the spirit and principle of the law captured by Lord Denning MR when he said that:

   The common law can, and should, keep pace with the times. It should declare … that the legal right of a parent to the custody of a child ends at the eighteenth birthday; and even up till then, it is a dwindling right which the courts will hesitate to enforce against the wishes of the child, and the more so the older he is. It starts with a right of control and ends with little more than advice.[2]

   [2] Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112, 129 (Lord Scarman), quoting Hewer v Bryant [1969] 3 All ER 578, 582 (Lord Denning MR).

4. In the Gillick case Lord Scarman said at [188]-[189]:

   … I would hold that as a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed. It will be a question of fact whether a child seeking advice has sufficient understanding of what is involved to give a consent valid in law.

5. In Marion’s case, Mason CJ, Dawson, Toohey and Gaudron JJ, in discussing the Gillick principle enunciated by Lord Scarman, said as follows at [237]-[238]:

   A minor is, according to [the Gillick] principle, capable of giving informed consent when he or she “achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed”.

   This approach, though lacking the certainty of a fixed age rule, accords with experience and with psychology. It should be followed in this country as part of the common law.

   (References omitted).

6. In Re: Jamie [2013] FamCAFC 110; 50 Fam LR 369 (“Re: Jamie”) the Full Court held that Stage Two treatment of gender dysphoria (administration of testosterone or oestrogen) was a medical procedure that required court authorisation, unless the Court found that the child was Gillick competent and thus able to fully understand and give informed consent to Stage Two treatment at the time it was to commence. The Full Court found that it was the Court’s responsibility to assess whether or not a particular child was Gillick competent.

7. In summarising her conclusion in Re: Jamie Bryant CJ relevantly said (inter alia) at [140]:

   …

   c)In relation to stage two treatment, as it is presently described, court authorisation for parental consent will remain appropriate unless the child concerned is Gillick competent.

   d)If the child is Gillick competent, then the child can consent to the treatment and no court authorisation is required, absent any controversy.

   e)The question of whether a child is Gillick competent, even where the treating doctors and the parents agree, is a matter to be determined by the court.

   (Original emphasis).

8. In that same case Finn J, whilst expressing reluctance to impose upon the child and his/her parents the costs and stress of further court proceedings, particularly when the Court may ultimately reach the same decision which the child and his/her parents had already reached with the child’s doctors, stated at [186]:

   Nevertheless, I have concluded that at least the question of the child’s capacity to consent to treatment which has the irreversible effects of stage two treatment must remain a question for the court. I have reached this conclusion because of the requirement by the High Court majority in Marion’s case for court authorisation for irreversible medical treatment in circumstances where there is a significant risk of the wrong decision being made as to the child’s capacity to consent to the treatment and where the consequences of such a wrong decision are particularly grave, as they would be in this case.

9. Her Honour, in reaching that conclusion, took into account “the persuasive submissions” made on behalf of the Australian Human Rights Commission and the public authority “which support continued court involvement in decisions concerning stage two treatment”.[3]

   [3] Re: Jamie [2013] FamCAFC 110; 50 Fam LR 369, [187].

10. In the same case Strickland J agreed with the outcomes proposed by both the Chief Justice and Finn J and generally for the reasons set out by each of them. He stated at [196] :

    Whether the child is able to fully understand and give informed consent to stage two treatment… is a threshold issue that the court must decide. This is because of the requirement by the High Court majority in Marion’s case that it is for the court to authorise medical treatment that is irreversible where there is a significant risk of the wrong decision being made as to the child’s capacity to consent to the treatment, and where the consequences of such a wrong decision are particularly grave.

11. There have been varying approaches to the framing of orders in these cases.

12. Only recently Watts J in  Re Kelvin [2017] FamCA 78 has stated a special case for the opinion of the Full Court under s 94A(1) of the Act concerning various questions set out in paragraph 8 of his Orders. This case has not yet been heard by the Full Court.

