Re: Christopher

[2015] FamCA 454

FAMILY COURT OF AUSTRALIA

RE: CHRISTOPHER [2015] FamCA 454

FAMILY LAW – CHILDREN – MEDICAL PROCEDURES – Where the applicant is the mother of a  child with Gender Dysphoria – where the applicant seeks a declaration that the child is competent to authorise his own stage two treatment – where the child’s treating medical experts and parents support the child commencing stage two treatment – assessment of whether 15 year old child is Gillick competent to consent to medical treatment – finding that the child is competent to consent and authorised to make his own decision about stage two treatment.

Evidence Act 1995 (Cth)
Family Law Act 1975 (Cth)
Family Law Rules 2004 (Cth)

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
Secretary, Department of Health and Community Services v JWB and SMB (1992) 175 CLR 218

APPLICANT: The Mother

RESPONDENT: The Father

FILE NUMBER: By Court Order File Number is suppressed

DATE DELIVERED: 16 June 2015

JUDGMENT OF: Johns J

HEARING DATE: 12 June 2015

REPRESENTATION

By Court Order the names of counsel and solicitors have been suppressed

Orders

1. That the name of the child Christopher born … 1999, (“Christopher”), Christopher’s family members and their occupations, the Hospital, Christopher’s medical practitioners, Christopher’s school, this Court, file number, the State of Australia in which the proceedings were initiated, the names of the mother’s lawyers, and any other fact or matter that may identify Christopher shall not be published in any way and only anonymised Reasons for Judgment and orders (with coversheets excluding the Registry, file number and lawyers’ names and details as well as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, it being noted that each party shall be handed one full copy of these Orders with the relevant details included for provision to the treating medical practitioners and to enable their execution, and one coversheet of Reasons for Judgment that includes the file number and the lawyers’ names.

2. That no person shall be permitted to search the Court file in this matter without first obtaining the leave of a Judge.

3. Upon the Court being satisfied that the child Christopher born … 1999 is competent to consent to the medical treatment described in the Initiating Application filed 5 June 2015, the Court authorises Christopher to make his own decision in relation to that treatment. 

4. That the applicant mother be at liberty to provide a copy of the un-anonymised orders and the un-anonymised Reasons for Judgment to all persons involved with Christopher’s treatment.

5. That the applicant’s Initiating Application filed 5 June 2015 be otherwise dismissed.

AND THE COURT NOTES THAT

The treatment described in the applicant’s Initiating Application filed 5 June 2015 is the following treatment for Gender Identity Dysphoria:-

(i)      That under the guidance of Christopher’s treating medical practitioners including but not limited to Dr T (Paediatrician) and Associate Professor P (Consultant Psychiatrist), Christopher undergo treatment by way of monthly intramuscular injections of Sustanon 250 in a dose of 0.5mL monthly.  The dose may be increased to 1mL monthly depending on any adverse side effects experienced by Christopher;

(ii)That under the guidance of Christopher’s treating practitioners as set out at sub-paragraph (i) herein and if considered appropriate by Christopher’s treating practitioners, Christopher be treated using long-acting Reandron 1000 injections every 3 months and Christopher continue with this treatment long-term, being monitored to adjust the frequency as is necessary, depending on side effects and adequacy of the testosterone does;

(iii)Any other hormone and/or psychiatric or psychological treatment as recommended by Christopher’s treating Paediatrician and Psychiatrist from time to time.

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

FAMILY COURT OF AUSTRALIA

FILE NUMBER: By Court Order the File Number is suppressed

The Mother
Applicant

And

The Father  

Respondent

REASONS FOR JUDGMENT

Introduction

1. Christopher is aged 15 ½ years.  Although biologically female, since he was approximately three years of age he has wished to live as a boy.

2. Since that time Christopher has identified as a male; he has maintained his appearance as that of a boy with respect to his hair-style and dress.  His peer group and choice of activities have been those traditionally identified as male.

