TM, Re

Where a child requires medical treatment, the court may authorise procedures that are in the child’s best interests, having regard to their risks, burdens and potential benefits. A parent may express views about the treating clinicians, but cannot ordinarily dictate which competent doctor performs treatment at the hospital, absent a clear and compelling reason. A reporting restriction order may protect the anonymity and medical confidentiality of the child and family while permitting identification of the treating hospital, where the prescribed procedure has been followed.

The NHS Trust applied for declarations concerning the medical treatment of TM, a seven-year-old child with severe disabilities and impaired swallowing. The proposed treatment involved replacing an existing gastrostomy with a gastrojejunal tube under general anaesthesia, followed by gastrointestinal investigations. The application arose after disagreements between the hospital and TM’s mother, including her objection to the involvement of the treating paediatric surgeon.

The court also considered the continuation of reporting protections for TM, her parents, relatives and medical staff after an earlier temporary blanket injunction.

1. Medical treatment. The court declared that it was in TM’s best interests to undergo removal of the existing gastrostomy, insertion of a gastrojejunal tube under general anaesthesia, and subsequent gastrointestinal investigations. The procedure involved some anaesthetic and physical risks, but these were limited in context and were outweighed by the potential benefits, including improved nutrition and hydration and removal of the PICC and nasogastric feeding.
2. Choice of treating doctor. Although a parent’s confidence in treating clinicians is important, it was not acceptable to impose a condition excluding the paediatric surgeon from treatment at the hospital without a clear and good reason. A child treated at a particular hospital, and the court authorising treatment there, should not ordinarily be subject to a parental or judicial direction as to which competent doctor performs the procedures. The order therefore permitted the investigations to be determined by the surgeon or any doctor to whom he delegated care.
3. Reporting restriction. The court made a reporting restriction order preventing identification of TM, her parents and relatives, and the medical and other staff caring for her. Identification of Great Ormond Street Hospital as the applicant and the place of treatment was permitted. The court was satisfied that the prescribed service requirements under Human Rights Act 1998, section 12, had been complied with.

First-instance decision. No appellate history is stated in the judgment.