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Discussion point: can children consent to puberty blockers? What about other drastic treatments?

Before you weigh in, please read both the Guardian articles.

“UK court hears children cannot consent to puberty blockers”, reports the Guardian today.

In a statement in the submission, Bell said she had been left with “no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered”. She had to live with the fact that if she had children in the future, she would not be able to breastfeed. “I made a brash decision as a teenager (as a lot of teenagers do) trying to find confidence and happiness, except now the rest of my life will be negatively affected,” she said.

On the other hand, the abstract of this medical study published in the official journal of the American Academy of Pediatrics records that the study found that

There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.

Another Guardian article published on 28 September raised similar issues of principle regarding a treatment that must be given to children if it is to work at all:

‘There is a fear that this will eradicate dwarfism’: the controversy over a new growth drug.

Two extracts:

Samuel Gray is very brave about his daily injections. At six-and-a-half, confident and happy, he was a boy who knew his own mind and made a big decision about his future. His parents had asked him if he wanted to take part in a clinical trial for a drug that could improve some of the conditions associated with achondroplasia, the most common form of dwarfism, with which Samuel was born.

[…]

In 2015, BioMarin Pharmaceutical, the company that developed vosoritide, released the results of phase two of its study. At the time, Leah Smith, a spokeswoman for Little People of America (LPA), the largest organisation in the US for people with dwarfism, said: “People like me are endangered and now they want to make me extinct.” Recently, the actor Mark Povinelli, who is president of the LPA, told the New York Times that the drug “is one of the most divisive things that we’ve come across in our 63-year existence”.

54 comments to Discussion point: can children consent to puberty blockers? What about other drastic treatments?

  • Before anyone asks, yes I’ve read the links (except the data for the scientific article which required an account).

    Firstly, the fundamental difference between vosoritide for kids with achondroplasia and puberty blockers for transgender kids is that the 1st is attempting to deal with a physical illness whereas the 2nd is trying to deal with a mental illness (often a mental illness of the mother to be honest).

    In both cases the drugs are effective almost exclusively on preteens and pointless after that, so you can see why there is consternation from those who grew up without access to these drugs and therefore have to live with the consequences. The PORGs in adulthood have a point. You don’t get many closet dwarves and it’s pretty obvious to anyone the nature of their physical condition, but why would you want to inflict suffering and early death on kids if you didn’t have to? Apart from the aspect of “I suffered and so should they”, which is just a form of sadism disguised as personal growth

    The other aspect of this is the consequences of decisions made by children and the effect they have in adulthood. From that perspective the drug to treat achondroplasia is clearly a winner because the only consequences of taking it seem to be the potential for having a normal life, but the consequences of taking puberty blockers (even if they don’t go ahead with gender reassignment surgery) are permanent and life long, since there is no way of rerunning puberty and more hormonal tinkering in adulthood just makes matters worse.

    As for the older PORGs complaints that “We’re effectively exterminating dwarves!”, I understand their anger that the treatment cannot work for them as well as their genuine fear that their community would be wiped out if this treatment proves effective and becomes used widely, but surely the greater good is in effective treatment.

    The difference between the trans argument and the dwarf argument is not about informed consent, but rather about the potential (or even likely) consequences of that decision.

  • “Nobody could sensibly think that a child of 13 or under who cannot in law give valid consent to sexual acts could possibly give informed consent to treatment of dubious benefits and lifelong consequences.”

    While one can say much for ‘sensibly’, I would probably replace it with ‘logically’ or ‘consistently’ to make the word ‘Nobody’ robust in the sentence – less at risk of counter-example.

    It might lend useful broadness to the discussion if we imagine scientific advances offering freedom of choice in either direction. Imagine discovering e.g. that some specific early-puberty-period hormonal imbalance in the brain was sometimes the efficient cause of gender disphoria in a physically binary teen – and was correctable, if child and parents thought it a good idea. As regards dwarfism, it may be that science already well knows how to stunt a child’s growth, had any child and parents ever wished it.

    We live in a world rotten with political correctness, and a vast amount can be said against decisions, ‘science’ and etc. that we know or sensibly suspect is just PC fraud. However I think Natalie is also here using this as a hook to prompt thinking more abstractly about liberty in a world with less need to put the fight against PC front and centre – a future world or a science fiction world in which the choice of how to handle an issue were accompanied by the choice not to have the issue.

    Though I would not at all support them, I can see where the dwarfists are coming from. As soon as not being a dwarf is a choice – a choice that not all affected children and/or parents may make but which many will – then dwarfs, already a small minority (please excuse hard-to-avoid pun 🙂 ), need only see some make the choice eagerly to then see other parents and children look at dwarfs’ yet more diminished options for compatible society and so feel more strongly pressed to do the same. Thus, as generations pass, it becomes a crazy choice not to make, a cruel choice for parents not to urge. Other minorities might also fear choices that, by the free but statistically predictable choices of children and parents, risk make them a yet smaller minority. A harsh summary would be: ‘misery loves company, but company does not reciprocate’. One could put it more sympathetically: when the state you and others were ‘born with’ (whether in fact or just not disprovably) becomes a choice for which you are responsible, your desire for more company can conflict with others’ desire for the company of the majority over and above whatever case exists against the minority choice.

  • Natalie Solent (Essex)

    John Galt,

    I could have sworn that when I first found the link to that scientific article I could see it all, but when I looked again after seeing your comment it was behind a paywall. I didn’t read the whole article properly, though, I just read the abstract and skimmed the rest. I’ve made slight changes to the wording of my post to allow for Samizdata readers not being able to read the whole study unless they happen to have access to that journal. I mostly just wanted to make the point that there was another side to the story.

    Thanks to both you and Niall Kilmartin for two such thoughtful comments.

  • There is also an implicit bias in this argument which favours the treatment for Achondroplasia which is that it is too early in the medical testing phase for there to have arisen any significant problems (including regret) of those taking it. Maybe in 20 years there will be a group of small adults who were treated with Vosoritide and as such they have had a normal physical development, but are short of stature and as such they feel excluded from PORG society, but normal society still treats them as “midgets” and the boys especially (given female “heightist” preferences) end up sexually frustrated, isolated and suicidal. All of a sudden that sounds quite a lot like the trans community…

    Maybe only time will tell.

