M Children's Hospital NHS Foundation Trust v Y

In determining whether to authorise medical treatment for a child, the court must make the child’s welfare paramount. Best interests include medical, emotional, familial and social considerations. The court should approach treatment intended to prolong or enhance quality of life with a strong assumption that it should, where possible, be attempted. Religious objections by a parent are important competing considerations, but they do not determine the outcome. Where the evidence establishes that treatment offers the child the best prospects of recovery, the court may authorise it without parental consent. Any continuing authorisation should be subject to consultation with the parents and consideration of reasonable alternatives, particularly where the situation is no longer imminently life-threatening.

T, aged 13½, suffered rapidly progressing post-infectious central nervous system demyelination and was critically ill in hospital. The treating Trust applied urgently for authority to administer plasma exchange treatment, including blood and blood products, without parental consent. The treatment was regarded by the clinical team as the best available option, although its evidence base in children was limited and it carried risks.

T’s mother, a Jehovah’s Witness, could not consent on religious grounds. Neither parent opposed the application formally, and both indicated that they were content for the court to decide. The central issue was whether the proposed treatment was in T’s best interests.

1. Best interests. The child’s welfare was paramount. The assessment had to include medical, emotional, familial and social interests, viewed from the assumed perspective of the child.
2. Presumption in favour of life-enhancing treatment. There was a strong assumption that treatment designed to prolong and enhance quality of life should, wherever possible, be attempted.
3. Balancing exercise. The court weighed the significant potential benefits of plasma exchange against its risks and took full account of the mother’s religious objection. The unanimous clinical view was that plasma exchange offered T the best possible chance of recovery, while withholding it left only slight prospects of substantial recovery.
4. Authorisation. It was in T’s best interests to receive plasma exchange immediately. The Trust was authorised to commence the treatment, including administration of blood and blood products, without parental consent where the situation was immediately life-threatening.
5. Continuing safeguards. If the situation became less than imminently life-threatening, the Trust had to consult the parents and consider alternative management proposed by them. If the treating clinicians concluded after consultation that there was no reasonable alternative, they were authorised to administer blood or blood products without parental consent. The order took effect forthwith.

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