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 baby should undergo surgery. The prospects of success were good whilst without transplantation the expectation of life was just over 2 weeks. The baby at the age of 3 weeks had undergone surgery which had caused much pain and distress and been unsuccessful. The parents refused to consider a liver transplant but this was ordered.
Held: A loving parents’ decision not to treat a child who suffered from a life threatening disease stood, and was not to be interfered with as their assessment of what was in the child’s best interests. The court must consider the paramount welfare of the child and not whether the parents might be unreasonable. There was a presumption in favour of prolonging life, but that was not the sole objective and to require that at the expense of other considerations might not be in a child’s best interests. The facts were unusual. This case involved a devoted caring mother who was well informed with major invasive surgery. It was not in the best interests of the child to order a course of treatment with which she did not agree and the child’s welfare required that future treatment be left for the parents to decide.
Butler-Sloss LJ discussed the existing case law and said: ‘All these cases depend on their own facts and render generalisations – tempting though they may be to the legal or social analyst – wholly out of place. It can only be said safely that there is a scale, at one end of which lies the clear case where parental opposition to medical intervention is prompted by scruple or dogma of a kind which is patently irreconcilable with principles of child health and welfare widely accepted by the generality of mankind; and that at the other end lie highly problematic cases where there is genuine scope for a difference of view between parent and judge. In both situations it is the duty of the judge to allow the court’s own opinion to prevail in the perceived paramount interests of the child concerned, but in cases at the latter end of the scale, there must be a likelihood (though never of course a certainty) that the greater the scope for genuine debate between one view and another the stronger will be the inclination of the court to be influenced by a reflection that in the last analysis the best interests of every child include an expectation that difficult decisions affecting the length and quality of its life will be taken for it by the parent to whom its care has been entrusted by nature.’ Butler Sloss: ‘The first argument of Mr Francis that the court should not interfere with the reasonable decision of a parent is not one that we are able to entertain even if we wish to do so. His suggestion that the decision of this mother came within that band of reasonable decisions within which a court would not interfere would import into this jurisdiction the test applied in adoption to the refusal of a parent to consent to adoption. It is wholly inapposite to the welfare test and is incompatible with the decision in In Re Z.’
Waite LJ, Butler-Sloss LJ, Roch LJ
Times 28-Oct-1996, Gazette 13-Nov-1996, [1997] 1 FLR 502, [1997] 1 WLR 242, [1997] 8 Med LR 166, (1997) 35 BMLR 63, [1997] 1 All ER 906, [1997] 2 FCR 363
Bailii
England and Wales
Citing:
Cited – Camden London Borough Council v R (A Minor) (Blood Transfusion); in Re R (A Minor)(Blood Transfusion) FD 8-Jun-1993
Child A’s doctors considered that she would need treatment over the following two years and that this could involve the need for blood transfusions at any time. The parents were Jehovah’s Witnesses and refused consent.
Held: The order allowing . .
Cited – Re O (A minor) (Medical Treatment) FD 12-Apr-1993
The local authority applied for a care order in relation to the child, on the ground that there was an urgent and continuing need for medical treatment which included blood transfusions. The court considered the legal effect of a parent’s belief (as . .
Cited by:
Cited – A and D v B and E FD 13-Jun-2003
In two separate actions, fathers with parental responsibility sought orders requiring the mothers of their children to ensure they received the MMR vaccine. Each mother objected, having suspicions as to the safety of the treatment. Specific issue . .
Cited – 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 . .
Cited – B (A Child); Re C (Welfare of Child: Immunisation) CA 30-Jul-2003
The father sought a specific issue order for the immunisation of his child in particular with the MMR vaccine. The mother opposed all immunisation.
Held: Whether a child was to be refused immunisation was an issue on which both parents should . .
Approved – LA v SB and Others CA 12-Jul-2010
The local authority had applied for a care order under the court’s inherent wardship jurisdiction in connection with a family where three children suffered a potentially life threatening disease, Rasmussens’s encephalitis. The parents were said to . .
Lists of cited by and citing cases may be incomplete.
Children, Health
Leading Case
Updated: 15 December 2021; Ref: scu.82224