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


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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  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.


  1. American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Publishing.

    Book  Google Scholar 

  2. Archard, D., and M. Skivenes. 2009. Balancing a child’s best interests and a child’s views. International Journal of Children s Rights 17 (1): 1–21.

    Article  Google Scholar 

  3. Auckland, C., and I. Goold. 2019. Parental rights, best interests and significant harms: Who should have the final say over a child’s medical care? Cambridge Law Journal 78 (2): 287–323.

    Article  Google Scholar 

  4. Australian Law Reform Commission. 2019. Family law for the future: An inquiry into the family law system (Report No. 135).

  5. Benson & Hughes. 1994. FLC 92-483.

  6. Brazier, M. 2005. An intractable dispute: When parents and professionals disagree. Medical Law Review 13: 412–418.

    Article  Google Scholar 

  7. Brennan, C. 2002. Children’s choices or children’s interests: Which do their rights protect? In The moral and political status of children, ed. D. Archard and C. Macleod, 53–67. Oxford: Oxford University Press.

    Chapter  Google Scholar 

  8. Brownsword, R. 2004a. Reproductive opportunities and regulatory challenges. Modern Law Review 67 (2): 304–321.

    Article  Google Scholar 

  9. Brownsword, R. 2004b. Regulating human genetics: New dilemmas for a new millennium. Medical Law Review 12 (1): 14–39.

    Article  Google Scholar 

  10. Bryant, D. 2009. It’s my body, isn’t it? Children, medical treatment and human rights. Monash University Law Review 35 (2): 193–211.

    Google Scholar 

  11. Cheung, A.S., et al. 2019. Position statement on the hormonal management of adult transgender and gender diverse individuals. Medical Journal of Australia 211 (3): 127–133.

    Article  Google Scholar 

  12. Clark, A.B., et al. 2020. Conditions for shared decision making in the care of transgender youth in Canada. Health Promotion International.

    Article  Google Scholar 

  13. Cockburn, T., and M. Fay. 2019. Consent to innovative treatment. Law, Innovation and Technology 11 (1): 34–54.

    Article  Google Scholar 

  14. Coleman, E., et al. 2012. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, 7th version. Retrieved March 17, 2021 from World Professional Association for Transgender Health website:

  15. De Roo, C., et al. 2016. Fertility options in transgender people. International Review of Psychiatry 28 (1): 112–119.

    Article  Google Scholar 

  16. de Vries, A.L.C., et al. 2014. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 134 (4): 696–704.

    Article  Google Scholar 

  17. Diaz, A., et al. 2004. Legal and ethical issues facing adolescent health care professionals. Mt Sinai Journal of Medicine 71 (3): 181–185.

    Google Scholar 

  18. Dimopoulos, G. 2021a. Rethinking Re Kelvin: A children’s rights perspective on the ‘greatest advancement in transgender rights’ for Australian children. University of New South Wales Law Journal 44 (2): 637–672.

    Google Scholar 

  19. Dimopoulos, G. 2021b. A theory of children’s decisional privacy. Legal Studies 41 (3): 430–453.

    Article  Google Scholar 

  20. Donnelly, M., and U. Kilkelly. 2011. Child-friendly healthcare: Delivering on the right to be heard. Medical Law Review 19 (1): 27–54.

    Article  Google Scholar 

  21. Dylan & Dylan. 2007. FamCA 842.

  22. Eekelaar, J. 1994. The interests of the child and the child’s wishes: The role of dynamic self-determinism. International Journal of Law and the Family 8 (1): 42–61.

    Article  Google Scholar 

  23. Eekelaar, J. 2002. Beyond the welfare principle. Child and Family Law Quarterly 14: 237–250.

    Google Scholar 

  24. Eekelaar, J. 2006. Deciding for children. Australian Journal of Professional and Applied Ethics 7: 66–81.

    Google Scholar 

  25. Eekelaar, J. 2015. The role of the best interests principle in decisions affecting children and decisions about children. International Journal of Children’s Rights 12: 3–26.

    Article  Google Scholar 

  26. Elliston, S. 1996. If you know what’s good for you: Refusal of consent to medical treatment by children. In Contemporary issues in law, medicine and ethics, ed. S.A. McLean, 29–55. New Hampshire: Dartmouth Publishing.

    Google Scholar 

  27. Family Law Act 1975 (Cth).

  28. Family Law Rules 2004 (Cth).

  29. Feigerlová, E., et al. 2019. Fertility desires and reproductive needs of transgender people: Challenges and considerations for clinical practice. Clinical Endocrinology 91 (1): 10–21.

    Google Scholar 

  30. Fortin, J. 2006. Accommodating children’s rights in a in a post Human Rights Act era. Modern Law Review 69 (3): 299–326.