3. Christopher was diagnosed with Gender Dysphoria in 2014 and has been undertaking Stage 1 treatment for that condition since that time.  Christopher now wishes to commence treatment to begin the process of masculinisation through the administration of testosterone (Stage 2 treatment).

4. I am asked to determine two questions, being:-

   ·Whether or not Christopher is legally competent to consent to the Stage 2 treatment he desires and if so to make orders authorising his consent to that treatment; and

   ·If I determine that he is not legally competent to provide such consent, whether then to authorise his mother to consent to the treatment on his behalf. 

Background

1. Christopher was born in 1999.  He has an older brother, aged 17 years. 

2. When aged approximately three years, Christopher told his mother “I am not a girl, I am a boy” and further that “when I was in your tummy I was a boy but I heard you wishing for a girl”.  At about that time, Christopher cut his hair off at the roots.

3. Christopher commenced primary school in 2003.  Upon commencing school he formed close friendships with the boys in his class.  He enjoyed playing football. 

4. In 2007, Christopher’s family migrated to Australia. 

5. In mid-2013, when travelling with his mother in Asia, Christopher commenced dressing as a boy.  Upon his return to Australia after that holiday, Christopher continued living as a boy.

6. In September 2013 when almost 14 years of age, Christopher began starving himself in order to lose weight due to his desire to have smaller breasts and reduce the size of his hips.  It was at that time that Christopher commenced asking his parents to consent to his commencing testosterone treatment.  He also requested that he be referred by the name “Christopher” rather than his given female name.

7. Fortunately for Christopher, his parents were understanding and supportive of his needs.  To that end, in November 2014 his parents registered his change-of-name with the family’s country of origin official records.  They also completed the necessary applications to change his registered name on his Medicare card and with the family’s private health insurer. 

8. As a result of Christopher’s desire to live as a boy, he was subjected to bullying at his previous school.  One child in particular often asked him questions such as “do you have a dick?”.  Understandably, that experience was distressing for Christopher. 

9. In 2015, Christopher commenced attending a selective entry school.  He is enrolled as a boy and it is only his teachers who are aware that he is being treated for Gender Dysphoria.  Christopher is a bright child and is performing well at that school. 

Christopher’s Medical Treatment

1. In November 2013 Christopher commenced attending the Hospital for treatment.  Initially, Christopher attended upon Dr T, paediatrician, at the Hospital. 

2. Christopher also attended upon Associate Professor P.  Associate Professor P is a child and adolescent psychiatrist and psychotherapist and has significant experience working with children and adolescents who have gender identity development disorders. Associate Professor P had his first appointment with Christopher in January 2014.

3. Associate Professor P has assessed Christopher as meeting the criteria for Gender Dysphoria.  Gender Dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.  Associate Professor P confirms that Christopher meets the criteria for the diagnosis of Gender Dysphoria in Adolescents and Adults in accordance with DSM V, 2013.  He also confirms that Christopher meets the criteria for diagnosis of Gender Identity Disorder of Adolescence in accordance with the World Health Organisation ICD 10 health classification system.

4. Second opinions as to that diagnosis have been obtained from Dr M and Dr K, both child and adolescent psychiatrists.  Dr M met with Christopher on 2 March 2015.  In his report dated 4 May 2015, Dr M confirms that Christopher satisfies the DSM V diagnostic criteria for Gender Dysphoria in Adolescence.  In that report Dr M confirms that Christopher displays:-

   consistent incongruence between his experienced gender and his assigned gender of more than six months duration and manifest by all six of the six criteria outlined in the DSM V. He demonstrates marked incongruence between his gender and his primary sex characteristics, a strong desire to be rid of his primary sex characteristics, a strong desire for the sex characteristics of the male gender, a strong desire to be of the other gender, a strong desire to be treated as the other gender, and a strong conviction that he has the feelings and reactions of male gender.