13. Watts J in that decision refers to the different approaches taken by Judges of this Court in these type of applications.[4]

    [4] Re Kelvin [2017] FamCA 78, [13]-[16].

14. At the commencement of the hearing counsel for the parents was provided with a copy of the judgment of Watts J and advised of my usual approach to these applications.  I indicated that until such time as the Full Court determines the special case stated I propose to follow my usual approach in these applications and determine whether to make a finding as to Gillick competence and whether to authorise the child to make his or her own decision.

15. Counsel for the parents sought leave to withdraw the alternative proposals for the framing of the orders in the Initiating Application and sought that an order be made in accordance with paragraph 3 of the application as follows:

    3.  … upon the Court being satisfied that the child is competent to consent to the administration of Stage Two Treatment, being the administration of oestrogen in such manner, in such dose and with such frequency as determined by and under the guidance of the child’s treating medical practitioners, the Court authorises the child to make her own decision in relation to that treatment.

Jurisdiction

1. This application is brought under Part VII of the Act.

2. Section 69H(1) of the Act provides that jurisdiction is conferred on the Family Court in relation to matters arising under this part.

3. Section 67ZC of the Act provides additional jurisdiction under Part VII of the Act to make orders relating to the welfare of children. It was inserted by an amendment to the Act in 1995 and reads:

   (1)In addition to the jurisdiction that a court has under this Part in relation to children, the court also has jurisdiction to make orders relating to the welfare of children.

   (2)In deciding whether to make an order under subsection (1) in relation to a child, a court must regard the best interests of the child as the paramount consideration.

4. Subdivision BA of Part VII of the Act deals with how the Court determines a child’s best interests.

5. The Court has power to make an order under s 67ZC of the Act to authorise medical treatment. In the circumstances of this case it is not necessary to do so because, for the reasons set out below, I am satisfied that Andrea is Gillick competent.

Procedure

1. Section 97(3) of the Act mandates that the court shall proceed without undue formality and shall endeavour to ensure that the proceedings are not protracted.

2. Section 68L of the Act allows for the appointment of an Independent Children’s Lawyer in proceedings under the Act in which a child’s best interests are, or a child’s welfare is the paramount, or a relevant consideration. It is a discretionary matter for the Court as to whether a child’s interests in the proceedings ought to be independently represented by a lawyer.

3. Having regard to all the circumstances of this case, including the urgency of the proceedings, I am satisfied that the appointment of an Independent Children’s Lawyer is unnecessary. In Re K (1994) FLC 92-461 at 80,773 the Full Court issued guidelines as to the circumstances in which an Independent Children’s Lawyer should usually be appointed. One of the categories referred to in those guidelines were applications in the Court’s welfare jurisdiction relating in particular to the medical treatment of children where the child’s interests are not adequately represented by one of the parties. In the circumstances of this case, I am satisfied that the child’s interests are adequately represented by the parents who are the applicants. I am fortified in that view by the evidence of the expert witnesses.

Service of the Application

1. Rule 4.10 of the Family Law Rules 2004 (Cth) (“the Rules”) requires that an application for a special medical procedure be served upon the prescribed child welfare authority.

2. The applicants rely on two affidavits of service filed 27 March 2017.  I am satisfied that Ms W representing the Department and Mr G representing the Office of the Public Advocate (“OPA”) were each served with a copy of the Initiating Application and the supporting affidavits.

3. An email from the Department dated 29 March 2017 was tendered by counsel for the applicants which states that “the department does not seek to participate or make submissions regarding this application” (Exhibit A).

4. Similarly, a letter from the OPA dated 28 March 2017 was tendered which states that after reading the material and speaking with Dr P they “do not see that it is necessary for [the OPA] to appear at the proceedings …” (Exhibit B).

Evidence and Standard of Proof

1. The rules provide that evidence may be given in the form of an affidavit or orally with the Court’s permission.[5] The documentary evidence relied upon for this hearing is listed in Annexure A to these reasons. 

