CCBI News – The Cass Review, Final Report, April 2024

May 22, 2024

Dear Friends of CCBI,

Cass Report, April 2024

Several issues of NEWS ago, I mentioned changing reactions to currently accepted treatment for gender dysphoria, and how some countries have withdrawn use of treatments such as puberty blockers for young people because of fears about misdiagnosis and the irreversibility of the treatments. Medical facilities in Canada and in the United States seem to be ignoring such changes, and it is of interest to compare practice and research and to see what has precipitated change. We noted changes that had occurred in Europe at national levels, and one of the most well-known changes in practice occurred in the United Kingdom.

The UK government commissioned the Cass Report after the major gender clinic, the Tavistock Clinic, said it would stop treatments because of a lack of evidence for and mounting evidence against the use of puberty blockers to redirect the young person’s hormonal activity at that stage. This was a massive corrective to those who promote such treatments somewhat indiscriminately and perhaps ideologically in the pursuit of advocacy for gender change, not primarily to help those who appear to suffer from the condition known as gender dysphoria, recognized in psychiatric manuals.

Relying on such psychiatric definitions, CCBI has always referred to gender dysphoria as a condition, something which can be treated, and not as a ‘given.’ We try to follow clinical evidence, but, of course, fully accept Catholic teaching that we are made in God’s image, therefore do not accept the ‘born this way’ approach which establishes ‘givenness’ based on personal feeling or knowledge, regardless of objective criteria such as physical bodies. Great distinctions are made between ‘sex’ (biological) and ‘gender’ (subjective feeling or personal knowledge) in order to prove that only the person himself or herself truly knows to which gender he/she belongs.

That narrative was challenged by some at first and is nowadays increasingly challenged, with many countries and medical personnel now viewing gender issues less in a political context of rights and autonomy and more in the realm of longer-terms studies and emerging evidence that run counter to the practices of the last ten to fifteen years.

The Cass Report: Final Report – Cass Review, April 2024

CCBI plans to analyse the report over the next two or three weeks, but meantime anyone who so desires can read the report, either the summary or the full report.

Final Report – Cass Review

The report deals with many of the questions that some bioethicists and medical personnel have been asking for years, even when many in society seemed to ignore those questions and even tried to diminish the questioners’ competence to challenge current practice. As Catholics, we start with a different perspective in accepting and believing that all human beings are made in God’s image and that our bodies are good and right. Not everyone accepts this reasoning, which for us is foundational. This declaration of faith is, however, bolstered by the Catholic Natural Law tradition, which looks to our purpose in life, (‘ends’) taking into account centuries of human experience regarding the nature of human desires and the nature and purpose of human sexuality. Even with differing interpretations of ‘family’ today, there is no doubt that most people want to belong to a loving, relational unit which gives them ‘roots,’ stability, and eventually ‘wings’ to go forward as an adult, replicating the same basic behaviour of sexual attraction, procreation and stability, generation after generation. This is the sort of observation based on purpose and experience that is the basis of natural law. It is not an abstract or hypothetical ‘theory.’

Allied to that and to human flourishing are social and legal issues that speak to all of us, and that demand reflection and prudence. The question of consent is one of the most important. Can, for example, an 11- or 12-year-old properly consent to hormone-changing treatments which may turn out to be irreversible even if the young person changes his or her mind about wanting to change gender, as is mostly (80%) the case? What leads some parents to acquiesce to such a request from a child, a minor far from adulthood?

Overview of Recommendations from the Final Report

Out of interest, here is the Overview of Recommendations, taken directly from the Final Report, above):

The recommendations set out a different approach to healthcare, more closely aligned with usual NHS clinical practice that considers the young person holistically and not solely in terms of their gender-related distress. The central aim of assessment should be to help young people to thrive and achieve their life goals.

• Services must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.
• Expand capacity through a distributed service model, based in paediatric services and with stronger links between secondary and specialist services.
• Children/young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.
• Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and cooccurring conditions, including support for parents/carers and siblings as appropriate.
• Services should establish a separate pathway for pre-pubertal children and their families. ensuring that they are prioritised for early discussion about how parents can best support their child in a balanced and non-judgemental way. When families/carers are making decisions about social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a clinical professional with relevant experience.
• NHS England should ensure that each Regional Centre has a follow-through service for 17–25-year-olds; either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey.  This will also allow clinical, and research follow up data to be collected. 
• There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.
• A full programme of research should be established to look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.
• The puberty blocker trial previously announced by NHS England should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/feminising hormones.
• The option to provide masculinising/feminising hormones from age 16 is available, but the Review recommends extreme caution. There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18.  Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT).
• Implications of private healthcare on any future requests to the NHS for treatment, monitoring and/or involvement in research, and the dispensing responsibilities of pharmacists of private prescriptions needs to be clearly communicated.

Note from CCBI: To be continued!

Cass Review – Independent Review of Gender Identity Services for Children and Young People

Pope Francis’ Intentions for May:
For the formation of religious and seminarians

We pray that religious women and men, and seminarians, grow in their own vocations through their human, pastoral, spiritual and community formation, leading them to be credible witnesses to the Gospel.

Moira and Bambi