    Another point I would make, although a bit outside Natalie’s scope is that some percentage of trans kids are not suffering from a crisis of gender identity, but rather have a form of gender dysphoria related to autism. Rather than giving kids puberty blockers and setting them on the seemingly unstoppable railroad towards gender reassignment surgery (and the consequences of post-surgical regret, suicide and death that so often results), if they were correctly diagnosed with autism related gender dysphoria AND TREATED FOR THAT then many of the follow on problems can be avoided.

    The problem with trans kids is that the whole debate has become so politically charged and brutal that those “sensibleists” who might have spoken out and offered alternatives are essentially silenced. Nobody wants the professional and social death that comes from being a health professional or academic tainted with being “Trans-Exclusionary”.

    When people like JK Rowling, Germaine Greer and others are essentially outcast for even the mildest protestations, those whose tenure is a bit more tenuous will stay silent.

    “Whom the gods would destroy they first make mad”
    The Masque of Pandora – Henry Wadsworth Longfellow, 1875.

  • Nullius in Verba

    “In a statement in the submission, Bell said she had been left with “no breasts, a deep voice, body hair, a beard, affected sexual function and who knows what else that has not been discovered”.”

    There’s something wrong with that statement. The idea behind puberty blockers is to reversibly *delay* puberty until the child is old enough to make an informed decision, at which point they start taking hormones to trigger the puberty appropriate to their mental gender, which is where the deep voice and beard come from. A ‘puberty blocker’ that results in a beard isn’t working!

    Someone isn’t being entirely straight with us. This smells political.

    “‘There is a fear that this will eradicate dwarfism’: the controversy over a new growth drug.”

    That’s an interesting one – it’s similar in that there is a question about whether a dwarf can identify as ‘a normal person inside’ with a ‘wrong’ body that doesn’t reflect their internal state, or whether they can identify as ‘a dwarf’ mentally as well as externally, a point of view in which our external body is ‘who we are’. That’s the way you’re born. That’s how nature intended you to be. That’s the body you grew up in. If you have a dwarf body, then your brain ought to consider itself a dwarf’s brain, too, some might say. A dwarf who thinks they’re a normal-sized person ‘inside their head’ and the body they were born with is somehow ‘wrong’ must be ‘mentally ill’, they might say. It’s a curious point of view!

    On the question of consent being asked – nobody can foretell the future, not even adults can predict and understand all the possible future consequences of their decisions. And every decision has a failure rate. That applies just as much to the consequences of the decision not to get treatment as to get it. There will no doubt be a few people who regret taking treatment to cure their dwarfism, as there are for any such treatment. But the odds are generally such that they’re vastly outnumbered by those for who treatment was the best thing that ever happened to them. So I don’t think the fact that it sometimes proves to be the wrong decision justifies making it harder for everyone for who it is very much the right decision, and if you’re going to require a court order to allow one to take a controversial treatment (like a court can predict the future consequences of such a decision either…), then by the same logic you should also need a court order to take the decision not to. Both decisions can be wrong. Both decisions can have irreversible, life-shattering consequences. So if the children and their parents themselves can’t be allowed to make the one choice for themselves, then they can’t be allowed to take the other on their own, either. Of course, this is another example of the nanny statists enforcing their own viewpoint on us ‘for our own good’, because they have the right and duty to tell the rest of us how we should be allowed to live. They’ll forbid only the choice they don’t like, and try to force everyone into their approved mould.

    By the way Natalie, I think that was a very fair and even-handed discussion-starter! I’m impressed. But it’s liable to turn nasty. This topic always does! So I’d like to say in advance – I didn’t start it!

  • bobby b

    One might place a few articles here about the “right” of a parent to deny his child cochlear implants because the parent wishes his child to be deaf like him.

  • MadRocketSci

    Before anyone asks, yes I’ve read the links (except the data for the scientific article which required an account).

    Whenever any of you come across a scientific article, look at the little string of numbers in the citation: The DOI number “digital object identifier”. Then go find the current location of Sci-Hub, an “academic piracy” website. It can usually get around the paywalls and blocks on scientific articles.

    And if any of you are any good with cryptocurrency, and can recommend a way to acquire it, let me know. I’d like to donate to the site at some point. It’s providing an important public service: Ensuring publicly funded science (from which the authors receive no financial gain, and often have to pay fees to publish) is actually *published*.

  • MadRocketSci

    Irreversibility is the root of all evil: The 2nd law of thermodynamics.

  • …the “right” of a parent to deny his child cochlear implants because the parent wishes his child to be deaf like him.

    Indeed, that was another aspect that I had in mind. Their being an inflection point here where the right of a parent to make decisions for an underage child (which may conflict with the child) and the classic family court one liner “Doing what is in the best interests of the child”.

    The problem with both of these issues is the lack of neutrality on behalf of the parent. Not unreasonably, they “want their child to be like them”, but the price paid by the child is non-trivial from social exclusion and bullying to (for the Achondroplasia suffering child) to chronic pain and early death.

    In this circumstance you end up asking whether the parent is competent (i.e. sufficiently neutral) to make a decision for the child one way or the other. The problem there is that as soon as you start saying that parents aren’t competent or sufficiently neutral to make decisions for their child, you’ve effectively killed the concept of “Parental Responsibility”.

    Go directly to Soviet Russia.
    Do not pass Go.
    Do Not Collect 200 Roubles.

  • Irreversibility is the root of all evil: The 2nd law of thermodynamics.

    Nah. Just needs another “Fiat Lux” moment…

    The Last Question – Issac Asimov”

  • bobby b

    1. Does society have the right (or power, I suppose) to declare what is a “defect”, and what is simply an existing fact?

    2. Do we allow adults to override this decision on their own behalf?

    3. Do we allow minors to override this decision on their own behalf?

    4. Do we allow adults to override this decision on behalf of the minors over whom they exert parental control?

  • 1. Does society have the right (or power, I suppose) to declare what is a “defect”, and what is simply an existing fact?
    Yes. Look at Downs Syndrome where even in the present day we check foetuses / foeti for the chromosomal abnormality and offer the mother the option to have an abortion. Since the child would be viable (albeit with mental and physical disabilities) is this a defect or fact? Personally, I see it as a defect since the mental and physical impairment is significant and life-long.

