Re: Sasha

[2015] FamCA 785

FAMILY COURT OF AUSTRALIA

RE: SASHA [2015] FamCA 785

FAMILY LAW – CHILDREN – MEDICAL PROCEDURES – Where the applicants are parents of a child with Gender Dysphoria – Where the applicants seek a declaration that the child is competent to consent to her own Phase 2 treatment – Where the child is 17 years of age – Where the child has been diagnosed with Gender Dysphoria, major depressive disorder and social-anxiety disorder – Consideration of whether the child is Gillick competent – Where the child’s treating medical experts and parents support the child commencing Phase 2 treatment – Where the child’s treating practitioners have expressed the opinion that the child is Gillick competent – Declaration made that the child is Gillick competent.

Family Law Act 1975 (Cth)

Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112
Re: Jamie (2013) FLC 93-547

1^ST APPLICANT: The Mother

2^ND APPLICANT: The Father

INDEPENDENT CHILDREN’S LAWYER

FILE NUMBER: By Court Order File Number is suppressed

DATE DELIVERED: 9 July 2015

JUDGMENT OF: Johnston J

HEARING DATE: 9 July 2015

REPRESENTATION

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

Orders

1. That Orders be made in accordance with paragraphs 1, 2, 3 and 4 of Annexure A to the Initiating Application filed on 25 May 2015 as set out hereunder:-

1.That the Court declares that the child … known as Sasha born … 1998 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.

2.That the full name of the child, her family members, her hospital, the Independent Children's Lawyer, her medical practitioners, her school, this court's file number, any Family Consultant, the State of Australia in which the proceedings were initiated, the name of Sasha's parents' lawyers, her proposed name Sasha, and any other fact or matter that may identify Sasha shall not be published in any way, and only anonymised reasons for judgment and orders (with cover-sheets excluding the registry, file-number, and lawyers' names and details, as well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 numbers 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 otherwise all existing applications shall be dismissed, the case removed from the list of cases awaiting finalisation, and the appointment of the Independent Children's Lawyer shall be discharged.

1. That the hearing on 31 August 2015 be vacated.

IT IS NOTED that publication of this judgment by this Court under the pseudonym Re: Sasha 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

1^ST Applicant

And

The Father

2^ND Applicant

And

The Independent Children’s Lawyer

REASONS FOR JUDGMENT

1. Sasha is 17 years, two months of age.  She was born biologically a male and commenced life as a child given a male name. She has the condition of transsexualism called gender dysphoria.  I shall use the female pronoun when referring to Sasha. 

2. Sasha did not experience gender dysphoria or demonstrate any overtly gender-variant behaviours until entering puberty.

3. Sasha’s parents seek orders which would permit Sasha to access medical treatment which would enable her to develop secondary female characteristics. 

4. The treatment of gender dysphoria is conducted in two stages.  Phase 1, also referred to as stage 1, involves hormone treatment to suppress puberty and is reversible.  But in Sasha’s case, it is too late to have puberty-blocking medication.  Phase 2 involves hormone treatment to stimulate physical changes which bring about the characteristics of the affirmed sexual identity.  Phase 2 is not readily reversible. 

5. The application is that orders are sought to the effect that the court declares that the child, Sasha, is competent to consent to the administration of stage-2 treatment for the condition of transsexualism called gender dysphoria in adolescence and adults in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. 

6. The parents also seek various other orders to assist in the child’s privacy and their privacy, and I propose to make those orders.  It is unnecessary to refer in detail to those orders.  The parents also sought fallback or alternative orders.  And while I make reference to them in this judgment, it is unnecessary to refer to those orders at the present time.

7. The brief background matters are as follows.  The parents met in 1984, and they commenced their relationship in 1987.  They married in 1990.  At the time of their marriage, each had two children by their previous marriages.  They had two children prior to Sasha’s birth.  As I have said, Sasha was born in 1998.  They subsequently had four children. 

8. When Sasha reached puberty at approximately age 13 to 14 years, she began to withdraw from her homeschooling activities, friends and family.  She spent a lot of time in her room and did not participate in activities which she used to enjoy.  When Sasha did come out of her room, she was loud and boisterous and demanded a lot of attention from the family.  Sasha’s father has been seeing a psychologist, Mr D, since January of 2014. 

