Our attention has been refocussed on the LGBTQI + issue in recent times, and more so after the unambiguous and categorical statement made by the Archbishop of Colombo, Macolm Cardinal Ranjith a few days ago.

In The Sunday Island lead news item on 17 August, he is quoted as saying among other things, “A group of psychologists are issuing certificates that allow children to change their gender identity”. And then he has gone on to homosexuality – as “a danger to our younger generation”. He has further claimed that certain political parties and their leaders were involved in promoting this agenda.

As a medical academic, I have advocated that any human sexual activity is acceptable between consenting adults – with absolute emphasis on ‘consenting’, the issues of same gender sex is not at issue where I am concerned. It is a matter of private personal preference and choice between consenting adults.

But I am very much concerned about an emerging trend that to me, to say the least, is highly alarming. That is, the strong emerging trends of transsexualism pervading the West and the pharma-politico-financial backing it is receiving in recent times. There is now a backlash on men trying to be women and taking advantage of the situation in invading ‘private places’ previously dedicated to women, and legal encroachment in individual and team sports. The worst aspect of it is the encroachment of these powerful corporate social segments on the Rights of the Child.

In this narrative, what I will attempt to do is make a few random ‘brush strokes’ on the large canvas of the current scenery on the ‘Child as a Person’ that may paint an abstract picture of this subject. You may see a pattern, or you may not. It will be in the eyes of the beholder.

“The child is the father of the man.”

Wrote William Wordsworth – in his 1802 poem, “My Heart Leaps Up”.

On first reading of this old aphorism, it seems a confounding paradoxical statement. What did the poet mean when he used this confusing idea? It is said that he meant that the foundation of our adult personalities is laid during our childhood. But is it really so? As a child grows into adulthood, he/she will gradually lose the curiosity and the sense of wonder about the world. The child gradually begins to conform to the dictates of society, beginning with the dictates of parents. Then comes the restraining confines of school discipline about which Ivan Illych wrote in his path-breaking book “Deschooling Society” in 1970 – 55 years ago! Schools as mass collective education catering to the lowest common denominator. But, on the other hand, it is my view, that the basic core attitudes of an individual are first formed at home. It is from the home that one will learn the rudiments of ‘good’ and ‘bad’ or of ‘right’ and ‘wrong’. That is often why, some children who come from dysfunctional family backgrounds, whatever later attempts are made, end up in anti-social circumstances.

What we can learn from this thought from Wordsworth is that even as early as the beginning of the 19^th century, the importance of childhood in the future development of the adult had been appreciated. What it certainly does is to put our topic of the day – “The child is a person” in perspective. In other words, Wordsworth’s idea, enhances our topic of the day.

The recognition that ‘the child is a person’ is a necessary precondition to accept that the child is the future.

This saying attributed to Abraham Lincoln:

“A child is a person who is going to carry on what you have started … the fate of humanity is in his hands.”

Perhaps he was the first to use the title of this article. When I chose it, I did not know that Abraham Lincoln had use the phrase before. There is another proverb that is more telling – and perhaps for that reason, remains anonymous:

“He who takes a child by the hand, takes the future by the scruff of its neck!”

This leaves us with little doubt about the importance of the child as a person. But before that, let us ask another question, rhetorically: ‘When does a child become an individual?’. ‘When does a child become a person?’

Here, we get into serious controversy. The multiple issues of ‘the embryo, the foetus and the unborn child’, reproductive rights, women’s rights and their socio-religious implications fall upon us like a ton of bricks. For example, are the words ‘foetus’, ‘unborn child’ and ‘unborn baby’ interchangeable? Are there any differences between these words and their usage? Are they mere semantics that no subtle importance need be attached to them? Does it depend only on the perspective of the person who uses them? Let us leave aside such complexities for our purpose of this article. Let us be aware that there are areas that “even angels fear to tread”. But we will bear those issues in mind, nevertheless.

Capacity of children to make legal decisions.

I wouldn’t want to delve into ‘foetal rights’ at this point as it is voluminous enough for books and volumes by itself. Therefore, we plunge straight into ‘child rights’ though ‘foetal rights’ is necessarily and conceptually the basis of ‘Child Rights’.

The child’s wishes and decisions in the family courts, for example. It was long thought that a child lacked legal capacity to give valid consent in law regarding decisions such as consenting to medical procedures. Therefore, the capacity to make decisions and act in the child’s best interest was vested in their parent or guardian. These parental powers existed until the child attained legal adulthood.