    A more hardline policy would be that since Achondroplasia is genetic it could be tested in the foetus and mothers similarly given the option to dispose of their offspring before birth. Would the Little People of America prefer that solution over a drug to inhibit the worst excesses of their disease? Personally I find that Eugenic approach far, far worse.

    2. Do we allow adults to override this decision on their own behalf?
    Yes, as long as they have sufficient competence.

    3. Do we allow minors to override this decision on their own behalf?
    No, because they do not have sufficient competence.

    4. Do we allow adults to override this decision on behalf of the minors over whom they exert parental control?
    Yes, because otherwise we’ve destroyed the entire concept of parental responsibility and every child becomes little more than a ward of the state who happens to reside in their biological (or not) parents house.

  • bobby b

    4. Do we allow adults to override this decision on behalf of the minors over whom they exert parental control?
    Yes, because otherwise we’ve destroyed the entire concept of parental responsibility and every child becomes little more than a ward of the state who happens to reside in their biological (or not) parents house.

    And there’s the nub. So, mom wanted a girl, but got a boy. You’re saying that we allow mom the choice of transitioning Johnny into Julie?

  • Fraser Orr

    Honestly, @Natalie, I don’t think we can discern much from the links. The case of the person who regretted it is a single story, and as we say in science, data is not the plural of anecdote. However, on the other side the academic paper is impossible to judge because all we have is the abstract, and these sorts of politically charged papers need to be examined extremely carefully as to methodology, which we can’t do. Based on the available info it says that 16.9% of 20619 transgender subjects were even interested in the suppression therapy, and of these only 2.5% took it. By my math that means 87 of those people took the drugs which is a miniscule number of people to measure such things (I can’t imagine where they came up with a 95% confidence interval with such a small population.) To me this abstract bristles with unanswered questions, and so can’t be judged without seeing more data. So from my perspective it tells us nothing at all (just as the anecdote tells us nothing at all.)

    However, the second point I think is a lot more interesting, because it raises, with less controversy, the nature of what should and should not be treated. In the past for sure transgenerism would have been treated as a mental disorder, now it is treated rather differently. There is no suggestion that we should try to treat the putative transgender person to stop them from being transgender; such a thought is entirely out of bounds now, even though thirty years ago the answer would undoubtedly have been yes.

    How do we decide such a thing? I don’t think there is a moral imperative, it is simply that which society choses to accept as within the bounds of “normal”. And that evolves (much as, for example interracial marriage would have been recently considered entirely outside the bounds of normal by both black and white people, but now doesn’t cause a single eye to bat.) There isn’t a guiding principle except that which we, as a society, come together and agree on. And we have to accept that it changes and morphs over time.

    But then there becomes the question of what parents can decide for their children. Parenting is a bargain made between society and parents, namely that the child will, for a while, be subject to the parent, while the parent accepts an obligation to act in the best interest of the child. And that “best interest of the child” matter also evolves and changes as society changes its mind. I find it interesting that people on the right, who tend to very much favor giving great latitude to parents to determine what “the best interest of the child is”, whereas people on the left tend to think that that state and society should have much more right to dictate this. However, it is interesting, is it not, that on this matter of transgenderism, that the opposite is true.

    And I just wanted to comment on cochlear implants, because they are parallel to this dilemma. I find it repugnant that a parent would not want this for their deaf child. But I don’t think that parents that reject them do so want to make their child deaf just as they are deaf, rather they want their child to be part of the deaf community, to be part of their culture and society. And that is a very natural thing for parents to do. Were a child raised Amish, for example, that child will in many ways be significantly disadvantaged. But I doubt there are too many on the right who would favor taking children away from Amish just because they are Amish. Or perhaps, in a more extreme example, were we to find some primitive tribe in the amazon jungle, nobody would suggest that the children of this tribe, obviously greatly disadvantaged, should to stolen away to the west with penicillin, the internet, public schools and all that. In fact, on the contrary, we are rather ashamed of our history of doing precisely that.

    FWIW, I have very mixed feelings about all these matters, and I think both sides tend to oversimplify.

  • MadRocketSci

    But then there becomes the question of what parents can decide for their children. Parenting is a bargain made between society and parents, namely that the child will, for a while, be subject to the parent, while the parent accepts an obligation to act in the best interest of the child. And that “best interest of the child” matter also evolves and changes as society changes its mind. I find it interesting that people on the right, who tend to very much favor giving great latitude to parents to determine what “the best interest of the child is”, whereas people on the left tend to think that that state and society should have much more right to dictate this. However, it is interesting, is it not, that on this matter of transgenderism, that the opposite is true.

    Perhaps a better representation of the position of the right is this: Parents are the only people who have a natural genetic predisposition to be *interested* in the interests of the child. If they don’t care, or want to experiment recklessly with the child, then the child’s not guaranteed to find a better custodian in society: Society has an entirely different set of goals than the child’s or ideally the child’s parents: In how useful the child can be made to society or some fraction thereof. (That can mean anything from teaching them useful skills that will enable them to take up a productive role to brutalizing/diminishing them to break them down into cannon fodder or slaves.)

    Children have natural long-term goals which they can’t make good decisions about while inexperienced. If parents care about their children, they’ll look after those goals. If they don’t, they’re at the mercy of the kindness of strangers.

    I don’t think the conservatives believe that the state has the childs best interests at heart automatically (far from it in most cases) – they just believe they can recognize cases where the parents clearly don’t.

  • 4. Do we allow adults to override this decision on behalf of the minors over whom they exert parental control?
    Yes, because otherwise we’ve destroyed the entire concept of parental responsibility and every child becomes little more than a ward of the state who happens to reside in their biological (or not) parents house.

    And there’s the nub. So, mom wanted a girl, but got a boy. You’re saying that we allow mom the choice of transitioning Johnny into Julie?

    Sex selection is currently outlawed in the UK by the Human Fertilisation and Embryology Act 2008 (I presume there is a US equivalent), but there is no barrier other than the financial from mom going to somewhere like Korea to obtain the same, but declaring and programming their male child to “identify as a trans girl” isn’t illegal or child abuse.

