A & D v B & E

In determining a dispute between parents about childhood immunisation, the court must treat the child’s welfare as paramount and make an independent, objective assessment of best interests. Immunisation is not compulsory, and a caring parent’s opposition deserves careful respect. However, the parent with whom the child lives has no overriding decision-making right. Where persuasive medical evidence establishes that vaccination is in the child’s best interests, the court may make a specific issue order despite parental opposition. The court must balance the medical benefit against vaccination risks, the risk of disease, the child’s wishes and the possible effect on the child’s relationship with the primary carer. The greater the scope for genuine medical debate, the more cautiously the court should intervene.

Two unrelated applications concerned girls aged four and ten who had received no immunisations. Each child lived with her mother. Each father had parental responsibility and contact, and sought a specific issue order under the Children Act 1989 requiring age-appropriate immunisation.

The mothers opposed vaccination on medical, philosophical and emotional grounds. The court heard extensive evidence from two leading paediatric specialists, an opposing medical expert, the children’s representative and, in one case, a psychiatrist. The central issues were whether vaccination was in each child’s best interests and whether the effect of an order on the mothers and their relationships with the children justified refusing it.

1. Outcome. The applications were granted. The court declared that immunisation, subject to the specific qualifications identified in the judgment, was in the best interests of both children and should prevail over the mothers’ opposition.
2. Under section 1 of the Children Act 1989, each child had to be considered separately and welfare was paramount. The court had to take account of wishes and feelings, physical and emotional needs, likely effects of change, risk of harm, parental capacity and the available powers. The older child’s views received some weight, but her willingness to accept the court’s decision reduced their determinative force.
3. The court applied an independent and objective judgment. A devoted and responsible parent’s decision deserved respect but could be overridden where the court concluded, after careful consideration, that a different course served the child’s welfare. The primary carer had no greater legal right than the other parent, although the child’s bond with that carer required particular protection.
4. The medical evidence of Dr Conway and Professor Kroll was balanced and convincing. Dr Donegan’s evidence was treated with great reserve because she had allowed deeply held views to override her duty to provide objective, unbiased assistance to the court. The court assessed each vaccine by balancing the risk and seriousness of the disease, vaccine risks and benefits, the child’s age, and the consequences of delay. It accepted recommendations for most proposed vaccinations, but declined pertussis and Hib vaccination for the older child and BCG vaccination for the younger child, subject to the stated conditions.
5. Parental distress was a material consideration, especially where invasive treatment was opposed by the primary carer. Nevertheless, neither mother’s distress was likely to impair care or cause significant harm to the child. Article 8 rights could be interfered with where necessary for the protection of health. The decision was fact-sensitive and was not a general approval of immunisation in every case.