The current approach views parental powers in a different way: they establish that these are effective only so long as they are needed for the protection of the person and property of the child. Therefore, it is no longer the accepted rule that children remain under parental control until they are of a certain age. At some point of the child’s life, the parental right yields to the child’s right to decide for him or herself. However, this is increasingly seen by the courts as an incremental process, in the course of which, the child’s independence and ability to make decisions grow, while the extent of the parental responsibilities and right to decision-making gradually diminish.

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

By the way, ‘The Gillick case’ involved a UK health departmental (NHS) circular advising doctors on the contraception of minors (for this purpose, under sixteens). The circular stated that the prescription of contraception was a matter for the doctor’s discretion and that they could be prescribed to under sixteens without parental consent. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. Gillick sought a declaration that prescribing contraception was illegal because the doctor would commit an offence of encouraging sex with a minor (which in Sri Lanka, is statutory rape) and that it would be treatment without consent as consent in this aspect should be vested in the parent; she was unsuccessful before the High Court but succeeded in the Court of Appeal.)

It means that the legal authority for parents to make medical decisions on behalf of their children is revoked when the child reaches sufficient maturity to make their own decisions. There is no hard-and-fast age at which a child can be considered ‘Gillick competent’, and it is something decided on a case-by-case basis.

Gender Dysphoria

This is an area in which I want to invest some extra time during this narrative; on what I believe is an issue that is heavily laden with controversy. Serious current controversy. Here, whether the child is a person, and what decision-making role they can play, at what age, which is critical for their future personal identity, come into serious contention.

Specialist paediatricians in Sri Lanka should be very much aware of this relatively new phenomenon. Which to my mind, is a frightening development where paediatricians and child psychiatrists are at the epicentre of this global controversy. Perhaps, it is not quite correct for me to call it global. Perhaps, not yet.

It is still very much a subject of medical controversy in the West including Australia. But the fall out may not be too far in coming to our shores. And paediatricians, must be fully cognisant of all issues concerned and policy decisions taken in this regard at the level of professional bodies as well as at the Ministry of Health.

Where should I begin?

I wouldn’t want to get into the debatable area of biological sex. Whether there are six of them (as is now classified) or less. But we can simplify by making them three. Male, female and all others lumped into the category – intersex. Intersex being individuals born with any of several variations in sex characteristics including chromosomes, gonads, sex hormones or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, “do not fit the typical definitions for male or female bodies“.

One of the most famous intersex personalities of recent times was Caster Semenya, the South African middle-distance runner and 2016 Olympic gold medalist in the 800 metres, who was assigned as a female at birth with naturally elevated testosterone levels due to an enzyme (5α-Reductase) deficiency. In a landmark case for athletes’ rights, Caster Semenya, the star South African runner, won her case at the European Court of Human Rights (ECtHR) on July 10, 2025. “Caster Semenya’s victory is a victory for all women and all athletes because the European Court found that the Court of Arbitration for Sport and Swiss Federal Tribunal had failed to uphold human rights norms despite credible claims of discrimination.” reported Human Rights Watch. But our issue here today, is not about intersex.

But I am digressing.

From biological sex, we get into “gender assignment”. Gender assignment is the discernment (subjective judgement) of an infant’s sex at birth. Assignment may be done prior to birth through prenatal sex discernment – as is commonly done now by obstetricians by ultra sound scans. In the majority of births, it is a relative, a midwife, a nurse or a physician who inspects the genitalia when the baby is delivered, and sex or gender is assigned without any expectation of ambiguity. The global number of births with ambiguous genitals is in the range of 0.02% to 0.05%.

If it was only such cases of ‘intersex’, that has aroused controversy, that would be a non-issue. As we come to understand, it goes far beyond that. For instance, a whimsical comment by a female child “I am a boy” would be enough to register her in a gender dysphoria clinic to be kept under observation for later interventions to change her ‘birth gender’.

In consequence, what was once straight forward biological sex determined on a biological construct has changed to a very fluid ‘social construct’. A child’s sex or gender is increasingly being determined by societal imperatives and not biological analysis.

Gender dysphoria has been broadly stated as ‘the sense of unease arising from one’s physical sexual characteristics which are not aligning with one’s gender identity’.