    Texas mother trying to transition her seven-year-old son into a girl loses in court as judge orders her to share custody with ex-husband who says boy is just ‘confused’

    The problem of what to do when a parent is controlling, coercing or otherwise “programming” a child into doing something that is not of their own inception. However, given the highly politicised nature of the trans argument, it’s a brave doctor that would openly challenge a woman who says “My child is not a boy but a trans girl” or whatever. In a less charged environment many of these cases would simply put down to a nutcase mother forcing her child to be something he/she isn’t for attention.

    Medical professionals used to refer to this sort of behaviour as “Munchhausen syndrome by proxy” / FDAI which was recognised as a form of child abuse for which the answer was counselling of the parent (presumably as well as the child subject to the abuse), but that sort of diagnosis of behaviour rather than mental illness seems to have fallen by the wayside.

    A lot of this stems from the rise of single-motherhood where the parent is absent or excluded (as in the case above), which may well explain the dramatic rise of transgenderism in recent years…

    There is an internet meme about “A transgender child being is a vegan cat…it ain’t them doing the choosing”. I don’t think that covers every case, but it certainly covers a lot of them…

  • Children have natural long-term goals which they can’t make good decisions about while inexperienced. If parents care about their children, they’ll look after those goals. If they don’t, they’re at the mercy of the kindness of strangers. I don’t think the conservatives believe that the state has the child’s best interests at heart automatically (far from it in most cases) – they just believe they can recognise cases where the parents clearly don’t.

    Absolutely. Indeed where the state has intervened and taken children away from their parents (justified or not), those that end up in the care system have the worst outcomes of every group in society and that is NOT ANECDOTAL, but based upon well documented evidence going back to the earliest care systems (Barnado’s, Christian Brothers, etc.).

    I am not saying that parents are always right, but rather that we should trust parental judgement UNLESS EXPLICITLY PROVEN OTHERWISE, which is a very different proposal to that of the leftwing Nazis of the Council Child and Family Services Department.

    I find it repugnant that a parent would not want this for their deaf child. But I don’t think that parents that reject them do so want to make their child deaf just as they are deaf, rather they want their child to be part of the deaf community, to be part of their culture and society.

    Fair point in and of itself, but unlike Vosoritide and puberty blockers, cochlear implants do not have an explicit time window within which they must be implanted or prove ineffective. An 18 year old can still choose to have a cochlear implant done and gain most of the benefit (although having it earlier would address other issues).

    You can’t wind the clock back on puberty or childhood growth though. They are strictly the domain of the adolescent and therefore why there is question over child consent because the treatment is time limited.

  • Chester Draws

    “We’re effectively exterminating dwarves!”

    We are not “exterminating” anybody, effectively or not. We are working on exterminating the condition.

    We’re also working on getting rid of other social groups, such as the illiterate. “We’re effectively exterminating illiteracy” is something governments would boast of.

    And goodness knows how much fuss we have about our urgent need to eradicate homelessness, despite the homeless often being quite happy to remain in that community.

    The tell is that the pleas are to save “the community”, not to give the child the best life possible. Such cries from the illiterate or homeless, that their community needs saving and if people have to be denied the ability to read or have a house so be it, would be given very short shrift.

  • Complete borked the quote, so I’ll try again.

    “A transgender four year old is like a vegan cat. We all know who’s making the lifestyle choices”.

  • bobby b

    Fraser Orr
    October 8, 2020 at 1:58 am

    “But I don’t think that parents that reject them do so want to make their child deaf just as they are deaf, rather they want their child to be part of the deaf community, to be part of their culture and society. And that is a very natural thing for parents to do.”

    I don’t buy this. I think it goes right back to, cui bono?

    For whose benefit would a parent do such a thing? I submit that at best it might be for the benefit of “the community” of the parent, which is just another way of saying it is for the parent’s benefit.

    This isn’t akin to raising a child as Amish, with all of the limitations inherent. This isn’t a case of keeping your child within a specific religion, teaching your child the old songs and a specific way of worshiping a deity, all because you think this is the correct way to live in order to keep your child right with God, for the child’s own benefit.

    This is the unneeded promotion of a physical disability in a child, so that the child stays more comfortable with the limited social group to which the parent belongs. This benefits the parent and the parent’s social group, not the child.

    If I were missing a foot, and I sought a doctor to whack my son’s foot off so that he would feel more akin to me and my foot-amputee social group, you’d laugh a bit, and then bundle me off somewhere for examination and treatment. You would not entertain the notion that I was acting in the best interests of my son.

    Cui bono?

  • This is the unneeded promotion of a physical disability in a child, so that the child stays more comfortable with the limited social group to which the parent belongs. This benefits the parent and the parent’s social group, not the child.

    I’m sure the Little People of America would disagree, but then again they would say that wouldn’t they? Can’t have “Little People of America” without the Little People, can you? From that perspective it seems a lot like forced dependency and group-think to ensure the group survives even if the individual suffers (or at least fails to thrive).

    I don’t think the Amish are a fair comparison because their focus is on excluding technology that doesn’t add value to their community. I think the Roma / Gypsies / Traveller communities are closer to the mark.

  • bobby b

    “From that perspective it seems a lot like forced dependency and group-think to ensure the group survives even if the individual suffers (or at least fails to thrive).”

    Yeah, exactly, that’s why I think you need to look at who benefits. At least the Amish believe they’re keeping their kids right with God, for the good of the kids.

  • Rich Rostrom

    The gender dysphoria issue is a really awkward one. It is in fact possible for a young child to have genuine intractable gender dysphoria. In such cases, puberty blockers allow the child to grow up without irreversibly developing the external characteristics of the “wrong” sex. When and if the child seeks gender transition (which is highly probable in such cases), the result will be much better than if those characteristics developed.

    That’s one side of the coin. The other side is that many if not most children who display some degree of gender dysphoria are “going through a phase”, will revert to normal (sometimes with moderate encouragement), and do not require gender transition. In these cases, puberty blockers cause irreversible and unnecessary damage to the child.

    And as far as I know, there is no reliable way to differentiate between the two categories. (I do believe that at the present time, gender dysphoria is over-diagnosed. Also, because of the hostility of traditional parents to diagnosis of gender dysphoria and pressure to “cure” it, many therapists and counselors feel that every possibly dysphoric child should be treated as a full-on dysphoric.

    Right now, I think there are a lot more false positives than untreated genuine positives. Both categories, and for both categories, the effect of the decision is irreversible.