5. Dr K is a child and adolescent psychiatrist at the Hospital. Dr K met with Christopher on 26 February 2014.  In her report dated 29 April 2015, Dr K confirms her assessment that Christopher meets the criteria for the diagnosis of Gender Dysphoria.

6. Dr T, Christopher’s treating paediatrician, first saw Christopher in November 2013.  She has been treating Christopher for Gender Dysphoria since that time.  In her report dated 12 February 2015, Dr T confirms that Christopher has transitioned from social to full-time living in the male role.  Further, she confirmed that he is currently treated with the puberty blocker, Zoladex, a gonadotrophin which releases a hormone analogue.

7. Dr T now proposes to treat Christopher with testosterone, the male sex hormone, in order to masculinise his body.  This is the Stage 2 treatment.  She proposes to start the treatment using a monthly intra-muscular injection of testosterone in a dose of 0.5ml (125mg) monthly.  The effect of such treatment on Christopher’s body will include:-

   ·Development of hair in the pubic area, armpits and on the beard area of the face;

   ·Changes in facial shape and appearance;

   ·Irreversible changing of the voice, due to growth of the larynx (Adam’s Apple) and lengthening of the vocal chords;

   ·Muscle development;

   ·Increased oil production by the skin which may result in acne;

   ·Growth of the clitoris and an increased number of erections;

   ·Stopping the development of ova (eggs) in the ovaries, with loss of fertility;

   ·Stimulation of bone mineral density; and

   ·The possibility of affecting Christopher’s behaviour by stimulating more assertiveness (sometimes aggression) and sexual desire.

8. Christopher seeks to commence that treatment immediately.  He is supported by his mother and his father in his desire to commence treatment.

9. The proposed treatment will be monitored by Dr T and Associate Professor P.

10. There are risks associated with the proposed treatment which are identified by Dr T in her report.  Those risks include the possibility that Christopher’s mood may be affected and that Christopher could become aggressive if the testosterone dose is increased too rapidly.  Further, Dr T confirms that the effect of testosterone on the ovaries and other female organs over time is not well-understood and there is a danger of inducing abnormalities, such as ovarian cancer, although this has not yet been extensively studied.  Dr T confirms that the long-term effects of the proposed treatment are still being studied.  She also confirms that in the event that Christopher ceases testosterone treatment in the future, some of the effects of the testosterone will not be reversible. In particular, the changes to Christopher’s voice, his face shape and appearance, the growth of the clitoris, and the potential loss of fertility may not necessarily be reversible once the treatment is stopped.

Material Relied Upon

1. The applicant relied upon the following material:-

   ·Initiating Application filed on behalf of the mother on 5 June 2015;

   ·Affidavit of the mother filed 5 June 2015;

   ·Affidavit of the father filed 5 June 2015;

   ·Affidavit of Associate Professor P filed 5 June 2015;

   ·Affidavit of Dr T filed 5 June 2015;

   ·Affidavit of Dr G filed 5 June 2015;

   ·Affidavit of Dr M filed 5 June;

   ·Affidavit of Dr K filed 5 June 2015.

Legal Principles

1. Section 60B(1) of the Family Law Act1975 (“the Act”) sets out the objects of Part VII of the Act. One of the objects is to ensure that parents fulfil their duties and meet their responsibilities concerning the care, welfare and development of their children.

2. In deciding a particular parenting order, the best interests of the child are the paramount consideration (s 60CA). The primary and additional considerations for the Court in determining what is in the child’s best interests are set out in ss 60CC(2) and (3) of the Act.

3. Generally it is within the scope of a parent’s responsibility to consent to medical treatment for and on behalf of their child.  However, there are certain procedures that fall beyond that responsibility and require determination by the Court, as part of the Court’s parens patriae or welfare jurisdiction (Secretary, Department of Health and Community Services vJWB and SMB (1992) 175 CLR 218 (“Marion’s case”)).

