In Re T (A Minor) (Wardship: Medical Treatment) – CA – 24-Oct-96 – Waite LJ, Butler-Sloss LJ, Roch LJ (Times 28-Oct-96, Gazette 13-Nov-96, [1997] 1 FLR 502, [1997] 1 WLR 242, Bailii, [1997] 8 Med LR 166, (1997) 35 BMLR 63, [1997] 1 All ER 906, [1997] 2 FCR 363) – Children – Health
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.”
Cases Cited:
Camden London Borough Council -v- R (A Minor) (Blood Transfusion); in Re R (A Minor)(Blood Transfusion) FD 8-6-1993 (Times 08-Jun-93, Independent 09-Jun-93, [1993] 2 FLR 757)
Re O (A minor) (Medical Treatment) FD 12-4-1993 (Ind Summary 12-Apr-93, [1993] 2 FLR 149)
Cited by:
A & D -v- B & E FD 13-6-2003 ([2003] EWHC 1376 (Fam))
In Re A (Minors) (Conjoined Twins: Medical Treatment); aka In re A (Children) (Conjoined Twins: Surgical Separation) CA 22-9-2000 (Times 10-Oct-00, Bailii, [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)
B (A Child); Re C (Welfare of Child: Immunisation) CA 30-7-2003 (Bailii, [2003] EWCA Civ 1148, [2003] 73 BMLR 152, [2003] 2 FLR 1095, [2003] 2 FCR 156)
LA -v- SB and Others CA 12-7-2010 (Bailii, [2010] EWCA Civ 1744) – Approved
