Protocol › Informed consent · Last reviewed 2026-05-16
Informed consent and assent
Summary
Under Dutch law (WGBO, article 7:450 BW), adolescents under 12 need the consent of a parent; in the 12–16 age category, dual consent of the minor and parents applies; from 16, the minor decides independently. The Dutch Protocol applied this framework and required extensive informed-assent procedures, including explanation of fertility, surgical implications, and known and unknown long-term effects of GnRHa and cross-sex hormones. See also /protocol/age-criteria/.
1. Legal framework (WGBO)
| Age | Decision-making authority | WGBO basis |
|---|---|---|
| < 12 | Parents / legal representatives | Art. 7:450 sub 1 BW |
| 12–16 | Dual consent: minor + parents | Art. 7:450 sub 2 BW |
| ≥ 16 | Minor independently | Art. 7:447 BW |
2. Content of the information
In the original VUmc trajectory, information was provided about:
- The nature and mechanism of action of GnRH agonists — see /protocol/the-three-phases/.
- Known and unknown long-term effects on bone density and cognitive development.
- The partially reversible effects of cross-sex hormones.
- Possibilities and limits of fertility preservation.
- The irreversible character of surgical interventions.
3. Debate on capacity
The English case Bell v Tavistock (2020) raised questions about the capacity of adolescents in relation to puberty suppression. The court initially ruled that it was "highly unlikely" that a child under 13 can be competent to consent to GnRHa treatment — a ruling that was overturned in 2021 by the Court of Appeal on procedural rather than substantive grounds.1 See /debate/legal-cases/.
Critical note
Levine, Abbruzzese and Mason (2022) argue that valid informed consent is in practice not possible when essential outcome information is missing: long-term effects on bone density, fertility, sexual function and brain development are partly unknown. The WPATH Files (2024) contain internal discussions in which clinicians themselves doubt whether adolescents aged 13–16 can sufficiently grasp the implications of loss of fertility and orgasmic function.2
See also
- Age criteria — the original age thresholds that set the consent framework.
- Inclusion criteria — capacity as a condition for inclusion.
- Legal cases — Bell v Tavistock and related litigation.
- Levine — critiques — argument that valid informed consent is missing.
- WPATH Files (2024) — internal doubts among clinicians.
- Ethical criticism — broader ethical concerns around decisions for minors.
- People register — Cohen-Kettenis, Bell, Levine.
- International comparison — consent frameworks per country.
- Timeline — Bell v Tavistock in chronology.
- FAQ · Glossary · For parents.
Footnotes
- Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274 (Admin); [2021] EWCA Civ 1363.
- Levine SB, Abbruzzese E, Mason JW. Reconsidering informed consent. J Sex Marital Ther. 2022;48(7):706–27. Hughes M. The WPATH Files. Environmental Progress; 4 March 2024.