Surgery to align an infant child's genitals to a medically assigned sex is controversial because it is irreversible and therefore may potentially be detrimental to the child as they develop into a gender identity. I argue that the significant issue for genital-normalizing surgery is decision-making and that English law does not promote or protect the best interests of the intersex child or the inherent human rights that are protected by both domestic and international law. Using a doctrinal and socio-legal methodology along with a close analysis of bioethical arguments, I argue that the interpretation of the best interests of infant intersex children is manipulated to support the lack of social, legal and medical acceptance of intersex as an 'abnormality' that must be corrected, in order to conform to the accepted normality of binary male and female sex. In acknowledgment of this legal and professional standards deficit, I will propose a shared-decision-making approach to support the welfare of the child, which, at its core, places the child as the primary decision maker.

Children attending hospital for a clinical procedure such as a scan or blood test can experience anxiety and uncertainty. Children who are informed and supported before and during procedures tend to have a more positive experience. Despite this, there is a lack of empirical evidence directly from children around how they would like to be supported before, during and after a procedure. This qualitative study used improvised drama workshops to investigate children’s ( n = 15, aged 7–14 years) perceptions and opinions of attending hospital for a procedure and what would help them have a positive encounter. Children portrayed themselves as having a small presence during a hospital procedure, depicted by the two themes of ‘having to be brave but feeling scared inside’ and ‘wanting to get involved but being too afraid to ask’. Within both themes, children described how the directive and reassuring language and actions used by health professionals and parents marginalized their contributions. This study shows that children attending hospital for procedures value the opportunity to have a presence and active role, to express their emotions, join in interactions and be involved in making choices about their care.

There have been ongoing debates as to how, or even whether, we should clinically classify gender diversity in children through clinical classification manuals. So‐called ‘depathologizing’ is argued as being vital to address the stigma that these children are somehow disordered or sick. Yet one argument in favour of continued clinical classification for transgender and gender non‐conforming children is that it better facilitates access to specialist psychological support. I argue that whilst continued clinical classification offers a seemingly pragmatic solution to ensuring access, it does in fact obscure our understanding of the individual needs of these children. In this paper I address fundamental issues that aim to better our understanding of need and thus why a child may benefit from specialist support. I do so by critiquing a paper I nearly wrote, which argued for the ongoing continued classification of gender incongruence in children. Ultimately, I argue that specialist psychological support and care should be driven by the needs of the individual child, as determined by the child and those involved with their care. By bettering our understanding as to why specialist psychological support may be beneficial for some, we move past the focus of such specialist support being provided because of the child’s gender diversity. Methodologically the paper may be unusual, in comparison to traditional normative counter‐argumentative bioethical position papers, but by presenting an argument for depathologization of gender diversity of children in this way there is also an alternative insight into the methods of bioethics.

In the case of controversial interventions there is a need for clinical guidelines to be founded on 'expert opinion' and an evidence base, in order to minimise individual clinicians making subjective decisions influenced by bias or cultural norms. This paper considers international clinical guidelines that through recommendation effectively prohibit the provision of genital-alignment surgery for competent adolescents with gender dysphoria. I argue that although the rationale for this particular guideline is based on serious concerns, these need to be better understood to allow reconsideration of this unilateral prohibitive recommendation. I do not propose that genital-alignment surgery should be prima-facia provided for any adolescent with gender dysphoria. Instead I argue that by developing our understanding of the current concerns, we can allow guidelines to incorporate a margin of clinical discretion, to allow clinicians to provide genital-alignment surgery to some adolescents, where clinically appropriate. In facilitating this we can move towards establishing a solid evidence-base. The basis of this position is that clinical guidelines and medical practice should treat these young people with the same standards of evidence-based care as others who have less controversial conditions. Whilst this paper uses English law and UK professional regulation for context, many of the ethical, legal and professional issues highlighted are applicable to other jurisdictions.

Purpose The purpose of this paper is to specifically analyse whether parents should have the legal authority to authorise a deprivation of liberty for children with a learning disability. As a result of parental consent being recognised as holding legal authority, these children have their right to liberty under Article 5 engaged. It will be argued that the courts’ failure to support this view stems from the confusing concept of the “zone of parental control”. Design/methodology/approach A doctrinal methodology is used, examining domestic law and the European Convention on Human Rights (ECHR), with analysis of relevant literature. Findings Decisions regarding deprivation of liberty in children under the age of 16 should undoubtedly include parental consent. The concern expressed here is the sovereignty of parental consent over all else. The law is confusing. In one respect rights under the ECHR are universal. However, both UK and European courts have accepted the premise that it is entirely within the zone of parental control to effectively deprive a child of liberty without procedural or judicial review. Furthermore, there are wider potential issues for children being considered to be deprived of liberty following Cheshire West. Originality/value The paper is a discussion piece that is critical of the existing law and uses the literature and original opinions to recommend an alternative approach.