9. In May 2014, Sasha’s mother discovered that Sasha was exploring gender issues when she made an appointment for herself at the Gender Centre.  Her mother took her to the appointment but did not tell her father or her siblings.  Her mother spoke with her counsellor and close friends about the issue at this time. 

10. Sasha told her mother in July 2014 that when she started going through puberty two or three years earlier, she had been angry and upset that her voice was breaking and that she was growing facial hair.  She said to her mother that she was very jealous of the other girls and their physical development.  In approximately July 2014, Sasha told her mother that she used to cry herself to sleep every night, pray to God to change her into a girl and make everyone forget that she was ever a boy.  She said that it upset her to look in the mirror and see facial hair, an Adam’s apple and lack of breasts.

11. At approximately this time, Sasha’s mother became aware that Sasha was dressing like a girl in private in her bedroom.  Her siblings, or at least two of her siblings, said they noticed that their clothes and make-up had gone missing and were later discovered in Sasha’s room.  Sasha later showed her mother a small suitcase of girls’ clothes that she had taken from her siblings.

12. In August 2014, Sasha told her mother that she had experienced suicidal thoughts throughout 2014 and earlier in 2013.  Sasha told her mother that when she had attended a youth convention in May 2014, she had planned to kill herself by jumping off a cliff.  The day after making these disclosures, Sasha visited the mental health emergency unit at X Hospital but was not admitted. 

13. In October 2014, Sasha commenced seeing counsellor Dr R, who specialises in gender issues.  Dr R advised Sasha’s parents that Sasha had gender dysphoria and that she needed to socially and medically transition to female as soon as possible.

14. In October 2014, Sasha told her drama group that she was transgender and that she planned to start transitioning from a male to a female.  Most children and parents involved in the group have been supportive of Sasha.  However, some have refused to call Sasha by her preferred name. Sasha went through a major depressive episode immediately after these incidents.

15. In early November 2014, Sasha commenced using the name Sasha during everyday life.  In late November, Sasha’s maternal and paternal grandparents were told that Sasha was transgender.  The mother reported them to be accepting and supportive.

16. Sasha started to live her life as a female full time in December 2014.  At approximately this time, she commenced casual work.  The mother said that people accepted her as a girl, but her anxiety and depression made it difficult for her to continue in this role.  The employer agreed that Sasha’s sister could work in Sasha’s place when Sasha was not able to do so.

17. In January 2015, Sasha began seeing Dr T at the V Medical Practice.  Sasha has also seen Dr K at the Department of Adolescent Medicine in Z Hospital.  Dr K has referred Sasha to Dr W, endocrinologist, at Z Hospital.  The parents have subsequently sought a referral to the endocrinologist Dr H.  In March 2015, Sasha started seeing psychologist Ms J at headspace.  Sasha has also seen psychiatrist Dr S at headspace every two weeks since January 2015. 

18. Sasha has been accepted into the Y School and commenced this program on 11 May 2015.  The school is a collaboration between the relevant State government agencies designed to help young people with mental-health issues to transition back into school, vocational training or employment.  Sasha will see a psychologist through this program and will no longer see Ms J. 

19. On 18 May 2015, Dr S prepared a report in these proceedings diagnosing Sasha with gender dysphoria, major depressive disorder in partial remission and social-anxiety disorder.  Sasha is keen to commence treatment and would desperately like to start taking female hormones.  Sasha has informed her parents that she wants to have surgery once she is older to further her transition.  Sasha continues to have suicidal ideations, but such thoughts have been alleviated by medication and psychiatric support. 

20. Sasha is currently involved in an amateur drama production.  Sasha currently lives with her parents and five of her siblings.  Her ambitions for the future include participation in the performing arts. 

21. I will turn to the applicable law.  In Re:  Jamie (2013) FLC 93-547 the Full Court deal comprehensively with the circumstances in which court authorisation is necessary for phase 1 and phase 2 treatment. The following points of guidance arise from the judgment. Firstly:

    The court has jurisdiction to hear and determine an application for authorisation of phase 1 treatment if there is a dispute about the proposed course of treatment, for example, between the views of the child, his or her parents or guardians and his or her treating medical practitioners.