    So it is… awkward.

  • @Rich:

    The most sensible option is “wait and see”, since usually children’s gender confusion stabilises as they grow older such that they no longer suffer from it and they become happy (or at least okay) with their gender assignment at birth.

    The rush to medicalise and treat what are essentially very rare and transitional developmental issues ends up with worse outcomes in aggregate.

    Those for whom “wait and see” doesn’t work (i.e. they become much worse to the point of suicide) can then be identified and reassessed individually.

    In the recent Texas case, appeal court intervention by 7-year old James’ father (he lost the original case) prevented his ex-wife from putting their 7-year old son on puberty blockers. The recommendation he is following in relation to his son is effectively one of “wait and see”. That seems appropriate to me and far less damaging than the hormonal wrecking ball of puberty blockers.

  • John

    John Galt

    Thank you for bringing The Last Question to my attention. I had somehow missed out on this particular work and am glad to have read it.

  • AFT

    @Chester Draws

    Excellent analogies. I was about to make the same point, albeit in a less impactful manner, but I don’t need to now.

  • Clovis Sangrail

    Apologies for being very rushed, but isn’t the paper Natalie links the one where the authors later contradicted their conclusions. I will try and check this when I have time if no-one else does.

  • William H. Stoddard

    John Galt: On the other hand, “I want my child to be like me” is also the motive for, for example, raising a child in a religion. I’m no admirer of religions, but I would hesitate to make such an upbringing illegal.

  • Nullius in Verba

    “Based on the available info it says that 16.9% of 20619 transgender subjects were even interested in the suppression therapy, and of these only 2.5% took it. By my math that means 87 of those people took the drugs which is a miniscule number of people to measure such things (I can’t imagine where they came up with a 95% confidence interval with such a small population.)”

    Smaller sample sizes just lead to broader confidence intervals.

    89 people took the drugs, of who 67 considered suicide and 22 didn’t. 3405 people wanted the drugs but didn’t get them, of who 3062 considered suicide and 343 didn’t.

    So the odds ratio is (67*343)/(22*3062) = 0.341.
    The confidence interval is calculated by using the fact the log(OR) distribution is approximately Gaussian.

    The standard error (i.e. standard deviation) of log(OR) = sqrt(1/67 + 1/22 + 1/3062 + 1/343) = 0.2522.

    So the confidence interval is exp(log(OR) +/- 1.96 SE) = (0.208, 0.559), which is what they say.

    “However, the second point I think is a lot more interesting, because it raises, with less controversy, the nature of what should and should not be treated. In the past for sure transgenerism would have been treated as a mental disorder, now it is treated rather differently. There is no suggestion that we should try to treat the putative transgender person to stop them from being transgender; such a thought is entirely out of bounds now, even though thirty years ago the answer would undoubtedly have been yes.”

    It has been suggested, but we don’t have the medical technology yet to rewire the brain. If the pre-natal hormone switches don’t work, and bits of the brain develops in the pattern intended for the other sex, there’s nothing you can do about it afterwards.

    But you’re right about how it would have been seen a few decades ago, as we also know from the treatment given to homosexuals. Unfortunately, it took a long time before they found that torture doesn’t work at changing minds. You can’t reprogram someone’s gender.

    “The problem of what to do when a parent is controlling, coercing or otherwise “programming” a child into doing something that is not of their own inception.”

    I agree. And that applies just as much to a parent who insists that their child conforms to society’s standard norms as a parent who insists that they don’t. They’re morally the same thing.

    “That’s one side of the coin. The other side is that many if not most children who display some degree of gender dysphoria are “going through a phase”, will revert to normal (sometimes with moderate encouragement), and do not require gender transition. In these cases, puberty blockers cause irreversible and unnecessary damage to the child.”

    The WPATH guidance notes that most of those referred to them before puberty do change their minds just before or at the start of puberty, but very few of those who continue through the initial stages of puberty change their minds later, which is why puberty blockers are only prescribed after puberty has started. The younger kids who later change their minds are not prescribed them.

    The entire point of using them is that they are reversible. If you stop taking the drugs, puberty restarts. It’s thought that there are some differences in growth resulting from puberty happening at a later age, but they’re within the range of normal human variation. But admittedly there is relatively little data so far.

    If the puberty blockers were not reversible, then you had might as well start transitioning straight away. It’s one issue I had with the Guardian story cited, as I discussed above. They’re mixing up the issue of puberty blockers with the cross-sex hormones that trigger the preferred sort of puberty. They’re trying to raise public alarm about the irreversible changes introduced by the latter and then pretend they’re being caused by the former. A ‘puberty blocker’ that results in a beard isn’t working!

    “Apologies for being very rushed, but isn’t the paper Natalie links the one where the authors later contradicted their conclusions. I will try and check this when I have time if no-one else does.”

    Not so far as I can see. But anyone is free to check.

  • John Galt: On the other hand, “I want my child to be like me” is also the motive for, for example, raising a child in a religion. I’m no admirer of religions, but I would hesitate to make such an upbringing illegal.

    You and me both. In fact I would go further and say that “It would be the end of human civilisation” if we did.

  • mongoose

    Isn’t there an issue about permanence and risk? We deny our children things using our judgment of what is good for them (not for us, I hope). We risk letting seven-year-olds walk to school and cross roads on their own but we don’t let them drink scotch, edit their body parts or otherwise do stuff that might have consequences the child cannot foresee, or understand even if they can foresee it. Cutting off a foot or a foreskin or a puberty are irreversible life-changing events. Adults make those calls. I put foreskins with crossing roads; feet and puberties are a different scale of event. If parents start making these big decisions for the wrong reasons – and all reasons are wrong except those that deliver the child hale and autonomous at 18 – then we have the law to protect the kids. The fly in the ointment is that it is said that gender-switching is best done before puberty. Personally – and I have no data – I find that a convenient argument.

    I also think that it is all just grievance-fostering to provide yet another political constituency that can be called to the progressive flag. I think the discussion is part of the long march – deny, obfuscate, bully, play the man not the ball, wear them down, make them anonymous behind their masks.

