In Re A (Minors) (Conjoined Twins: Medical Treatment); aka In re A (Children) (Conjoined Twins: Surgical Separation): CA 22 Sep 2000

Twins were conjoined (Siamese). Medically, both could not survive, and one was dependent upon the vital organs of the other. Doctors applied for permission to separate the twins which would be followed by the inevitable death of one of them. The parents, devout Roman Catholics, resisted.
Held: The parents’ views were subject to the overriding duty of the court to act to protect the child. In a terrible situation, the choice must be the lesser of two evils. The development of the defence of necessity meant that it would not be a criminal offence of murder to carry out the operation, although the law required parliamentary clarification. The three necessary requirements for the application of the doctrine of necessity are (i) the act is needed to avoid inevitable and irreparable evil; (ii) no more should be done than is reasonably necessary for the purpose to be achieved; (iii) the evil inflicted must not be disproportionate to the evil avoided. Those conditions were met in this case, and the appeal was refused.
The court set out the doctrine of necessity: ‘An act which would otherwise be a crime may in some cases be excused if the person accused can show that it was done only in order to avoid consequences which could not otherwise be avoided, and which, if they had followed, would have inflicted upon him or upon others whom he was bound to protect inevitable and irreparable evil, that no more was done than was reasonably necessary for that purpose, and that the evil inflicted by it was not disproportionate to the evil avoided —- The extent of this principle is unascertained. It does not extend to the case of shipwrecked sailors who kill a boy, one of their number, in order to eat his body.


Lord Justice Ward, Lord Justice Brooke And Lord Justice Robert Walker


Times 10-Oct-2000, [2000] EWCA Civ 254, [2001] 1 FLR 267, [2000] 4 All ER 961, [2001] Fam 147, [2001] 2 WLR 480, [2001] 9 BHRC 261, [2000] 3 FCR 577, [2001] Fam Law 18, (2001) 57 BMLR 1, [2000] Lloyd’s Rep Med 425, [2001] UKHRR 1