   [5] Family Law Rules 2004 (Cth), r 4.09(3)

2. The standard of proof applicable is on the balance of probabilities under s 140 of the Evidence Act 1995 (Cth).

3. At [139] of Re: Jamie, Bryant CJ held that for an application with respect to Gillick competence, the material in support would not need to be as extensive as an application for the Court to authorise treatment. Her Honour stated that in the absence of some controversy, she could see no reason why any other party needed to be involved and that it would be an issue of fact to be determined by the Court on the material presented.  The other members of the Full Court either did not express a contrary view or expressed implicit agreement with the Chief Justice on this point.

4. For the purposes of the hearing before me, no witnesses were cross-examined and the case proceeded by way of submissions only.

The Nature of the Proposed Medical Treatment

1. Andrea has been diagnosed and is receiving Stage One treatment for Gender Dysphoria (DSM-V302.85) (Diagnostic and Statistical Manual of Mental Disorders, fifth edition, American Psychiatric Association, 2013) which involves puberty blocking by subcutaneous injections every 10 to 12 weeks.  

2. The parents and Andrea propose that she commence Stage Two treatment for Gender Dysphoria in the form of the female sex hormone oestrogen to induce feminisation of her body.  This is further outlined in the evidence of the child’s paediatrician Dr P.

Evidence of the Parents

1. The mother filed an affidavit on 23 March 2017.  She deposed that she understood that the treatment proposed will have a physical effect on the child by feminising her physical features so that she can present as a female and that she understands that the treatment may well have irreversible effects for Andrea’s fertility in the future.  She deposed that the child is in the transition phase from childhood to adulthood and that she understands the nature of the treatment that is proposed including the potential side effects and that in her opinion having regard to the child’s age, intelligence and maturity that the child is competent to make this decision herself.

2. As to the family background, the mother deposed that she has been in a relationship with her husband for about 27 years and happily married for nine years.  The child has always lived with her parents and has one sibling.

3. The mother deposed that since early childhood, Andrea has been uncomfortable in her own skin and that she has experienced her gender to be female despite being born a male.  She deposed that since primary school Andrea has been bullied and from around the age of eight has suffered periods of isolation at school “with no one to play with or talk to.”  The mother deposed to the child becoming completely and systematically isolated in the schoolyard in grades five and six when she moved to a new school.  The mother deposed to observing the child to develop anxiety and beginning to wet the bed nightly. 

1. The mother deposed to the child making her first comment about having suicidal thoughts when she was in year seven and that in year eight the children at school started bullying her.  The mother deposed to the child telling her that she found it difficult to talk to people and as she grew older she became confused about her gender.  The mother deposed that in or around the end of 2013 when the child was 13 years old she told the parents that she was a girl and that she had personally undertaken a lot of research into the topic and informed the parents about her research.

2. The mother deposed to a continual cycle of highs and lows in the emotional state of the child which carried over into her home life and the child refusing to attend school.  The mother deposed to the child making a Facebook post in July 2015 where she informed her friends that she was female and received a lot of support from that post.

3. The mother deposed to the child being referred to a psychiatrist as a result of contacting “Headspace” in or around August 2015.  The mother deposed to attending an appointment on 7 April 2016 with Dr H, an adolescent psychiatrist and Dr P, a paediatrician at the X Hospital’s gender dysphoria clinic.  The mother deposed to the child commencing puberty “blockers” and observing the child to have an increased self-confidence and self-esteem and appearing “much happier”. The mother deposed to observing that the severity of the child’s anxiety appeared to reduce and her school attendance improved since she adopted a female image and transitioned socially to living as a female known to her friends and family as a female.

4. The mother deposed to discussing the possibility of delaying the treatment until the child is 18 but the child is adamant that she would like the treatment to commence immediately.  The mother deposed to being concerned about the child’s mental health issues, social isolation and any further delay in the progression of her education and social life having further negative consequences for her.  The mother deposed that it is clear to her that if the child is unable to commence the treatment that her emotional state will deteriorate and the risk of her self-harming or attempting suicide would increase. The mother deposed that the child has told her that if she was unable to have the treatment she would not likely “be around”.

