Re: Quinn (No 2)

[2017] FamCA 162

FAMILY COURT OF AUSTRALIA

RE: QUINN (NO. 2) [2017] FamCA 162

FAMILY LAW – CHILDREN – GENDER DYSPHORIA – Application for Stage 2 hormone treatment – Where the child is Gillick competent – Orders made for Stage 2 treatment to commence.

APPLICANTS: The Mother and the Father

RESPONDENT: The Department

FILE NUMBER:  By Court Order File Number is suppressed

DATE DELIVERED: 21 March 2017

JUDGMENT OF: Rees J

HEARING DATE: 17 March 2017

REPRESENTATION

By Court Order the names of solicitors have been suppressed

Orders

IT IS ORDERED

1. That the child Quinn, who was born on … 2001, is competent to consent to the administration of Stage 2 treatment for the condition of transsexualism called Gender Dysphoria in Adolescents and Adults in the Diagnostic and Statistical Manual of Mental Disorders (2013) DSM-5 on and from a date determined by his treating medical practitioners.

2. That the full name of Quinn, his family members, his hospital, the Independent Children’s Lawyer, his medical practitioners, his school, this Court’s file number, the State of Australia in which the proceedings were initiated, the name of Quinn’s parents’ lawyers, and any other fact or matter that may identify Quinn, shall not be published in any way, and only anonymised Reasons for Judgment and Orders (with cover-sheets excluding the registry, file number, and lawyers’ names and details, as well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, to enable their execution, and one cover-sheet of Reasons for Judgment that includes the file number and lawyers’ names.

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

4. That the appointment of the Independent Children’s Lawyer be discharged.

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 Quinn (No 2) 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 and the Father

Applicants

And

The Department 

Respondent

REASONS FOR JUDGMENT

1. This is the second application made by the parents of Quinn who was born in 2001 seeking a declaration that Quinn is competent to consent to treatment for the condition known as “gender dysphoria”. Quinn wishes to proceed with testosterone therapy, referred to as Stage 2 treatment.

2. The previous application (“the first proceedings”) was determined by a Judgment and Orders dated 26 July 2016. Those reasons should be read in conjunction with these reasons. In the earlier reasons, the law in relation to such an application was set out and it need not be repeated here. After considering the evidence, a declaration was made that Quinn was competent to consent to the proposed treatment. The treatment was carried out in August 2016.

3. The treatment which is now proposed is different and once again the Court is asked to determine whether Quinn is competent to consent.

4. After judgment had been handed down in the first proceedings, the Independent Children’s Lawyer (“ICL”), with the consent of the applicant parents and the representative of the Department, made an oral application for a declaration that Quinn is competent to consent to the proposed testosterone therapy. I indicated that the application would be dealt with when expert evidence had been filed.

THE EVIDENCE

1. Affidavits have been sworn by four experts. Dr R is Quinn’s counsellor and clinical supervisor. Dr Y is his consultant endocrinologist. Dr D is a consultant psychiatrist who has seen Quinn on three occasions since the completion of the treatment in August 2016. Dr M is a paediatric endocrinologist who prepared an updated report dated 19 December 2016.

2. Dr R in her report dated 15 December 2016, stated:

   [Quinn] feels very positive about the impact testosterone is likely to have and is aware that there may be effects of Testosterone administration that are unknown. [Quinn] is aware of research that has identified some negative effects on some trans teens regarding mood changes. However, [Quinn’s] focus is on the benefits he will gain as he explained the significant positive difference that [the administration of testosterone] will make to him.

3. Dr R deposed that Quinn was able to describe the advantages of testosterone administration and the disadvantages. Dr R stated “With respect to weighing the advantages and disadvantages, [Quinn] stated, ‘I’d have to say the advantages definitely outweigh the disadvantages because my happiness is dependent on being able to feel like myself’.”

4. Dr R continued “Regarding the future [Quinn] said, ‘If problems regarding the administration of testosterone occur in the future I understand that this was my decision to make.’ [Quinn] was clear that his need to present and be seen as a male override any future concerns.”

5. Dr R stated that in her expert opinion, Quinn was able to understand that the treatment would not necessarily address all or any psychological or social difficulties that he has had before the commencement of the treatment and that he is free, to the greatest extent possible, from temporary factors such as pressure or pain that could impair his judgement in providing his consent to the treatment.

6. Dr Y in his report dated 29 November 2016, stated:

   I believe that [Quinn] is able to comprehend the nature of the treatment such that he is able to provide informed consent, according to the Gillick standard. … [Quinn] is aware that some of the effects of testosterone, such as deepening of the voice and scalp hair loss, are permanent and remain even if treatment is discontinued. [Quinn] is cognisant of the fact that the treatment may have unforeseeable consequences. [Quinn’s] expectations of treatment are realistic such that he does not expect treatment to address all future psychological and social difficulties that he may encounter.

7. Dr D reviewed Quinn in September and November 2016 and again in January 2017. In his report dated 28 January 2017, Dr D stated:

   I have assessed [Quinn’s] capacity in regard to commencing testosterone treatment and feel he is competent to the Gillick standard to provide consent. [Quinn’s] psychiatric symptoms, whilst at times distressing, are not severe enough to affect his ability to retain existing and new information. There is no evidence of delirium or dementia which may also confound his capacity.

   [Quinn] is able to outline in sufficient detail what testosterone therapy entails, which is appropriate to his level of maturity and education. He can quite clearly describe the advantages he sees to the treatment as well as the disadvantages. He is able to weigh these up and arrive at an informed decision regarding whether he should proceed with treatment. He understands that there may be unforeseen consequences or side effects of undergoing treatment. [Quinn] is aware that the procedure will not ameliorate all his psychological and social difficulties and to the greatest extent possible I believe he is free from pressure or pain that impairs his judgement.

8. Dr M reviewed Quinn on 19 December 2016 and provided a report. Dr M discussed the commencement of Stage 2 treatment with Quinn. In her report she stated:

   [Quinn] understands that he could stop pubertal suppression at any time and return to a female gender role; he has firmly expressed that he does not wish to do this. I am of the opinion that the gender dysphoria remains firmly entrenched and that [Quinn] has a good knowledge and understanding of the effects of stage 2 testosterone therapy.

9. The evidence confirms that Quinn remains competent to consent to the treatment which is proposed.

10. Nothing in the expert evidence suggests that Quinn’s competence has deteriorated.

11. Orders will be made in accordance with the application of the ICL.

I certify that the preceding fifteen (15) paragraphs are a true copy of the reasons for judgment of the Honourable Justice Rees delivered on 22 March 2017.

Associate: 

Date:  21/3/2017