4. Section 67ZC of the Act was inserted in 1995 specifically providing that the Court has jurisdiction to make orders relating to the welfare of children. The children’s best interests remain the paramount consideration in making such orders.

5. The procedure to be followed with respect to applications requiring Court authorisation of medical procedures is set out at Division 4.2.3 of the Family Law Rules 2004 (Cth) (“the Rules”).

6. Rule 4.09(1) provides that evidence must be given that satisfies the Court that the proposed medical procedure is in the best interests of the child.

7. The Full Court in Re: Jamie [2013] FamCAFC 110; 50 Fam LR 369 (“Re Jamie”) confirms that if a proposed treatment falls within the ambit of Marion’scase, and if the child is not Gillick competent, the proposed treatment must be first authorised by the Court. 

8. The Full Court considered what is known as Stage 2 treatment of gender identity disorder in the decision of Re Jamie.  The issues considered therein included whether the Stage 2 treatment is a medical procedure for which consent lies outside the bounds of parental responsibility and thus requires the imprimatur of the Court. 

9. In determining that issue, the Full Court considered the question of the child’s capacity to consent to Stage 2 treatment; that is the question of whether a Gillick competent child could consent to the procedure.

10. In Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112, it was said by Lord Scarman at 188-189:-

    In the light of the foregoing 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.  Until the child achieves the capacity to consent, the parental right to make the decision continues save only in exceptional circumstances.  Emergency, parental neglect, abandonment of the child, or inability to find the parent are examples of exceptional situations justifying the doctor proceeding to treat the child without parental knowledge and consent: but there will arise, no doubt, other exceptional situations in which it will be reasonable for the doctor to proceed without the parent’s consent.

11. The Full Court in Re Jamie determined that a Gillick competent child could consent to such Stage 2 treatment.  In considering that question Bryant CJ stated:-

    134.    In my view, it would be contrary to the Convention on the Rights of the Child, and to the autonomous decision-making to which a Gillick competent child is entitled, to hold that there is a particular class of treatment, namely stage two treatment for childhood gender identity disorder, that disentitles autonomous decision-making by the child, whereas no other medical procedure does.  The High Court in Marion’s case, adopting the formulation in Gillick, held at 237 that a child is 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”.

    135.    I see no basis for reading this down because the treatment is for childhood gender identity disorder.  Indeed, one might think that, of all the medical treatments that might arise, treatment for something as personal and essential as the perception of one’s gender and sexuality would be the very exemplar of when the rights of the Gillick-competent child should be given full effect.

    (Original emphasis).

12. The next issue considered by the Full Court in Re Jamie was who should determine the question of Gillick competence.  It was held by the Full Court that, due to the nature of the Stage 2 treatment, it is a matter for the Court to determine whether a child is Gillick competent.  Following the reasoning of the High Court in Marion’s case, the Full Court held that this is so for two reasons: firstly due to the risk of making the wrong decision as to the child’s capacity to give consent and secondly, because the consequences of a wrong decision are particularly grave.

13. With respect to Stage 2 treatment, the Full Court held that once the question of Gillick competence was established, the Court would have no further role. 

14. As to how such proceedings are to be conducted, at paragraph 139 of the judgment, Bryant CJ held that in 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.  She stated there that:-

    The material in support of such an application, whilst needing to address the proposed treatment and its effects and the child’s capacity to make an informed decision, would not need to be as extensive as an application for the Court to authorise treatment and I can see no reason why any other party need be involved, absent some controversy.  It would be an issue of fact to be determined by the Court on the material to be presented. 

15. Rule 4.10 of the Rules requires that applications for medical procedures in relation to a child must be served on the prescribed child welfare authority. The prescribed child welfare authority is the relevant government department (“the Department”). An affidavit of Acknowledgement of Service upon the Department was filed on 10 June 2015. That affidavit indicates that all documents on the Court file have been served upon the Department. Counsel for the applicant submitted that no response has been received by the mother’s solicitors from the Department. I am satisfied that Rule 4.10 has been complied with.