  • I haven’t read the articles. I don’t universally trust the doctors – I’ve known several that were riding their own hobby-horse about this. I don’t trust the government, period. I’ve run into a lot of parents I don’t trust. This is a subject where there are no easy answers, and sometimes even the difficult ones are wrong.

    But here I am. When I was four, I knew I should have been a girl. As I grew older, the feeling changed to “woman”. In my fifties, I did something about it. And now, in my late seventies, I’m still glad I did something about it. I’ve been something closely resembling a woman for over twenty years now, and it’s been good for me.

    But. I’m one person. I’m old enough that the only surgical transsexual (that I know of) before I was born was Lili Elbe. She was happy, but she died of it. (Organ transplants didn’t work well, back in the Thirties.) Christine Jorgensen began her surgeries when I was ten, and worked out much better.

    That’s something to note: progress in medical understanding and techniques. As time goes on, surgical results improve. So do endocrinological results. There are more cases to study to improve techniques.

    Then there are social results. Now it has become relatively Politically Correct to treat transsexuals well. Back in the Fifties …

    Finally, there are life paths. I’ve had a busy and interesting life. I have no idea what my life would have been, had I gone through it as a girl/woman.

    Then there are all those other transfolk. Lot of variety there. (I’m using “trans” as a prefix here. Transsexual, transgender, transvestite, and more.) There’s a lot of variation. Some I felt immediate kinship for; others, I was nervous being in the same room. Some have taken to their new sex like ducks to water; others have not.

    In the end, all I can say is to use wisdom and compassion, not rules. The closest I can come to a rule of thumb is this: if people want to change sex when they are very young, and continue to do so up until the age of puberty, they probably mean it. If they suddenly decide when they’re teenagers, that is a matter that needs questioning, discussion, and research.

    There is one inescapable truth about puberty: if you decide you don’t like the way you’re heading, something should be done fast. Getting rid of a beard properly costs more than the surgery, and there is no way to get rid of being six feet tall with broad shoulders. Breasts, also, are expensive to deal with, and hips can prove problematic.

  • MadRocketSci

    Re: The Asimov story:
    One funny bit within it is that the computer is always THE computer: Some huge expensive centralized mainframe somewhere where everyone else has merely a terminal. Good example of prediction failing – I (while a bit of an unusual case) have more computers than I can easily keep track of. Many of them are the size of postage stamps. Two or three of them have the power to crunch on some serious Monte-carlo problems. None of it is expensive or centralized (or organized…)

    The people supplicating it like a deity, instead of likely cursing it as they lead it step-by-step through a problem that they themselves have to think through the meaning of is another amusing variance with the technological world of today.

    Not worried about the Y5B crisis myself, or the Y5T crisis for that matter: I think we’ll probably learn some things over 5 billion years that will change the game.

  • Clovis Sangrail

    @Ellen

    if people want to change sex when they are very young, and continue to do so up until the age of puberty, they probably mean it

    I hope it was clear that my comment is not a criticism of anyone (although I do reserve the right to be critical). I may not be a total/true libertarian but I believe that rational adults should get to choose as much as possible about their lives. I just think they should have accurate data.

  • Natalie Solent (Essex)

    Thank you for your comment, Ellen. In particular I hadn’t thought much prior to reading it what the effects of the advances in medical techniques would be like in terms of individual lives such as that of Lili Elbe.

    It is reasonable to suppose that medical advances will continue. But the trouble with basing any plans or policies on the discoveries the scientists are sure to make in the next few years is that science has a nasty habit of taking another direction entirely.

  • Clovis Sangrail
    October 8, 2020 at 8:19 pm

    I hope it was clear that my comment is not a criticism of anyone (although I do reserve the right to be critical). I may not be a total/true libertarian but I believe that rational adults should get to choose as much as possible about their lives. I just think they should have accurate data.

    I was a rational adult, and chose. For me, choosing at the onset of puberty was not feasible. But these are different times, with different possibilities. Today, choosing at the onset of puberty is vital for best results. At puberty kids are not rational adults, and they’re seldom able to pay for sexual reassignment themselves. “Puberty blockers” put the decision off for a couple of years, but I’m not sure there is such a thing as a puberty blocker. There are testosterone blockers, and presumably estrogen blockers, but that is a very different balancing act.

    In the end, every decision is casting dice with fate, and this is a rather large bet. To improve the odds, make sure it’s a steadfast decision, and not spur-of-the-moment.

  • Natalie Solent (Essex)
    October 8, 2020 at 9:31 pm

    Thank you for your comment, Ellen. In particular I hadn’t thought much prior to reading it what the effects of the advances in medical techniques would be like in terms of individual lives such as that of Lili Elbe.

    It is reasonable to suppose that medical advances will continue. But the trouble with basing any plans or policies on the discoveries the scientists are sure to make in the next few years is that science has a nasty habit of taking another direction entirely.

    Science has advanced quite far enough in this field. The BIG question is what politics will do.

  • Flubber

    There was a story recently that a school had six girls who declared themselves trans. With the advent of COVID and home schooling, three changed their minds.

    Kids do not think rationally.

    Any irreversible treatment, including puberty blockers, is immoral.

  • There was a story recently that a school had six girls who declared themselves trans. With the advent of COVID and home schooling, three changed their minds. Kids do not think rationally.

    In fairness the whole trans thing has been propagandised by the identitarians who are using it to effectively expel those who aren’t radical enough (i.e. insane), but this propaganda is getting wash over the internet onto the kids. That’s why the enquiries to the trans specialists have sky rocketed. Their isn’t some huge number of previously unrecognised trans kids around, the number of genuine cases is vanishingly small.

  • Flubber

    There isn’t some huge number of previously unrecognised trans kids around, the number of genuine cases is vanishingly small.

    I agree. But we need to protect the “attention seekers” from machiavellian bastards like the Tavistock clinic crowd.

    Reply

  • Nullius in Verba

    “One funny bit within it is that the computer is always THE computer: Some huge expensive centralized mainframe somewhere where everyone else has merely a terminal.”

    They call it “The Internet”… 🙂

    “There isn’t some huge number of previously unrecognised trans kids around, the number of genuine cases is vanishingly small.”

    How do you know? Do you have data, or is it just a feeling?

  • Paul Marks

    Drugs and sometimes surgery – to mutilate, for life, these children. To prevent them ever having children themselves.