5. The mother deposed that she has considered the risk that the child may regret her choice to have the treatment in the future however she is strongly of the view that the child identifies as a female and “that any regret in having the treatment would be minimal, if any”.

6. The father filed an affidavit on 23 March 2017. The father fully supported the commencement of the Stage Two treatment for the child being the administration of the female sex hormone oestrogen and agreed with the contents of the mother’s affidavit.

Evidence of paediatrician Dr P

1. Dr P is a paediatrician who works within the gender dysphoria clinic at the X Hospital. He prepared a report dated 8 December 2016 (Annexure KP-2 to his affidavit filed 23 March 2017).  I am satisfied that he qualifies as an expert witness on the basis of his qualifications and experience outlined in Annexure KP-3 of his affidavit.

2. Dr P confirmed the proposed treatment is for Gender Dysphoria (DSM-V 302.85) (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, American Psychiatric Association, 2013).   Dr P supports the parents’ application and is of the opinion that the child is Gillick competent. 

3. Dr P was first consulted on 14 April 2016 and has seen the child five times.  Dr P proposes to commence the child on a daily oral dose of oestradiol valerate that is individualised for her.   The dose will be reassessed and is likely to be increased after about 6–12 months and the final adult dose will be reached following two years of treatment. 

4. Dr P in his report stated that he communicates regularly with the psychiatrists who are part of a multidisciplinary team of doctors.  His report referred to discussions and correspondence with Child and Adolescent psychiatrist Dr H who confirmed that the child meets diagnostic criteria for Gender Dysphoria with an affirmed female identity which Dr P found consistent with his assessment of the child.

5. Dr P in his report outlined the nature and degree of any risk to the child including the longer term risks from taking oestrogen and spironolactone which include the following:

   Specific risks of Oestrogen;

   ·Chronic problems with veins in the legs

   ·Heart disease

   ·Pulmonary embolism (blood clot to the lungs)

   ·Stroke

   ·Type 2 diabetes

   ·Liver disease

   ·High cholesterol and high blood pressure

   ·Gallstones

   ·Headaches or migraines

   ·Prolactinoma (non-cancerous tumour of the pituitary gland)

   Specific risks of spironolactone;

   ·Gastrointestinal symptoms (cramping, diarrhoea, nausea, vomiting, ulceration and gastritis)

   ·Drowsiness

   ·Lethargy

   ·Headache

   ·Skin reactions

6. Dr P stated that the child is consistent in requesting the treatment and his opinion is that the treatment will help to improve her mental state and maximise her emotional, social and educational potential by giving her the ability to live within a body that is more consistent with her gender identity.

7. Significantly Dr P stated in his report that he has had numerous discussions with the child about the treatment and the risks and benefits that are known which include the risk of regret and impact on fertility. He is of the opinion that the child “engages in sophisticated discussion on the topic of oestrogen and asks relevant questions”.  Dr P cited examples of his discussions with the child which disclosed that the child consistently sought treatment and had an understanding of the effects of treatment including the risks.

8. Four months after the child had commenced puberty blockers, Dr P was of the opinion that the child:

   …appears to have a reasonable understanding of the likely benefits and risks of oestrogen….. She has thought about taking oestrogen for an extended period of time, and has consistently expressed this to me. She has demonstrated that she is well aware of the effects of oestrogen on her body, the possible risks and the importance of prioritising her own healthcare. She has clear views about fertility and parenthood and is aware of the effect of oestrogen on sperm.

9. The report of Dr P also confirmed the support that both parents have expressed for the child to commence treatment.

Evidence of consultant psychiatrist Dr H

1. Dr H is a consultant psychiatrist working within the gender dysphoria clinic at the X Hospital. He prepared a report dated 24 November 2016 (Annexure CH-2 to his affidavit filed 23 March 2017). I am satisfied that he qualifies as an expert witness based on his qualifications and experience outlined in Annexure CH-3 of his affidavit.