22. Secondly:

    In the absence, of such a dispute, court authorisation is not required for phase 1 treatment.

23. Next point:

    In relation to phase 2 treatment, if the court is satisfied that the child is Gillick competent, then in the absence of any controversy, the child can consent to the treatment and no court authorisation is required.

24. And, of course, that is the situation which the parents are putting before the court immediately. 

    The question of whether a child is Gillick competent is a matter to be determined by the court.  If the court is not satisfied that the child is Gillick competent, then court authorisation for phase 2 treatment is required.

25. What is meant by Gillick competence was set in the House of Lords decision in Gillick & West Norfolk and Wisbech Area Health Authority [1986] AC 112. The relevant passage is that of Lord Scarman at pages 88 to 90, which is as follows:

    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 parents 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 parents’ consent.

26. And, as an aside, I just say don’t worry about the age 16; that was obviously something relevant in the United Kingdom, and we have a different – well, perhaps have a different age of majority.  But, as you would be aware, it is 18 years of age in this country.

27. I turn to Sasha’s condition.  As I say, Sasha has been diagnosed as having the condition of gender dysphoria by Dr S.  Now, the diagnostic criteria for the condition of gender dysphoria is set out in the Diagnostic And Statistical Manual Of Mental Disorders, which is known as the DSM-5.  And Dr S’s opinion of how Sasha meets each of such criteria are as follows.  So what I am doing is I am referring to each of the criteria, because there are quite a few, and then I am setting out what Dr S says in respect of each of those criteria under the Diagnostic and Statistical Manual of Mental Disorders.  So, firstly, gender dysphoria in adolescence and adults.  And this is referring to the DSM-5:

    A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least two of the following:

    1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics or, in young adolescents, the anticipated secondary sex characteristics.

    Now, about this, Dr S says as follows:

    This has been a source of increasing personal distress and dysphoria since the onset of puberty at 13 years of age.  [Sasha] avoids having showers, as this forces her to confront her naked body in its male form. 

28. Now, the second of the criteria is:

    …a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender, or, in young persons, a desire to prevent the development of the anticipated secondary sex characteristics.

    Dr S says:

    [Sasha] is distressed by the emergence of facial and body hair and dislikes her low voice.  She hides her genitalia by tucking and wears androgynous or female-gendered clothing by preference.

29. The next criterion is:

    …a strong desire for the primary and/or secondary sex characteristics of the other gender.

    And about this, Dr S says:

    [Sasha] avoids physical exercise that might build muscle mass and reduce her subcutaneous fat.  She wishes to have smooth, hairless skin and a higher voice.  She’s growing out her hair.  [Sasha] wishes to develop breasts but has not stated to me at this stage that she is desirous of having an orchiectomy and vaginoplasty.

30. Fourth criteria:

    …a strong desire to be of the other gender or some alternative gender different from one’s assigned gender.

    About this, Dr S says as follows.  He said that:

    [Sasha] has felt this way since age 14, although she did not disclose this to her parents until turning 16, following disclosure of her depression, suicidality and gender dysphoria at a religious youth camp. 

31. The next criterion is a strong desire to be treated as the other gender or some alternative gender different from one’s assigned gender.  And Dr S says:

    [Sasha] presents socially in androgynous or feminine clothing, long hair and sometimes wearing jewellery.  She has legally adopted the female given name [Sasha], in place of [X], and prefers to be referred to using feminine pronouns.  [Sasha] strongly desires to be seen, known and treated as a female by existing and new friends and acquaintances.

32. The next criterion is a strong conviction that one has the typical feelings and reactions of the other gender.  And Dr S says:

    [Sasha] considered herself to be gender neutral since early childhood.  She has de-identified as a male since puberty and does not relate to many of the stereotypical interests and concerns of boys in her age peer group.  Since discovering the existence of transgenderism at age 14, [Sasha] realised that this was what was happening to her.  [Sasha] does retain an avid interest in metal music and video gaming but regards herself as being primarily female in nature at this time.

33. And there is another criteria which is headed up in the DSM-5 under this section, with the prefix B, and it is this:

    The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning. 