    Article  Google Scholar 

  31. Fortin, J. 2009. Children’s rights and the developing law. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  32. France, K. 2014. Let me be me: Parental responsibility, Gillick competence, and transgender minors’ access to hormone treatments. Family Law Review 4 (4): 227–248.

    Google Scholar 

  33. Franklin-Hall, A. 2013. On becoming an adult: Autonomy and the moral relevance of life’s stages. The Philosophical Quarterly 63 (251): 223–247.

    Article  Google Scholar 

  34. Freeman, M. 1983. The rights and wrongs of children. London: Frances Pinter.

    Google Scholar 

  35. Gilbar, R., and O. Gilbar. 2009. The medical decision-making process and the family: The case of breast cancer patients and their husbands. Bioethics 23 (3): 183–192.

    Article  Google Scholar 

  36. Gillick v West Norfolk and Wisbech Area Health Authority. 1986. AC 112.

  37. Giordano, S., F. Garland, and S. Holm. 2021. Gender dysphoria in adolescents: Can adolescents or parents give valid consent to puberty blockers? Journal of Medical Ethics 47: 324–328.

    Google Scholar 

  38. Gorin-Lazard, A., et al. 2012. Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. The Journal of Sexual Medicine 9 (2): 531–541.

    Article  Google Scholar 

  39. Harrison v Woollard. 1995. 18 Fam LR 788.

  40. Hazel, G.B., and J.H. Pietsch. 2004. Legal implications surrounding adolescent health care decision-making in matters of sex, reproduction, and gender. Child and Adolescent Psychiatric Clinics of North America 13 (3): 675–694.

    Article  Google Scholar 

  41. Hembree, W.C., et al. 2017. Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 102 (11): 3869–3903.

    Article  Google Scholar 

  42. Heywood, R. 2012. Parents and medical professionals: Conflict, cooperation, and best interests. Medical Law Review 20: 29–44.

    Article  Google Scholar 

  43. Huxtable, R. 2018. Clinic, courtroom or (specialist) committee: In the best interests of the critically ill child? Journal of Medical Ethics 44 (1): 471–475.

    Article  Google Scholar 

  44. In re Marion (No 2). 1994. FLC 92-448.

  45. Jacks & Samson. 2008. 221 FLR 307.

  46. Jowett, S., and F. Kelly. 2021. Re Imogen: A step in the wrong direction. Australian Journal of Family Law 34 (1): 31–56.

    Google Scholar 

  47. Kelly, F. 2016. ‘The court process is slow but biology is fast’: Assessing the impact of the Family Court approval process on transgender children and their families. Australian Journal of Family Law 30 (2): 112–128.

    Google Scholar 

  48. Kilkelly, U. 2020. The health rights of children. In The Oxford handbook of children’s rights law, ed. J. Todres and S.M. King, 367–381. Oxford: Oxford University Press.

    Google Scholar 

  49. Kuczewski, M.G. 1996. Reconceiving the family: The process of consent in medical decisionmaking. The Hastings Center Report 26 (2): 30–37.

    Article  Google Scholar 

  50. Lennings, N. 2015. Forward, Gillick: Are competent children autonomous medical decision makers? New developments in Australia. Journal of Law and the Biosciences 2 (2): 459–468.

    Article  Google Scholar 

  51. Lovine & Connor. 2011. FamCA 432.

  52. Lundy, L., J. Tobin, and A. Parkes. 2019. Article 12: The right to respect for the views of the child. In The UN Convention on the Rights of the Child: A commentary, ed. J. Tobin, 397–434. Oxford: Oxford University Press.

    Google Scholar 

  53. Mackenzie, C., and N. Stoljar, eds. 2000. Relational autonomy: Feminist perspectives of autonomy, agency, and the social self. New York: Oxford University Press.

    Google Scholar 

  54. McLarnon, K. 2017. Consent to medical treatment of the mature minor: Is autonomy achievable? Primary Health Care 27 (5): 35–42.

    Article  Google Scholar 

  55. Notini, L., R. McDougall, and K. Pang. 2019. Should parental refusal of puberty-blocking treatment be overridden? The role of the harm principle. The American Journal of Bioethics 19 (2): 69–72.

    Article  Google Scholar 

  56. O’Connor, M., and B. Madden. 2019. In the footsteps of Teiresias: Treatment for gender dysphoria in children and the role of the courts. Journal of Law and Medicine 27 (1): 149–163.

    Google Scholar 

  57. Olson, K.R.L., et al. 2016. Mental health of transgender children who are supported in their identities. Pediatrics 137 (3): e20153223.

    Article  Google Scholar 

  58. Parker, S. 1994. The best interests of the child: Principles and problems. In The best interests of the child: Reconciling culture and human rights, ed. P. Alston, 26–41. Oxford: Clarendon Press.