2. Dr H has seen the child on four occasions with the first consultation occurring on 7 April 2016.  He stated that in November 2016 he recommended to the paediatricians that the child is appropriate to be treated hormonally to induce feminisation of her body.  The effect of the report is that the doctor made a formal diagnosis of Gender Dysphoria and that a second opinion was obtained from psychologist Dr S who confirmed the  diagnosis.

3. Dr H stated in his report that in his opinion the treatment is in the child’s best interests and is necessary for her welfare.  In particular the doctor was of the opinion that the treatment is necessary for the child’s mental health.  At page 2 of his report he stated:

   …it will play a role in decreasing her risk of self harm and death via suicide.  Research consistently demonstrates that denial of support and medical treatment for children and adolescents with gender dysphoria carries with it a 50% risk of self harm and a 30% risk of attempted suicide during adolescence. Access to the treatment proposed for [Andrea] has been shown to decrease anxiety and depression (De Vries, 2014)

4. Relevantly further at page 2 of his report, Dr H said:

   I consider that [Andrea] has the intelligence and emotional maturity to consent to the procedure. I also believe that she agrees to the procedure. The treatment pathway was initiated by [Andrea] herself and she has been the one to drive the process through assessment and treatment.

5. He goes on to state on page 3 that:

   I have had a number of discussions with [Andrea] about her wish to use hormonal treatments. [Andrea] is clear that her mood has improved and her anxiety lessened as a result of consulting our service, moving towards these treatments and living more in the social role of female, coming out to friends and family and using female pronouns. She is certainly more confident and engaged with life than when I first met her early this year.

   I have absolutely no doubt that [Andrea] agrees to the procedure.

6. In terms of Andrea weighing up the treatment Dr H stated at paragraph (e):

   Some patients choose to live with gender dysphoria and not take hormonal treatments, however this option is not considered acceptable to [Andrea] who feels it is very important to her to feminise her body. There is no way of inducing feminising changes in the body of a biological male other than by administering oestrogen.

Findings and Conclusion

1. I accept the unchallenged evidence of the expert witnesses and the parents of the child and note that the treating professionals support the application.  The evidence of the parents must be given considerable weight in that the child has lived with them for her whole life and they have the advantage of having observed her maturing over time.  I am satisfied that the child has demonstrated the intellectual capacity and sophistication to understand the information relevant to making the decision and to appreciate the potential consequences, some of which may be irreversible.  I am satisfied that the risks have been explained in detail to the child and that she has the intellectual capacity to understand and weigh up the information conveyed despite the fact that she is not yet 18.

2. On the basis of all the evidence I am satisfied on the balance of probabilities that Andrea is competent to fully understand the nature and consequences of the treatment described in the application and to make her own decision about that treatment.  Andrea is in the transition phase from childhood to adulthood referred to in the Gillick case and is competent to consent to this treatment.

3. I am satisfied that it is appropriate to make a finding that Andrea is competent to consent to the medical treatment described in the Initiating Application being Stage Two treatment for Gender Dysphoria and that it is appropriate to authorise the child to make her own decision about that treatment.

I certify that the preceding sixty seven (67) paragraphs are a true copy of the reasons for judgment of the Honourable Justice Thornton delivered on 21 April 2017.

Associate: 

Date:  21 April 2017

Annexure A

Documents relied upon by the applicants:

• Initiating Application filed 23 March 2017

• Affidavit of the Mother filed 23 March 2017

• Affidavit of the Father filed 23 March 2017

• Affidavit of Dr P filed 23 March 2017

• Affidavit of Dr H filed 23 March 2017

• Affidavit of service by Ms B filed 27 March 2017

• Second affidavit of service by Ms B filed 27 March 2017