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Re Imogen: the role of the Family Court of Australia in disputes over gender dysphoria treatment

Abstract

This article examines Re Imogen (No 6) (2020) 61 Fam LR 344, a decision of the Family Court of Australia, which held that an application to the Family Court is mandatory if a parent or a medical practitioner of a child or adolescent diagnosed with gender dysphoria disputes the diagnosis, the capacity to consent, or the proposed treatment. First, we explain the regulatory framework for the medical treatment of gender dysphoria in children and adolescents, including the development of the welfare jurisdiction under Section 67ZC of the Family Law Act 1975 (Cth). We then provide an overview of the Re Imogen decision, and discuss the balancing exercise involved in determining a child’s best interests in the medical treatment context. We challenge the Family Court’s conclusion that, in relation to a dispute about diagnosis or treatment, a finding that the child or adolescent is Gillick competent to consent to treatment is not determinative, and the Family Court must determine the dispute. We argue that this conclusion represents an unjustified incursion into the right of Gillick competent transgender children and adolescents to make decisions about their own bodies and identities, and that the protective role of parents and the Family Court cannot justify interfering with their bodily autonomy in this context. Finally, we propose an alternative regulatory framework that removes the Family Court from the medical treatment process for gender dysphoria in circumstances of dispute between a parent and their Gillick competent child.

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Notes

  1. 1.

    In this article, we refer to ‘child’ and/or ‘adolescent’ as appropriate to the context, noting that the Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents distinguish between ‘children (i.e. those who are in a pre-pubertal stage of development) and adolescents (i.e. those in whom puberty has commenced but are not yet legally adults)’ (Telfer et al. 2020, p. 9).

  2. 2.

    Deriving from the decision of the House of Lords in Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112.

  3. 3.

    ‘Parental responsibility’ is defined in the Family Law Act as ‘all the duties, powers, responsibilities and authority which, by law, parents have in relation to children’: s 61B.

  4. 4.

    An additional factual issue is whether the child is currently under a care order: see Re Alex (2004) 31 Fam LR 503, [151].

  5. 5.

    This term was not used by the High Court of Australia in Secretary, Department of Health & Community Services v JWB & SMB (1992) 175 CLR 218, and it is not a term used in the Family Law Act.

  6. 6.

    These matters are largely a codification of the matters listed in In re Marion (No 2) (1994) FLC ¶ 92–448.

  7. 7.

    As the condition was then known, per the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders.

  8. 8.

    Three parties in addition to Imogen’s father and mother (the applicant and respondent respectively) were involved in the hearing: an independent children’s lawyer appointed to represent Imogen’s interests, and two interveners, namely, the Commonwealth Attorney-General and the Australian Human Rights Commission.

  9. 9.

    The court refused to allow the decision of a Gillick competent 17-year-old Jehovah’s Witness to refuse a life-saving blood transfusion.

  10. 10.

    For a fuller account of the relevance and importance of children’s rights to Australian family law decision-making, see Dimopoulos (2021a).

  11. 11.

    Cf. Brazier (2005, p. 418), who argues that where a partnership of care between a child’s parents and treating medical professionals breaks down, the courts may be the only appropriate forum for resolving a dispute.

  12. 12.

    For a detailed discussion of relational autonomy, see Mackenzie and Stoljar (2000), and in the medical context, see Gilbar & Gilbar (2009: 185). For a detailed discussion of different relational approaches to medical decision-making, see Taylor-Sands (2013, pp. 109–123).

  13. 13.

    For a detailed discussion of a ‘process’ as opposed to an ‘event’ model for informed consent, see Taylor-Sands (2013, pp. 114–115).

  14. 14.

    While we do not canvas private arbitration of gender dysphoria disputes as an option in this article, it is interesting to note that in its final report upon its inquiry into Australia’s family law system, the Australian Law Reform Commission recommended that the Family Law Act be amended to allow some children’s matters to be arbitrated, although special medical procedures were excluded from ‘appropriate occasions for arbitration’ (ALRC 2019, pp. 289–292).

  15. 15.

    Priest (2019) argues for greater public awareness and funding to improve adolescents’ access to transgender treatment.

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Acknowledgements

The authors thank Eliza Waters for her research assistance, and the anonymous reviewer for their insightful comments on an earlier draft.

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Correspondence to Georgina Dimopoulos.

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Dimopoulos, G., Taylor-Sands, M. Re Imogen: the role of the Family Court of Australia in disputes over gender dysphoria treatment. Monash Bioeth. Rev. (2021). https://doi.org/10.1007/s40592-021-00138-0

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Keywords

  • Adolescent health
  • Autonomy
  • Best interests
  • Capacity to consent
  • Children’s medical treatment
  • Family Court of Australia
  • Gender dysphoria
  • Hormone treatment
  • Rights of the child
  • Special medical procedure
  • Welfare jurisdiction