34. And about this, Dr S says as follows:

    [Sasha] has consistently expressed her personal distress, due to experiencing a disjunction between her assigned gender and her experienced gender.  She has suffered severe and prolonged depressive episodes with suicidal ideation and has severe social anxiety disorder.  These difficulties have greatly restricted her social development and have made home schooling her only viable option.

35. Dr S says he believes that:

    She is a very intelligent young person who has significantly under-achieved academically because of the pressure of having to deny and suppress her gender experience amongst her peers.  It is my opinion that this has been grown into a clinical depression, which further impaired her motivation and performance.  There is no evidence of the occurrence of mood-congruent or mood-incongruent psychotic features.  There is no history of current clinical evidence on examination of any psychotic illness that might or might not explain or incorporate the gender dysphoria and [Sasha] denies any history of clinically significant substance abuse or substance dependence.

36. And he says:

    In addition, it is my judgment that the depression and the social anxiety are greatly contributed to by the gender dysphoria and her perceived risk of rejection and abuse should she disclose it or be it unable to comfortably pass as a female in general society.  However, the depression and social anxiety are such that they also require treatment in their own right.  To this end, [Sasha] is undertaking a period of residential treatment at the [Y] Adolescent and Family Unit.

37. Dr S goes on to diagnose Sasha as also suffering from major depressive disorder, in partial remission, and social anxiety disorder.  He sets out in his report her symptoms of these conditions but I consider it unnecessary to set these out in detail.  Now, I now propose to refer to the proposed procedure and its effects.  Professor W, Sasha’s specialist endocrinologist, will initiate and supervise Sasha’s medical treatment.  She has provided a report for the Court and describes the nature and purpose of the proposed procedure as follows:

    Gender reassignment from male to female requires a combination of therapy.  Firstly, GNRH analogues are used to block LH and FSH secretion, which stimulates the testes to produce testosterone and sperm.  The treatment with GNRH analogues is required to inhibit the effects of testosterone on phenotypic development as male.  This treatment is fully reversible if ceased, with the individual reverting to phenotypic male development.  Phase two treatment to allow development of a female phenotype requires the use of oestrogen therapy and sometimes additional blockade of androgens using cyproterone acetate. 

    Oestrogen is initially commenced at very low dose and in very low dose the effects are reversible.  And in the first 12 months of therapy [Sasha] is unlikely to get oestradiol doses above two milligrams of oestradiol equivalent, which, in effect, would still be reversible if she subsequently made a decision to stop treatment after the age of 18.  Very low doses of oestrogen are needed initially for priming of normal breast development and to allow subsequent normal female breast development to occur.  Higher doses of oestrogen used early can result in abnormal or tubular breast development.  This does not occur if oestrogen is initiated in low dose for the first one to two years of therapy.

1. And then Professor W describes the ways in which the procedure is necessary for Sasha’s welfare.  And she says as follows:

   [Sasha] is very specific, stating the onset of concerns about her gender identity from the onset of development of secondary sexual characteristics at the age of 12.  The development of hirsutism and need to shave and/or wax for removal of body hair is particularly distressing for [Sasha].  Up until the development of secondary sexual characteristics [Sasha] did not specifically assign herself to female or male but on the development of secondary sexual characteristics very clearly identified as female. 

   The treatment with GNRH analogue and subsequent oestrogen therapy is required specifically to prevent growth of secondary sexual hair in a male pattern and secondly, to assist breast development, which would be concordant with [Sasha’s] gender identity.  This alleviates considerable distress for the child with gender dysphoria.

2. Dr S said that Sasha’s welfare will be served by undergoing the proposed treatment.

3. He said that:

   Bringing greater congruence between [Sasha’s] sense of self and how [Sasha] is perceived by others would lead to significantly reduced psychological suffering, which will very likely also have a beneficial impact on [Sasha’s] coexisting mental health disorders.

4. And then Dr S refers to the likely short and long-term physical, social and psychological effects of the procedure on Sasha, including any risks. And he says, firstly:

   If the procedure is carried out, in the short-term [Sasha] will have arrest of masculinisation of the body in terms of further development of male secondary sexual characteristics.  Her skin will soften and facial and body hair growth will be minimised in amount and soften in texture.  Her voice will not deepen further.  In the longer-term she will develop breast tissue to an unpredictable degree.  Body fat distribution in the female pattern will develop to an extent which is not fully predictable.  She will experience reduced spontaneous erections, lowered aggressive and sex drives and will cease to produce sperm. 