16. There is no controversy in this matter; the mother, the father and Christopher are united in their position as to the question of Christopher’s competence to provide consent to the Stage 2 treatment.  Further, all of Christopher’s treating medical practitioners have assessed Christopher as Gillick competent. 

1. In the circumstances, I am satisfied that the appointment of an Independent Children’s Lawyer is unnecessary. The Full Court provided guidelines as to the circumstances in which such an appointment should be made in the decision of Re K (1994) FLC 92-461. One of the categories so identified in that judgment was applications in the Court’s welfare jurisdiction regarding the medical treatment of children where the child’s interests are not adequately represented by one of the parties. I am satisfied that that circumstance does not apply to this case. Both of Christopher’s parents have participated in these proceedings and have sworn affidavits confirming their support for Christopher’s treatment. Both have confirmed their assessment that Christopher fully understands the proposed treatment and therefore is Gillick competent.

2. The hearing was conducted on the papers.  None of the witnesses were required for cross-examination. 

3. The applicable standard of proof is on the balance of probabilities in accordance with s 140 of the Evidence Act 1995 (Cth).

Is Christopher Gillick Competent?

1. All of the medical evidence from Christopher’s treating doctors, together with the evidence of Dr M who has provided a second opinion with respect to the question of Christopher’s Gillick competence, overwhelmingly supports a finding that Christopher is Gillick competent.

2. Dr T first consulted Christopher in November 2013.  In her report dated 12 February 2015 she confirms her belief that Christopher is Gillick competent in relation to decision-making for the commencement of Stage 2 treatment of Gender Dysphoria.  At paragraph 8 of that report Dr T states as follows:-

   [Christopher] is an intelligent young man who has engaged with me during multiple medical consultations in a sophisticated and mature manner.  He has been the driving force behind commencement of assessment and treatment for gender dysphoria.  He is very keen to commence testosterone treatment as soon as possible.  [Christopher] is Gillick competent to make the decisions regarding commencement of stage 2 (testosterone) treatment.  He has a detailed understanding of what the treatment entails and is aware of the risks and benefits that are known, including the risk of regret.  He asks appropriate questions regarding the medication and the changes which are likely to occur in a physical and psychological sense.

3. Dr T confirms in that report that she has also discussed with Christopher the consequences for his fertility if Stage 2 treatment is commenced.  Dr T confirmed that she discussed with Christopher the effect of testosterone on his long-term fertility and that Christopher understood that information. 

4. Christopher has also attended upon Dr G a gynaecologist and director of paediatric and adolescent gynaecology at the Hospital.  Christopher has attended upon Dr G for treatment and management of his very heavy periods as well as in relation to the effect of the proposed Stage 2 treatment on his reproductive organs.  In her report dated 1 April 2015, Dr G details her treatment of Christopher and her assessment of him with respect to Gillick competence.  At paragraph 2 of that report Dr G states:-

   [Christopher] is well aware of the impact of testosterone on the development of facial hair, voice deepening and increasing muscle bulk.  We did not specifically discuss the impact of testosterone on other areas of physiology (eg strengthening bones, potentially altering lipid profile). 

5. At paragraph 5 of the report Dr G sets out the likely long-term physical, social and psychological effects of the proposed Stage 2 treatment.  She confirmed that she had provided to Christopher a careful explanation regarding the potential impacts of the proposed treatment on fertility and also discussed with him his options regarding fertility preservation, including the potential to retrieve or harvest eggs now for storage and future fertilisation and implantation.   As to her assessment of Christopher’s understanding of his options in that regard she noted:-

   I completed the consultation with a sense that [Christopher] had understood these options and asked appropriate questions that demonstrated his understanding.  He was clear that the option of egg or embryo storage which would require stimulated cycles using injections, did not appeal at all. 