    The idea that the children come up with these ideas themselves is absurd – they are being indoctrinated (brainwashed).

    “Clause 28”, the legal ban on such indoctrination of children by taxpayer money, was wildly attacked – but its repeal has opened the gates to this.

    Of the Western nations, as far as I know, only Poland is making a stand against this agenda.

    If a society will not make a stand against the mutilation of children to prevent them ever having children, it will make a stand against nothing – truly such a society is damned.

    A society that encourages this will not survive – and does not deserve to survive.

  • Paul Marks

    I wonder what Karl Marx and Frederick Engels would say about this – yes the people who are pushing it consider themselves Marxists (“liberals” in the bizarre misuse of language in the United States), but I think that Karl Marx and Frederick Engels, in spite of their many horrible faults, would be appalled by these practices.

    If this is the only way that “capitalist society” can be destroyed – then I hope Dr Marx and Mr Engels would agree that mutilating children, so that they can never have children of their own, is NOT acceptable even for their goal of destroying “capitalist society”.

  • If a society will not make a stand against the mutilation of children to prevent them ever having children, it will make a stand against nothing – truly such a society is damned. A society that encourages this will not survive – and does not deserve to survive.

    I’ve always believed that the line in the sand which will cause actual civil war would be the legalisation of paedophilia, which is something that the libtard elite thinks is totally fine and which the plebs find absolutely abhorrent. Given where we stand at the moment I doubt I will have to wait much longer.

    Need to find a good source of piano wire though…there are plenty of lamp posts.

  • bobby b

    “Need to find a good source of piano wire though . . . “

    Music makes everything better.

  • The NHS gender identity clinic yesterday defended giving puberty-blocking drugs to children as young as ten. Some young children are capable of consenting to being given the drugs because they already understand sexual concepts, judges were told. On the second day of a landmark High Court hearing it was also revealed that three ten-year-olds have been given puberty-blockers after seeking treatment from doctors at the London clinic over the past year or so.

    Around a quarter of patients given the drugs were 14 or under. The case has been brought by a mother who is trying to prevent the clinic, run by the Tavistock and Portman NHS Trust, from giving puberty blockers to her 16-year-old daughter. The drugs halt a child’s normal physical development during puberty, potentially making gender reassignment surgery easier later on. The woman, who can only be called ‘Mrs A’ for legal reasons, fears her child will be fast-tracked for transgender medical treatment once she is seen by clinicians at the Gender Identity Development Service (GIDS) in London.

    Mrs A believes her daughter’s desire to be male is driven by having Asperger’s syndrome, a mild form of autism. She fears the GIDS will simply ‘affirm’ the girl’s belief that she is really a boy and wants the High Court to rule that hormone-blocker treatments for children under-18 should be subject to approval by the courts.

    [LINK] – It’s OK to give children of 10 puberty blockers’: NHS gender identity clinic says some children understand sex so can consent to medication

    Sometimes there isn’t enough vomit in the world…

  • Nullius in Verba

    “The case has been brought by a mother who is trying to prevent the clinic, run by the Tavistock and Portman NHS Trust, from giving puberty blockers to her 16-year-old daughter.”

    The age of consent for medical treatments is 16.

  • @Nullius – And that is exactly what is being questioned in this case.

    People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances. Like adults, young people (aged 16 or 17) are presumed to have sufficient capacity to decide on their own medical treatment, unless there’s significant evidence to suggest otherwise. Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.

    Children and young people – Consent to treatment

  • Nullius in Verba

    “And that is exactly what is being questioned in this case.”

    In what sense? The court can’t change the law. Exceptions are made only if a person doesn’t have sufficient capacity, for which the bar is rightly set high. What’s the evidence of incapacity in this case? Having mental health conditions like Asperger’s isn’t necessarily incapacitating.

    There’s no standard set on your reasons for consenting to or refusing treatment – you can refuse treatment for religious reasons, for example. Or just because you want to. Patients are allowed to make decisions others consider unwise, or damaging to their health.

    “The object of this Essay is to assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, that the sole end for which mankind are warranted, individually or collectively in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinions of others, to do so would be wise, or even right. These are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him, or visiting him with any evil, in case he do otherwise. To justify that, the conduct from which it is desired to deter him must be calculated to produce evil to some one else. The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

    But nanny-staters always think they have the right to decide what’s wise and good for other people, and to use the coercive power of the state to override their freedom to control their own fate, for good or ill. Smoking bans. Sugar taxes. Minimum alcohol pricing. Compulsory ‘aversion therapy’. They never give up.

  • In what sense? The court can’t change the law.

    😆

    Well now you’re just being silly, since the Gillick component under question directly arises from a 1985 House of Lords decision relating to the competence of children to make decisions for themselves.

    Gillick competence is a term originating in England and is used in medical law to decide whether a child (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge.

    The standard is based on the 1985 decision of the House of Lords in Gillick v West Norfolk and Wisbech Area Health Authority. The case is binding in England and Wales, and has been adopted to varying extents in Australia, Canada and New Zealand. Similar provision is made in Scotland by the Age of Legal Capacity (Scotland) Act 1991. In Northern Ireland, although separate legislation applies, the then Department of Health and Social Services stated that there was no reason to suppose that the House of Lords’ decision would not be followed by the Northern Ireland Courts.

    [LINK] – Gillick competence

  • Nullius in Verba

    “Well now you’re just being silly, since the Gillick component under question directly arises from a 1985 House of Lords decision relating to the competence of children to make decisions for themselves.”

    But the Gillick component isn’t relevant or under question here, because it only applies to children under 16, and she’s over 16.

    “The case has been brought by a mother who is trying to prevent the clinic, run by the Tavistock and Portman NHS Trust, from giving puberty blockers to her 16-year-old daughter.”

    If you’re trying to change the rules so that the Gillick competency rules apply to people *over* 16, (“… and wants the High Court to rule that hormone-blocker treatments for children under-18 should be subject to approval by the courts.”) then that’s a change in the law, to raise the age of consent.

    But if you’re not trying to change or reinterpret the law, then being over 16 means the patient has the same assumption of competency as any other adult, and can only be overridden in the same extreme circumstances, if it’s clear that she’s incapable of understanding the question/decision due to being unconscious, hallucinating, having dementia, etc.