England and Wales


See AlsoIn Re A (Minors) (Conjoined Twins: Medical Treatment) (No 2) CA 15-Nov-2000
The failure by the Official Solicitor to pursue an appeal where leave had been granted, in a case of an application to the court for leave to separate conjoined twins, which separation would lead to the death of one of them, would not of itself . .
CitedJ v C (An Infant) HL 19-Feb-1969
The House sought to construe the meaning of the words ‘shall regard the welfare of the infant as the first and paramount consideration’. Lord MacDermott said: ‘it seems to me that they must mean more than that the child’s welfare is to be treated as . .
CitedS v McC; W v W HL 1972
The distinction between the court’s ‘custodial’ and ‘protective’ jurisdictions was recognised. The case concerned the ordering of blood tests with a view to determining the paternity of a child involved in divorce proceedings. This was not a matter . .
CitedIn re MB (Medical Treatment) CA 26-Mar-1997
The patient was due to deliver a child. A delivery by cesarean section was necessary, but the mother had a great fear of needles, and despite consenting to the operation, refused the necessary consent to anesthesia in any workable form.
Held: . .
CitedIn Re B (A Minor) (Wardship: Medical Treatment) CA 1981
The child was born with Down’s Syndrome and an intestinal blockage. She needed the obstruction to be relieved if she was to survive. If the operation were performed, the child might die within a few months but it was probable that her life . .
CitedAiredale NHS Trust v Bland HL 4-Feb-1993
Procedures on Withdrawal of Life Support Treatment
The patient had been severely injured in the Hillsborough disaster, and had come to be in a persistent vegetative state (PVS). The doctors sought permission to withdraw medical treatment. The Official Solicitor appealed against an order of the Court . .
CitedIn re T (Adult: Refusal of Treatment) CA 1992
A patient’s right to veto medical treatment is absolute: ‘This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or . .
CitedGillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security HL 17-Oct-1985
Lawfulness of Contraceptive advice for Girls
The claimant had young daughters. She challenged advice given to doctors by the second respondent allowing them to give contraceptive advice to girls under 16, and the right of the first defendant to act upon that advice. She objected that the . .
CitedIn Re R (A Minor) (Wardship: Consent to Treatment) CA 1992
A doctor may not operate without on a child the consent of the person apparently legally able to give consent: ‘It is trite that in general a doctor is not entitled to treat a patient without the consent of someone who is authorised to give that . .
CitedIn re F (Mental Patient: Sterilisation) HL 4-May-1989
Where a patient lacks capacity, there is the power to provide him with whatever treatment or care is necessary in his own best interests. Medical treatment can be undertaken in an emergency even if, through a lack of capacity, no consent had been . .
CitedRex v Poulton 18-May-1932
In summing up in a murder trial: ‘With respect to the birth, being born must mean that the whole body is brought into the world . . Whether the child was born alive or not depends mainly on the evidence of the medical men.’ . .
CitedRance v Mid-Downs Health Authority 1991
A child is born alive: ‘if, after birth, it exists as a live child, that is to say, breathing and living by reason of its breathing through its own lungs alone, without deriving any of its living or power of living by or through any connection with . .
CitedRegina v Handley 1874
The jury were advised of the need to consider whether a child had been born alive: ‘. . i.e. whether it existed as a live child, breathing and living by reason of breathing through its own lungs alone, without deriving any of its living or power of . .
CitedIn re B (A Minor) (Wardship: Sterilisation) HL 1987
Paramount Consideration in Wardship Application
The House considered a case involving the sterilisation of a girl just under 18, who suffered from mental disability.
Held: A court exercising wardship jurisdiction, when reaching a decision on an application to authorise an operation for . .
CitedIn re J (a Minor) (Wardship: Medical treatment) CA 1-Oct-1990
J was born at 27 weeks’, weighing only 1.1kg. He suffered very severe and permanent brain damage at the time of his birth, the brain tissue then lost being irreplaceable. He was epileptic and the medical evidence was that he was likely to develop . .
CitedIn re C (A Minor) (Wardship: Medical Treatment) CA 1989
. .
CitedRe C (Wardship: Medical Treatment) (No 2) CA 1989
The court had already made an order about the way in which the health professionals were able to look after a severely disabled baby girl; an injunction was granted prohibiting identification of the child, her parents, her current carers and the . .
CitedBirmingham City Council v H (A Minor) and Others HL 16-Dec-1993
The local authority applied for a care order in respect of a young baby. The mother was only 15 and was a ‘child’ herself.
Held: In an application under 34(4) the interests of the child who is the subject of the application are paramount, and . .
CitedBirmingham City Council v H (A Minor) CA 1993
An application was made by the local authority to take into care the daughter of a 15 year old mother. The question was whether any priority was to be given to the daughter’s interests when the mother herself was also a child.
Held: When the . .
CitedRegina v Gyngall 1893
The father of the child (a girl of about 15) was dead and it was the mother who was the guardian, it seems by operation of the Guardianship of Infants Act 1886. The decision of the first instance court not to return the girl to her mother, despite . .
CitedIn Re KD (A Minor) (Ward: Termination of Access) HL 1988
The local authority sought to terminate parental contact with a child taken into care under a wardship.
Held: The court had to consider the human rights of the parent as against the welfare interest of the child. Lord Oliver of Aylmerton said: . .
CitedIn re Z (A Minor) (Identification: Restrictions on Publication) CA 31-Jul-1995
The court was asked whether the daughter of Cecil Parkinson and Sarah Keays should be permitted to take part in a television programme about the specialist help she was receiving for her special educational needs.
Held: The court refused to . .
CitedIn Re T (A Minor) (Wardship: Medical Treatment) CA 24-Oct-1996
A baby boy who was 18 months old, suffered from a life-threatening liver defect. His parents were health-care professionals experienced in the care of sick children. The unanimous medical view was that as soon as donor liver became available the . .
CitedRegina v Sheppard HL 1981
The section made it an offence for anyone having care of a child to wilfully neglect the child ‘in a manner likely to cause him unnecessary suffering or injury to health’.
Held: The section speaks of an act or omission that is ‘likely’ to . .
CitedRegina v Woollin HL 2-Apr-1998
The defendant appealed against his conviction for the murder of his child. He had thrown the child to the floor, hitting the head. He said that he had not intended to kill the child.