    Google Scholar 

  59. Parkinson, P., and J. Cashmore. 2008. The voice of a child in family law disputes. Oxford: Oxford University Press.

    Book  Google Scholar 

  60. Priest, M. 2019. Transgender children and the right to transition: Medical ethics when parents mean well but cause harm. The American Journal of Bioethics 19 (2): 45–59.

    Article  Google Scholar 

  61. Re a Declaration Regarding Medical Treatment for ‘A’. 2020. QSC 389.

  62. Re Alex. 2004. 31 Fam LR 503.

  63. Re Alex (No 2). 2009. 42 Fam LR 645.

  64. Re B and B: Family Law Reform Act 1995. 1997. 21 Fam LR 676.

  65. Re Imogen (No 6). 2020. 61 Fam LR 344.

  66. Re Jamie. 2013. 278 FLR 155.

  67. Re Kelvin. 2017. 351 ALR 329.

  68. Re Lucas. 2016. FamCA 1129.

  69. Re Martin. 2015. FamCA 1189.

  70. Re Sam and Terry (Gender Dysphoria). 2013. 49 Fam LR 417.

  71. Re Sean and Russell (Special Medical Procedures). 2010. 44 Fam LR 210.

  72. Re T (adult: refusal of medical treatment). 1992. 4 All ER 649.

  73. Re Tahlia. 2017. FamCA 715.

  74. Reece, H. 1996. The paramountcy principle: Consensus or construct. Current Legal Problems 49 (1): 267–304.

    Article  Google Scholar 

  75. Richards, B., and K. Hutchison. 2016. Consent to innovative treatment: No need for a new legal test. Journal of Law and Medicine 23 (4): 938–948.

    Google Scholar 

  76. Secretary, Department of Health & Community Services v JWB & SMB (Marion’s case). 1992. 175 CLR 218.

  77. Sorbie, S. 2021. Children’s best interests and parents’ views: Challenges from medical law. Journal of Social Welfare and Family Law 43 (1): 23–41.

    Article  Google Scholar 

  78. Stewart, C. 2017. Cracks in the lintel of consent. In Tensions and traumas in health law, ed. I. Freckelton and K. Petersen, 214–233. Sydney: Federation Press.

    Google Scholar 

  79. Strickland, S. 2015, August. To treat or not to treat: Legal responses to transgender young people revisited. In: Paper presented at the Association of Family and Conciliation Courts Australian Chapter Conference, Sydney.

  80. Taylor-Sands, M. 2013. Saviour siblings: A relational approach to the welfare of the child in selective reproduction. Abingdon: Routledge.

    Book  Google Scholar 

  81. Telfer, M. et al. 2020. Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents, version 1.3. Retrieved March 17, 2021 from Royal Children’s Hospital web site.

  82. Tobin, J. 2013. Justifying children’s rights. International Journal of Children’s Rights 21 (3): 395–441.

    Article  Google Scholar 

  83. Tobin, J., and S.M. Field. 2019. Article 16: The right to protection of privacy, family, home, correspondence, honour, and reputation. In The UN Convention on the Rights of the Child: A commentary, ed. J. Tobin, 551–599. Oxford: Oxford University Press.

    Google Scholar 

  84. Tobin, J., and S. Varadan. 2019. Article 5: The right to parental direction and guidance consistent with a child’s evolving capacities. In The UN Convention on the Rights of the Child: A commentary, ed. J. Tobin, 159–185. Oxford: Oxford University Press.

    Google Scholar 

  85. Trowse, P. 2010. Refusal of medical treatment: A child’s prerogative? Queensland University of Technology Law and Justice Journal 10 (2): 191–212.

    Google Scholar 

  86. United Nations Convention on the Rights of the Child, opened for signature 20 November 1989, 1577 UNTS 3 (entered into force 2 September 1990).

  87. W and G (No 1). 2005. FLC 93-247.

  88. W v R. 2006. 35 Fam LR 608.

  89. Wayne, R.H. 2008. The best interests of the child: A silent standard – Will you know it when you hear it? Journal of Public Child Welfare 2 (1): 33–49.

    Article  Google Scholar 

  90. Wilkinson, D., and Savulescu, J. 2019. Puberty-blocking drugs: The difficulties of conducting ethical research. The Conversation. Retrieved March 24, 2021 from

  91. Williams, M., J. Chesterman, and P. Grano. 2014. Re Jamie (No 2): A positive development for transgender young people. Journal of Law and Medicine 22 (1): 90–104.

    Google Scholar 

  92. Woodhouse, B.B. 1993. Hatching the egg: A child-centered perspective on parents’ rights. Cardozo Law Review 14 (6): 1747–1866.

    Google Scholar 

  93. X v The Sydney Children’s Hospital Network. 2013. 85 NSWLR 294.

  94. Young, L. 2019. Mature minors and parenting disputes in Australia: Engaging with the debate on best interests v autonomy. University of New South Wales Law Journal 42 (4): 1362–1385.

    Article  Google Scholar 

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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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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).

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  • 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