   This procedure will greatly facilitate [Sasha’s] social transitioning as a female at a crucial period of her social and sexual development.  It will bring about physical and psychological alterations that are in accord with her female sense of identity and her strongly preferred way of being perceived and treated by others.  It is highly likely that the underlying dysphoria and the anxiety about her ability to be seen by others as a female passing will thereby be further significantly reduced.  [Sasha] will thereby be at a much lower risk of stress-induced anxiety, depression, risk-taking behaviours and mistreatment by others. 

5. And he says:

   Risks of the procedure include a somewhat higher propensity to anxiety and depression due to the change in sex hormone levels.  She will be more prone to venous thrombosis and will gain weight.  There is a higher risk of hypertriglyceridaemia and a possibility of increased risk of cardiovascular disease, hypertension, hyperprolactinaemia and type 2 diabetes in the presence of additional risk factors.  There may ultimately be a higher likelihood of the development of breast cancer.  [Sasha’s] testes will undergo some degree of atrophy and she will ultimately be infertile.

6. And then Dr S refers to if the procedure is not carried out and he says as follows:

   If the procedure is not carried out [Sasha] would require commencement on non-specific and expensive regular injections of goserelin (Zoladex), a sex hormone blocking treatment, until the age of 18 years when upon reaching maturity she could give her own consent to undergo cross-sex hormone treatment and other forms of gender reassignment treatments. 

7. Dr S says that:

   This delay would be a source of significant frustration and an implicit invalidation of her enduring and strongly-held personal and social identities.  It is also very much more expensive, inconvenient and uncomfortable medical treatment, requiring visits to a major hospital outpatients department for intramuscular injections at relevantly frequent intervals of time (every several weeks).

8. He says:

   A delay in the administration of feminising hormones and androgen-blocking therapy will impede [Sasha’s] psychosocial development as a young woman and is likely to cause the recurrence of severe depression, anxiety and social isolation.  [Sasha’s] past history of social anxiety and depressed mood are indicative of the very high importance of successful transitioning to the psychological and social wellbeing of this young person.

9. Professor W has also reported on the effects and risks involved and I have noted her opinion about these matters.  Now, she says in relation to the likely short and long-term physical, social and psychological effects of the procedure on Sasha, including any risks, Professor W says:

   If the procedure is carried out, there are multiple benefits demonstrated in those with gender dysphoria from prescribing the appropriate hormonal therapy for their gender identity.  The removal of testosterone and pituitary hormones will prevent spermatogenesis.  Sperm, however, can be cryopreserved, leaving the option open for future fertility without requiring [Sasha] to revert to genetic male.  This has been arranged.  Although there is removal of testosterone, which may cause a withdrawal syndrome with flashing and fatigue, the alleviation of distress from the unwanted effects of testosterone by discontinuing development of secondary sexual characteristics frequently outweighs the negative consequences of removal of the testosterone. 

   There is often significant relief for the individual with gender dysphoria when hormone inhibition is implemented, allowing them to start progression towards therapy consistent with their gender identity.

10. And Professor W says:

    Given [Sasha] is socially living life as female and will be attending school in female dress, the use of hormone therapies consistent with her gender assignment will have significant social benefits for her, as well as the physical benefits of preventing progression of hirsutism and, in fact, resolution in time of hirsutism completely.

11. And then the professor says:

    If the procedure is not carried out, [Sasha] would continue to experience considerable distress in the absence of hormone therapy consistent with her gender identity.

12. So the question becomes, is Sasha Gillick competent?  Professor W has opined as follows:

    Finally, I believe [Sasha] is fully competent to understand and retain both existing and new information regarding the proposed treatment.  She was able to provide a full explanation in terms appropriate to her level of maturity and education of the nature of phase two treatment and what she hoped to achieve with it.  She was able to describe both the advantage of phase two treatment and the disadvantages of phase two treatment and we broadened her understanding of those advantages and disadvantages at the consultation.  She was able to weigh advantages and disadvantages in the balance and arrived at an informed decision about proceeding with phase two treatment as soon as was practicable.