Today, increasingly, gender identity is the personal sense of one’s own gender. Gender identity can correlate with a person’s assigned sex at birth or can differ from it. ‘Gender expression’ typically reflects a person’s gender identity. New terminology is coming into this gender lexicon – for instance, “body-ownership networks”. The factors that determine gender is no longer chromosomes or genes. There are many determinants. Here is the least complex interpretation of what is now termed the ‘Sense of Gender’ – diagrammatically. (See diagram)

As can be seen, gender identity is becoming highly complex in today’s world.

Puberty Blockers

The mainstay of conservative management of, and treatment for, gender dysphoria is puberty blockers. I am not sure how many of our paediatricians are into this, as of now.

You know that the so-called puberty blockers, known formally as gonadotropin-releasing hormone (GnRH) antagonists, are medications that cause the body to stop producing sex hormones. They are delivered either as injections (also used in breast and prostate cancer treatment), which are administered by a healthcare worker every three months, or via an implant, which needs to be replaced annually.

For ‘transgender children’, taking these drugs will prevent breast tissue development and menstruation, or the growth of facial hair and a deepening voice. The effects of drugs are completely reversible, and if a person stops taking them their body will resume sex hormone production as it had done before they started.

Why might a child want puberty blockers? Because the child is unsure of its gender preference. The monitoring of such children has begun, in some instances, when they were as young as 4 years old. Puberty blockers are commenced sometimes soon after puberty (ages 12-14) when they have begun producing sperms and ova (when, they can be frozen for future fertility) or even before when they lose their fertility options! The controversial issue in this is who will be the decision-maker in this process? The child or the parents?

Dianna Kenny, Professor of Psychology, consulting psychologist, psychotherapist University of Sydney who has collected data on children enrolled in gender dysphoria clinics has discovered the emergence of a ‘new pandemic’. The statistics are alarming. There has been a dramatic increase in the number of children enrolled in gender dysphoria clinics since 2019.

Social Contagion

Diana Kenny in an article titled “Is gender dysphoria socially contagious?” explores the influence of ‘social contagion’ on what she calls “the disquieting upsurge in the number of children and young people whose parents are presenting to gender clinics around the world for advice regarding social transition, puberty blocking agents, cross sex hormones, and ultimately surgery in an attempt to change their gender.”

Evidence has been quoted of children prompted into what is now termed “rapid-onset gender dysphoria” by peer pressures. After the article on the subject by Dr. Lisa Littman of Brown University was first published, there was a ‘mob reaction’ by transgender activists who denounced the paper calling it hate speech and transphobic. The gender dysphoria issue has turned not only political, but disquietingly aggressive. Increasingly, younger and younger children are not just being given, but driven, to ‘radical surgical treatment’ for gender dysphoria.

In this context, let me digress a bit to relieve the monotony.

Lisa Marchiano, a Yungian psychoanalyst in Philadelphia, in her article titled “Outbreak: On Transgender Teens and Psychic Epidemics” published in ‘Psychological Perspectives’ – a Quarterly Journal of Yungian Thought in 2017 (Carl Yung) – writes this interesting historical aside:

“The earliest written record from the town of Hamelin in Lower Saxony is from 1384. It states simply, “It is 100 years since our children left.” Historical accounts indicate that sometime in the 13th century, a large number of the town’s children disappeared or perished, though the details of the event remain a mystery. “The Pied Piper of Hamelin”, as far I as have been able to determine, is the only Grimm’s fairy tale that is based substantially on a historical event. Both the actual event and the Grimm’s tale suggest an archetypal situation in which adults have allowed children to be seduced away into peril. This tale is a disconcertingly apt metaphor for various social contagions that have overtaken collective life throughout the centuries.”

William Manchester’s ‘A World Lit Only by Fire’ places the events in 1484, 100 years after the written mention in the town chronicles that “It is 100 years since our children left”, and further proposes that the Pied Piper was a psychopathic paedophile.

Now that is an interesting perspective on the children who followed the pied piper into oblivion. Is this what today’s adults are doing to our children. Taking decisions for them and taking them away into a “gender land of no return”? Decisions that could often irreversibly disturb their lives – psychologically? As some have said – ‘Seduce them into peril’??

The case against Tavistock and Portman NHS Trust

A UK News report dated Oct 7, 2020, describes a landmark case that will be heard in High Court about whether children who wish to undergo gender reassignment should be prescribed “experimental” puberty blockers and cross-sex hormones.