6. As to her assessment of Christopher’s capability of making an informed decision about the proposed Stage 2 treatment, Dr G reported as follows at paragraph 8:-

   [Christopher] understood the procedure and is keen to proceed with the testosterone treatment.  I was primarily responsible for ensuring that [Christopher] understood the potential impact of testosterone on future fertility (which is minimal) – and I was comfortable that he was Gillick competent in this understanding and thus decision-making relating to this.

7. In conclusion, Dr G noted:-

   [Christopher] is a very capable and intelligent young person who has carefully considered his options.  He has been forced to manage a number of complicated situations, several of them relating to school issues, as a result of his gender dysphoria.  On the accounts that I have received he has managed these issues with remarkable maturity.  I consider him to be Gillick competent. 

8. The report of Associate Professor P as to Christopher’s understanding of the proposed treatment is equally as unequivocal as the other medical practitioners’.  Associate Professor P has been consulting with Christopher since January 2014.  In his report dated 24 April 2015, Associate Professor P details his history of treatment of Christopher and his diagnosis of Christopher.  As to the question of Gillick competence Associate Professor P assesses Christopher as follows:-

   I believe [Christopher] understands the benefits and risks of testosterone treatment and he certainly meets the criteria for Gillick competence in this regard.  I believe it is in his best interests to commence testosterone treatment as soon as possible. 

9. Later in the same report Associate Professor P states:-

   I have spoken with [Christopher] on several occasions about his understanding of the consequences of testosterone treatment, and I believe he has a deep and comprehensive understanding of the impact of testosterone upon his body. He has access to the [Hospital] information sheet regarding hormone treatment and we were able to go through the contents of this in detail together.  He has also spoken at length with Dr T and Professor [G]. 

   [Christopher] has a mature and thoughtful understanding of the impact of hormone treatments, and even subsequent surgical treatment upon his body.  I believe he has a comprehensive understanding having researched the web and other resources.  [Christopher] does not feel he needs to have a baby from his own body and is aware of alternative ways that he may establish his own family such as adoption or surrogacy.  He said he would not cease testosterone in order to have ova implanted as he would become too distressed with a masculine body.

10. In conclusion Associate Professor P reported as follows:-

    [Christopher] presents as a young man with a thoughtful and mature approach to his own health, his relationships and his future.  I have considered whether [Christopher] meets the criteria for decision-making in respect of his own health, which would be consistent with the “Gillick competent” criteria.  I understand that this requires the that the young person have a high level of maturity and insight such that they are able to make their own decisions in relation to such matters as medical treatment… I believe that [Christopher] does have the insight and maturity to understand the nature of the treatment with testosterone as proposed.  He is aware of the perceived positive changes that will result with is bodily development: that his muscle bulk will increase, that his voice will change and that will have a masculine pattern of body hair.  He is aware that his bone density will increase.  He is aware that commencing testosterone will not of itself reduce the size of his breasts, and he would like to seek surgery at some time in the future to do so.  I believe that he is aware that testosterone treatment will affect the development of his ovaries and that he will not produce ova (eggs) from his ovaries whilst on the testosterone treatment.

11. The reports of each of Christopher’s treating medical practitioners sets out the history of Christopher’s treatment, the detailed discussions that each of the practitioners have had with Christopher over the course of the past 12 months with respect to the impact of the proposed treatment, as well as the short and long-term effects of the proposed treatment.  Further, it is evident from their reports that each of those medical practitioners has discussed with Christopher the potential irreversible effects of the proposed Stage 2 treatment.  Those medical practitioners are united in their view that Christopher is a mature and intelligent young man.  Each report has independently confirmed that Christopher has a thorough and detailed understanding of the consequences of the Stage 2 treatment.  I accept that evidence.