Held: On a murder charge, where the short direction on . .
MentionedRex v Gibbins and Proctor CCA 1918
Wretched parents were accused of murder after their children starved to death. The court was asked whether they should be tried together: ‘The rule is, that it is a matter for the discretion of the judge at the trial whether two people jointly . .
MentionedRegina v Gyngall 1893
The father of the child (a girl of about 15) was dead and it was the mother who was the guardian, it seems by operation of the Guardianship of Infants Act 1886. The decision of the first instance court not to return the girl to her mother, despite . .
CitedPerka v The Queen 1984
(Canada) The court analysed the defence of necessity. The concept of necessity is used as an excuse for conduct which would otherwise be criminal. The defence arose where, realistically, the individual had no choice, where the action was . .
CitedRegina v Howe etc HL 19-Feb-1986
The defendants appealed against their convictions for murder, saying that their defences of duress had been wrongly disallowed.
Held: Duress is not a defence available on a charge of murder. When a defence of duress is raised, the test is . .
CitedPaton v United Kingdom ECHR 1980
An abortion conducted in the tenth week of pregnancy was not condemned. The Commission construed Article 2 to be subject to an implied limitation to allow a balancing act between the interests of mother and unborn child. . .
CitedMcCann and Others v The United Kingdom ECHR 6-Oct-1995
Wrong assumptions made by police officers in the killing of terrorists amounted to a human rights breach, despite the existence of danger to the public of an imminent attack. Article 2(1) is ‘one of the most fundamental provisions in the . .
CitedAttorney-General’s Reference (No 3 of 1994) CACD 29-Nov-1995
The defendant was convicted of murder. He stabbed a pregnant woman, causing the premature birth and then death of her child.
Held: Murder is a possible charge for a wound inflicted on an infant en ventre sa mere, but dying after a live birth. . .
CitedRegina v Dudley and Stephens QBD 9-Dec-1884
Three survivors of the yacht Mignonette were landed from a German sailing barge at Falmouth in September 1884. On the day they landed all three of them described the circumstances in which the fourth member of the crew, the ship’s boy had been . .
CitedRegina v Gotts HL 3-Jun-1992
The defendant had been convicted of attempted murder, and appealed the rejection of his defence of duress.
Held: The defence of duress is not available to an accused facing a charge of attempted murder as a matter of policy, since it would not . .
CitedRex v Bourne 1939
An eminent surgeon openly in a public hospital operated to terminate the pregnancy of a 14 year old girl who had become pregnant in consequence of a violent rape.
Held: The court suggested when summing up that there might be a duty in certain . .
CitedRegina v Kitson 1955
K had a lot to drink and went to sleep in the passenger seat of a car driven by his brother-in-law. When later charged with driving car under the influence of drink, he said in his defence that when he woke up, he found that the driving seat was . .
CitedRegina v Willer (Mark Edward) CACD 1986
The defendant appealed against his conviction for reckless driving (absolute discharge and ten penalty points). He drove his car slowly on the pavement in front of a shopping precinct. He said that this had seemed to him to be the only way in which . .
CitedRegina v Conway 1989
The defendant said that he had driven recklessly because he was in fear for his life and that of his passenger.
Held: The court was bound by Willer to rule that a defence of duress was available. It was convenient to refer to this type of . .
CitedSouthwark London Borough Council v Williams CA 1971
No Defence of Homelessness to Squatters
The defendants, in dire need of housing accommodation entered empty houses owned by the plaintiff local authority as squatters. The court considered the defence of necessity.
Held: The proper use of abandoned council properties is best . .
CitedDirector of Public Prosecutions for Northern Ireland v Lynch HL 1975
The House considered the availability of duress as a defence on a charge of aiding and abetting murder. Referring to the basic elements of criminal liability, mens rea and actus reus: ‘Both terms have, however, justified themselves by their . .
CitedRegina v Instan 1893
It was legitimate to break the law where it was necessary to rescue someone to whom one owed a positive duty of rescue, because a failure to act in such a situation might itself constitute a culpable act or omission. . .
CitedRegina v Abdul-Hussain; Regina v Aboud; Regina v Hasan CACD 17-Dec-1998
The law of the defence of duress arising out of threat or circumstances is in need of urgent parliamentary clarification. Appeals were allowed where the defendants hijacked an airplane in order to escape deportation to a hostile country. ‘The . .
CitedRegina v Pommell CACD 16-May-1995
The defendant appealed against his conviction for possessing a loaded shotgun. He had wished to advance a defence to the effect that on the previous evening he had taken it ‘off a geezer who was going to do some damage with it’ in order to stop him. . .
CitedRegina v Hudson and Taylor CACD 17-Mar-1971
Two teenage girls committed perjury by failing to identify the defendant. When prosecuted they pleaded duress, on the basis that they had been warned by a group, including a man with a reputation for violence, that if they identified the defendant . .
CitedAbbott v The Queen PC 20-Jul-1976
The appellant was charged as a principal in the first degree, and the issue was whether the defence of duress was available. The Board considered the availability of duress as a defence to a criminal charge.
Held: The defence was not open to . .
CitedRegina v Martin (Colin) CACD 29-Nov-1988
Defence of Necessity has a Place in Criminal Law
The defendant appealed against his conviction for driving whilst disqualified. He said he had felt obliged to drive his stepson to work because his stepson had overslept. His wife (who had suicidal tendencies) had been threatening suicide unless he . .
CitedPaton v United Kingdom ECHR 1980
An abortion conducted in the tenth week of pregnancy was not condemned. The Commission construed Article 2 to be subject to an implied limitation to allow a balancing act between the interests of mother and unborn child. . .
CitedPeters v Netherlands ECHR 1994
The court considered the right not to be subjected to compulsory medical interference. . .
CitedRe T and E (proceedings: conflicting interests) 1995
Where a court had to recincile conflicting interests involving children, the court must normally undertake a balancing exercise to achieve the situation of least detriment. . .
CitedRegina v Cox 18-Sep-1992
Whether the questioning of a suspect in a police station amounted to an interview was a question of fact dependant upon all the circumstances, including the rest, arrival at the police station, caution, the notification of rights, and the nature of . .