Kiera Bell, a 23-year-old woman who began taking puberty blockers when she was 16 before “detransitioning” last year – i.e., going back to being a girl, is suing the Tavistock and Portman NHS Trust, which runs the UK’s only gender identity development service (GIDS) for children.

The legal challenge is also being brought by Mrs A, the mother of a 16-year-old autistic girl who is currently on the waiting list for treatment.

In January 2021, the pair were given the go-ahead to bring the action against the trust after claiming that the way informed consent is obtained from children is “materially misleading”.

At the hearing in London, Ms Bell and Mrs A’s lawyers will argue that children under the age of 18 cannot give “informed consent” to treatment which has “irreversible, lifelong consequences”.

Professor Carl James Heneghan, a clinical epidemiologist and a Fellow of Kellogg College, Oxford and the Director of the University of Oxford’s Centre for Evidence-Based Medicine and Editor-in-Chief of BMJ Evidence-Based Medicine has called the use of puberty blockers to treat transgender children an “unregulated live experiment on children.”

It was reported that in 2019 five clinicians working at the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust in London in the United Kingdom (UK) resigned, and one of the governors of the Trust also resigned. Among other reasons, they adduced that puberty ‘blockers’ are prescribed experimentally to gender diverse youth, without sufficiently robust evidence around efficacy and safety, and without sufficiently robust diagnosis.

Other countries….

Under some of the proposed new laws across the United States, doctors could be barred from prescribing puberty-blocking drugs to children. A measure introduced in South Carolina last year would revoke the licenses of doctors who treat transgender children.

Meanwhile, the South Dakota legislature voted down a bill that will see doctors charged with a misdemeanour if they prescribe puberty blockers. The Republican state representative Fred Deutsch, who sponsored the bill, said on Twitter ahead of the vote on Feb. 10, 2020: “The world is upside-down; protecting children from sterilization and mutilation is causing a firestorm,”

The issue has spilled beyond the borders of the United States, with many countries mulling new laws preventing poorly discriminated decisions on prescribing puberty blockers for children.

On the other hand, Brazil lowered the age at which young people can access gender reassignment surgery from 21 to 18 and dropped the age requirement for hormone therapy from 18 to 16 – although those under 18 must have the consent of a parent or guardian.

There are other connected and important issues. One is:

The gender dysphoria epidemic and the vested interests of the medico-pharma-insurance industry is quite similar to the ADHD medication controversy, of the recent past.

The debates and controversies go on. The paediatric endocrinologists, child psychologists and transgender surgeons are teeming on either side of the barricades – where, and on what side would you stand? The ‘child as a person’ seems to have been lost in this medical / legal battle ground.

I hope with these ‘brush strokes’ of information, I have adequately covered the topic that I ventured to write on, mainly due to the emergence of discussions on transgenderism and gender dysphoria that seems to be slowly, but surreptitiously, creeping into our legal system under the coercive influence of multiple Western agencies such as the UNHRC and the IMF. The complexities of this developing socio-political-legalistic phenomenon is both bewildering and frightening.

Are there conditions and constraints to ‘The child being a person’? Here are some concluding thoughts, not as conclusions, but as questions.

· When would a child be considered ‘Gillick competent’ in Sri Lanka?

· Will adults allow a child to decide on its own gender identity?

· Should adults decide that their child is a male or female before the child can decide for itself?

· Is it ethical to offer a child the option of gender surgery against the will of their parents as is being done in some centres in the West now?

· Where does society draw the line on when a child becomes a person?

· When does a child become a person?

· When will adults allow a child to be a person?

· When should adults allow a child to be a person?

I am not sure what kind of reaction I will have from Paediatricians and Child Psychiatrists in Sri Lanka to this narrative as there are strongly contrary positions taken by them the world over. Will the outcome of these controversies determine the future of humans as a thriving species?

Questions and more questions for both the legal and medical professionals. In the final analysis, I am leaving you with more questions than answers. In a world that has, in many ways, turned itself upside down, that would not be too surprising, would it?

(I have taken extensive extracts for this article from my presentation for the Dr. BJC Perera Research Prize Oration 2020, Sri Lanka College of Paediatricians.)

by Dr. Susirith Mendis ✍️
Emeritus Professor
University of Ruhuna
(susmend2610@gmail.com)