    “His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinions of others, to do so would be wise, or even right.”

    Being over 16, it’s the same rule that applies to all the rest of us. Do you really want the nanny statists to be able to take control of *your* medical treatment if they think you’re decisions are unwise or wrong?

  • mongoose

    The point is that Ellen makes a rational and compassionate argument for adult transgenderism that I find it hard to take against. I find it, alas, less easy to accept that acting “fast” (before puberty) is argument enough to so drastically re-compass a young person’s life. It isn’t enough to say that we should do this now because doing it later will be less effective if we are doing it on the wish of a child. Particularly so when the rise in cases is so obviously externally driven.

  • mongoose
    October 10, 2020 at 1:15 am

    The point is that Ellen makes a rational and compassionate argument for adult transgenderism that I find it hard to take against. I find it, alas, less easy to accept that acting “fast” (before puberty) is argument enough to so drastically re-compass a young person’s life. It isn’t enough to say that we should do this now because doing it later will be less effective if we are doing it on the wish of a child. Particularly so when the rise in cases is so obviously externally driven.

    As I did mention – if the child in question has wanted to be the opposite sex since earliest memory, and still wants to at puberty, let the kid have it before puberty makes the change ever so much harder. If it’s a sudden desire, do a lot of investigating first – and if puberty can be put off for a year or two, that’ll give more time to investigate. (And a more rational child. I’ve worked with kids. They are a lot nicer and more sensible before puberty hits.)

    Then again, there’s the ‘stage mother’ thing. No matter what is involved – movies, beauty pageants, ice skating, whatever – the results can be horrendous. Social pressure happens, but it’s not nearly as consistent as parental pressure.

    This isn’t hypothetical for me. I have a grand-nephew for whom I suspect the question will arise. And my nephew and his wife will come around asking me questions about what to do, if I live long enough. Firsthand experience, after all. So I’ve given this some thought.

  • It is in fact possible for a young child to have genuine intractable gender dysphoria. … The other side is that many if not most children who display some degree of gender dysphoria are “going through a phase” …

    So it is… awkward. (Rich Rostrom, October 8, 2020 at 5:34 am)

    My take is that, in a sense (a sense that what follows will, I hope, explain), it’s only awkward if you know someone well. Let’s first look at a couple of analogous issues.

    Firstly, consider teen suicide. Transitioning from a child to an adult is stressful. A teenager’s emotions lie to them at times. Many a teen has suicidal thoughts, sometimes “sorry when I’m dead” anger that the world will not let them do as they please and applaud them for it, very occasionally a not-so-surprising response to genuinely vile circumstances, but usually one of those teenage moments when their emotions tell them to do what sense would not. Only if you know a particular person very well, might you think that, in averting that particular teen’s moment of danger or making them throw up the poison they’ve just swallowed or whatever, you may only be delaying things – that this most unusual teen is expressing a truly suicidal temperament, not a mad moment of teenage angst. If you don’t know them, you assume what is overwhelmingly likely – that if you can save them now, you’ve saved them for life. (I knew one girl who was saved, and has since lived a most impressive life, and one boy who would very likely have lived such a life but what he swallowed proved to be just far enough beyond what the doctors could save him from.)

    Secondly, let’s consider a less downbeat issue: teenage sex. I know an intelligent, principled girl who fell very much in love with her older boyfriend when she was 13. It soon became so obvious that her parents stepped back a century and demanded he state his intentions, Victorian style. He promised honourable marriage (and observing of all age-related laws), he and she both promised to observe these delays enforced by law – and the parents kept a close eye on things. When time allowed, they married. Looking back with the benefit of hindsight, I could make an argument that her parents and the law needlessly delayed the moment at which the couple began to “live happily ever after”. But of course, we all know the odds, and even those who knew her well can hardly be blamed for thinking the law’s choice was also the unquestionably right choice. (To be fair, while her parents knew her very well, they did not, back when she was 13, know the boy nearly so well.) 13 is of course far beyond Ellen’s “earliest memory” criteria, but I get a bit closer to it with another couple (the husband recently died at an advanced age) who were childhood sweethearts virtually from the (slightly younger) girl’s first day in their primary school, who needed no eagle-eyed parents (this was a pair of well-brought-up kids long before the 60s) but who would have married younger if they’d lived under the laws and customs of mediaeval times – and in their particular case taken no harm thereby.

    Ever day we make decisions based on imperfect information – information usually far more imperfect than that which guides our one-age-suits-all laws, or what Burke calls the “bank-and-deposit-of-the-ages’ wisdom that multiplies the wisdom of whoever is not too arrogant to draw on it. It need not feel awkward to have a clear view of what is right – right to decide or right to advise as your role allocates – while simultaneously having the humility to know that you will at best only very usually be right. When you know someone well, you (usually won’t of course – on the contrary – but might) move from ‘the usual rule’ to ‘is my friend one of the rare exceptions?’.

    It’s a bit like the rule saying “stay with your plane” if you have crashed in the wilderness. If you had a perfect knowledge of your surroundings, you might devise a ‘trek-out’ plan more likely to save you. If you don’t, you have to resist the intense temptation to “do something” and instead stay with your plane, hoping that society will find you and save you.

    A final remark: Ellen’s “earliest memory” rule has an excellent chance of weeding out every teenage angster let alone every victim of “catch them when they’re vulnerable” PC propaganda. Obviously it is, in one sense, a reasonably demanding test. Could I argue that it is so demanding that a few cases (a very very very few, given how rare this all is anyway) will fail it although, if we knew all and/or knew the future, we would say, well in this one case there was nevertheless the same issue as in those that passed the rule? I can easily imagine myself arguing in some future forum that Ellen’s criteria should not be weakened – while assessing that such a rule, in saving many from ruining their lives, will every rare now and then misclassify someone who, if we knew all, we’d put in the same group as those that passed it.

    (Oliver Wendell Homes once described the 1st Amendment as “a conjecture based on imperfect information” – quoted from memory. I don’t believe in free speech any the less for thinking he was right.)

    As a closing aside, I’ll quote Natalie’s sensible latest remark in the thread above.

    It is reasonable to suppose that medical advances will continue. But the trouble with basing any plans or policies on the discoveries the scientists are sure to make in the next few years is that science has a nasty habit of taking another direction entirely.

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