13. And Professor says:

    [Sasha] was also able to understand that the decision to proceed with phase two treatment could have consequences that could not be entirely foreseen at the time of the decision and she also understood that phase two treatment would not necessarily address all or any psychological or social difficulties that she has before the commencement of the treatment but believed it would help considerably in alleviating the distress currently caused by her current physical phenotype.  There would appear to be no temporary factors, such as pressure or pain that could impair her judgment in providing her consent.

14. Then Professor says:

    In light of my assessment of [Sasha], I believe she is competent to the Gillick standard to provide her consent for gender reassignment therapy.

15. And Dr S, on the question of Gillick competence, reported as follows.  And he said:

    [Sasha] demonstrated a capacity to comprehend and retain both existing and new information regarding the proposed treatment.  She was able to integrate knowledge about the treatment, modified her existing knowledge was new information was presented for her consideration and incorporated both existing and new information in a rational discussion concerning the proposed treatment.  [Sasha] was able to provide a full explanation in terms appropriate to her level of maturity and education of the nature of phase two treatment. 

    [Sasha] understood that she would be taking oral medication in the form of female sex hormones, primarily or exclusively oestrogen, for many years and possibly for the rest of her life.  She knows that she will also be taking an anti-androgen agent while her body retains the capacity to produce its own testosterone in physiologically significant amounts.  She understood that this treatment needs to be accompanied by regular medical monitoring and supervision, including occasional blood tests to check the hormone levels. 

    She understood that the changes will be gradual and cumulative over months to years.  [Sasha] demonstrated that she was able to describe the advantages for her of phase two treatment.  She told me that the oestrogen will cause body fat redistribution to promote development of a female body shape, an unpredictable amount of breast development, change in hair texture and quantity, and perhaps some change in skeletal development, such as pelvic shape.  [Sasha] recounted the advantages of anti-androgen treatment as being the minimisation of facial and body hair growth, inhibition to further muscle development, and reduction of skin oiliness.  [Sasha] saw the major advantage of the above physical changes as enabling a greater degree of psychological comfort as her body comes into line with her strong sense of being female in gender, leading to reduction in gender dysphoria. 

    [Sasha] anticipates that this will enhance her personal happiness, enable a greater enjoyment of life and an increased capacity for social relationships.  [Sasha] was able to describe the disadvantages of phase 2 treatment, including the inconvenience of taking medication on a daily basis which she perceives as very minor, the possibility of being more prone to depression and anxiety, reduced energy and sex drive, weight gain, an increased likelihood of blood clots and, perhaps, an increased risk of certain cancers.  [Sasha] told me that she is giving consideration to sperm storage and accepted that this is best done prior to commencement of phase 2 treatment.

    [Sasha] was able to weigh the advantages and disadvantages in the balance, and arrive at an informed decision about whether and when she should proceed with phase 2 treatment.  She expressed a clear and informed decision to commence this treatment as soon as possible.  [Sasha] openly acknowledged and understood that phase 2 treatment will not necessarily address all of the psychological and social difficulties that she had before the commencement of treatment, and that further support and treatment in these regards will be of benefit to her.  She is committed to pursuing ongoing treatment of these issues.  It is my opinion that anxiety and depressive conditions notwithstanding, [Sasha] is free to the greatest extent possible from temporary factors that could impair her judgment in providing consent to the procedure.

16. The solicitor for the Independent Child Lawyer informed the Court that she had met with Sasha recently.  The solicitor said that Sasha has a clear understanding of the proposed procedures and their effects, advantages and disadvantages.  Sasha’s mother is completely supportive of Sasha’s decision to commence hormone therapy and her father is not opposed to commencement of the therapy.

17. In conclusion, it is my view, on the basis of the evidence of both experts, that of Sasha’s parents and also the solicitor’s reporting of her meeting with the child, that this Court is satisfied that Sasha is Gillick competent, that is, she has a sufficient understanding of what is involved in the proposed medical procedure to give a consent valid in law.

I certify that the preceding fifty-five (54) paragraphs are a true copy of the reasons for judgment of the Honourable Justice Johnston delivered on 9 July 2015.

Associate:

Date:  9 July 2015