12. Christopher has also had the benefit of attending other specialist medical practitioners for second opinions in relation to his diagnosis and treatment.  As noted earlier in this judgment, he attended upon Dr M on 2 March 2015.  Dr M confirmed the diagnosis of Christopher as having Gender Dysphoria.  It was Dr M’s assessment of Christopher that he is a very intelligent young man and very well-read and researched into the area of Gender Dysphoria and its treatments.  

13. Those views were echoed by Dr K in her report dated 29 April 2015 where she observed that “[Christopher] is a bright young man who is able to demonstrate full understanding of the nature of the stage one treatment, including side-effects and limitations and was actively requesting the treatment when I saw him February 2014.”  Dr K has not consulted with Christopher in relation to the proposed Stage 2 treatment.

14. I accept the unchallenged evidence of Christopher’s treating medical practitioners with respect to their assessment as to Christopher’s Gillick competence. Each of those practitioners has observed Christopher to be mature and intelligent and to have demonstrated a depth of understanding as to the potential impact of the proposed treatments. 

15. Having regard to that evidence, I am satisfied on the balance of probabilities that Christopher is competent to fully understand the nature and consequences of the proposed treatment and to make his own decision in relation to that treatment.

16. The applicant also sought orders that the Court approve a change of Christopher’s name pursuant to the provisions of the relevant State legislation. During discussion with counsel for the applicant it was conceded by him that such order was unnecessary in circumstances where the registration of Christopher’s name had already been affected in his country of origin and where Christopher does not reside in this State.  Accordingly, that application will be dismissed.

17. I make orders as follows:-

    1.That the name of the child Christopher born … 1999, (“Christopher”), Christopher’s family members and their occupations, the Hospital, Christopher’s medical practitioners, Christopher’s school, this Court, file number, the State of Australia in which the proceedings were initiated, the names of the mother’s lawyers, and any other fact or matter that may identify Christopher shall not be published in any way and only anonymised Reasons for Judgment and orders (with coversheets excluding the Registry, file number and 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, it being noted that each party shall be handed one full copy of these Orders with the relevant details included for provision to the treating medical practitioners and to enable their execution, and one coversheet of Reasons for Judgment that includes the file number and the lawyers’ names.

    2.That no person shall be permitted to search the Court file in this matter without first obtaining the leave of a Judge.

    3.Upon the Court being satisfied that the child Christopher born … 1999 is competent to consent to the medical treatment described in the Initiating Application filed 5 June 2015, the Court authorises Christopher to make his own decision in relation to that treatment. 

    4.That the applicant mother be at liberty to provide a copy of the un-anonymised orders and the un-anonymised Reasons for Judgment to all persons involved with Christopher’s treatment.

    5.That the applicant’s Initiating Application filed 5 June 2015 be otherwise dismissed.

AND THE COURT NOTES THAT

The treatment described in the applicant’s Initiating Application filed 5 June 2015 is the following treatment for Gender Identity Dysphoria:-

(i)      That under the guidance of Christopher’s treating medical practitioners including but not limited to Dr T (Paediatrician) and Associated Professor P (Consultant Psychiatrist), Christopher undergo treatment by way of monthly intramuscular injections of Sustanon 250 in a dose of 0.5mL monthly.  The dose may be increased to 1mL monthly depending on any adverse side effects experienced by Christopher;

(ii)That under the guidance of Christopher’s treating practitioners as set out at sub-paragraph (i) herein and if considered appropriate by Christopher’s treating practitioners, Christopher be treated using long-acting Reandron 1000 injections every 3 months and Christopher continue with this treatment long-term, being monitored to adjust the frequency as is necessary, depending on side effects and adequacy of the testosterone does;

(iii)Any other hormone and/or psychiatric or psychological treatment as recommended by Christopher’s treating Paediatrician and Psychiatrist from time to time.

I certify that the preceding sixty (60) paragraphs are a true copy of the reasons for judgment of the Honourable Justice Johns delivered on 16 June 2015

Associate: 

Date:  16 June 2015