Cited by:

See AlsoIn Re A (Minors) (Conjoined Twins: Medical Treatment) (No 2) CA 15-Nov-2000
The failure by the Official Solicitor to pursue an appeal where leave had been granted, in a case of an application to the court for leave to separate conjoined twins, which separation would lead to the death of one of them, would not of itself . .
CitedRegina (Smeaton) v Secretary of State for Health and Others Admn 18-Apr-2002
The claimant challenged the Order as regards the prescription of the morning-after pill, asserting that the pill would cause miscarriages, and that therefore the use would be an offence under the 1861 Act.
Held: ‘SPUC’s case is that any . .
CitedJD v East Berkshire Community Health NHS Trust and others HL 21-Apr-2005
Parents of children had falsely and negligently been accused of abusing their children. The children sought damages for negligence against the doctors or social workers who had made the statements supporting the actions taken. The House was asked if . .
CitedQuayle and others v Regina, Attorney General’s Reference (No. 2 of 2004) CACD 27-May-2005
Each defendant appealed against convictions associated variously with the cultivation or possession of cannabis resin. They sought to plead medical necessity. There had been medical recommendations to move cannabis to the list of drugs which might . .
CitedCorner House Research and Campaign Against Arms Trade, Regina (on the Application of) v Director of the Serious Fraud Office and Another Admn 10-Apr-2008
The defendant had had responsibility to investigate and if necessary prosecute a company suspected of serious offences of bribery and corruption in the conduct of contract negotiations. The investigation had been stopped, alledgedly at the . .
CitedNicklinson v Ministry of Justice and Others QBD 12-Mar-2012
The claimant suffered locked-in syndrome and sought relief in a form which would allow others to assist him in committing suicide. The court considered whether the case should be allowed to proceed rather than to be struck out as hopeless.
CitedNicklinson and Another, Regina (on The Application of) SC 25-Jun-2014
Criminality of Assisting Suicide not Infringing
The court was asked: ‘whether the present state of the law of England and Wales relating to assisting suicide infringes the European Convention on Human Rights, and whether the code published by the Director of Public Prosecutions relating to . .
CitedElgizouli v Secretary of State for The Home Department SC 25-Mar-2020
Defendants were to face trial in the US, accused of monstrous crimes. The appellant challenged the release of information to the USA by the respondent to support such prosecutions when the death penalty was a possible outcome of a conviction: ‘The . .
Lists of cited by and citing cases may be incomplete.

Criminal Evidence, Health, Human Rights

Updated: 07 August 2022; Ref: scu.81629