Clare Rowe is an Educational and Developmental Psychologist and Director of Rowe & Associates in Sydney. She specialises in child and adolescent mental health, family conflict, and court-related matters. Clare is also a media commentator, writer, and Adjunct Fellow at the Institute of Public Affairs, focusing on child wellbeing and education issues.
The recent public comments by former Chief Justice of the Family Court of Australia, the Honourable Diana Bryant AO KC, have prompted renewed discussion about the legacy and ongoing impact of Re Jamie (2013) – the decision that shaped the pathway for children and adolescents seeking access to puberty blockers and other genderaffirming interventions.
More than a decade on, Bryant’s acknowledgement that she now holds “doubts” about the ruling is significant not only in its substance but also in its timing. It arrives amid growing scrutiny of paediatric gender medicine, new evidence emerging internationally, and increasing calls for clear legislative frameworks.
For family law professionals, clinicians, and those working at the intersection of law, medicine, and child wellbeing, Bryant’s reflection invites a careful examination of what Re Jamie decided, how the field has evolved, and where responsibility should lie for decisions involving irreversible or high-risk interventions for young people.
In Re Jamie, the Full Court determined that Stage 1 treatment (puberty blockers) for gender dysphoria did not constitute “special medical treatment” requiring court authorisation, provided parental consent and appropriate clinical assessment were in place. Stage 2 treatment (cross-sex hormones) could proceed without the Court where there was no dispute between parents, child, and treating practitioners.
The judgment was built on the evidence base available in 2013, a period when genderaffirming interventions were understood to be largely reversible, low-risk, and beneficial for psychological outcomes.
The ruling reflected the Court’s longstanding principle that medical decisions should not come before the judiciary unless intervention is required to protect the child from harm or resolve disputes.
At the time, Re Jamie was widely considered a progressive step that removed unnecessary barriers for families navigating a difficult and sensitive clinical pathway.
Diana Bryant’s recent statement that expressed her uncertainty about whether judicial discretion alone is the most appropriate safeguard for these cases, and suggesting that legislatures may be better placed to regulate the field, carries weight for several reasons.
Working With Families For clinicians and legal representatives supporting gender-distressed children, Bryant’s comments do not alter current legal obligations. However, they do highlight themes that are critical for clinical governance and client support.
1. Informed consent now requires far broader and more cautious discussion.
Given recent findings about uncertain long-term outcomes, potential impacts on fertility, bone density, and neurodevelopment, clinicians must ensure families receive balanced, evidence-based information. The standards of 2013 no longer suffice.
2. Mental health assessment remains central.
Contemporary research shows high rates of co-occurring conditions among genderdistressed youth (anxiety, depression, trauma, ASD traits). Clinicians must follow thorough assessment pathways to differentiate underlying drivers of distress.
3. The role of parents must be taken seriously.
The consent framework established in Re Jamie presumes parental understanding and involvement. As evidence evolves and risks become clearer, supporting parents with transparent information is fundamental to ethical care.
Bryant’s comments present an opportunity for constructive reflection across family law, mental health, and policy circles. At present, practitioners operate in a space where legal expectations, clinical standards, and emerging evidence are not fully aligned.
Legislative frameworks , as Bryant suggests, could provide consistent national standards, reducing uncertainty for families and professionals. The issues raised by Re Jamie sit at the intersection of child development, medical ethics, parental responsibility, and judicial oversight.
Any future reform must involve clinicians, lawyers, researchers, and policymakers working together rather than in parallel. Regardless of shifts in evidence or law, the guiding question remains unchanged: what pathway best safeguards the child’s long-term wellbeing?
Bryant’s intervention invites all sectors to re-examine this question with honesty and rigour.
Diana Bryant’s reflections on Re Jamie do not diminish the historical significance of the decision. Rather, they highlight the dynamic nature of evidence, the challenges of regulating complex medical practice through judicial mechanisms alone, and the need for ongoing dialogue about how best to support vulnerable young people.
For practitioners across the family law ecosystem, the moment is an opportunity: to strengthen clinical practice, to refine legal pathways, and to ensure that decisions made for children today are firmly grounded in both contemporary evidence and the enduring principles of child-centred practice.
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Former Chief Justice Diana Bryant AO KC’s recent reflections on the landmark Re Jamie (2013) decision reignite debate on gender-distressed youth, puberty blockers, and the evolving role of courts in complex medical cases.
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