King (A Child), Re

In decisions about medical treatment for a child, welfare is paramount, with regard to the child’s rights under Articles 2 and 8 of the European Convention. Parents ordinarily bear responsibility for deciding treatment. State interference is justified only where the child is suffering, or is likely to suffer, significant harm because the care provided falls below what it is reasonable to expect a parent to give. Where competing treatment options are each reasonable, a coherent parental plan is supported by credible arrangements for timely treatment, transport and funding, and the court should not substitute its own preference. The fact that one option is relatively untested does not itself make the parental choice unreasonable. The justification for intervention must be assessed on the evidence and circumstances existing at the time.

A five-year-old child with a brain tumour underwent surgery and required post-operative chemotherapy and radiotherapy. His parents disagreed with the treating hospital’s proposed conventional radiotherapy and wished to pursue proton therapy in Prague. After the parents removed him from hospital and travelled abroad, the local authority applied under the inherent jurisdiction. On 29 August 2014, a deputy judge made the child a ward of court and directed that he be presented for medical treatment.

After the parents were released and reunited with the child, the court received evidence of a coherent treatment plan, safe transport, available funding and arrangements with medical teams in Prague. The central issue was whether the parents’ proposal created a sufficient risk of significant harm to justify continued state intervention and whether permission should be given for the child to receive treatment abroad.

1. Outcome. Permission was granted for the parents to take the child to Prague for treatment at the University Hospital Motol and the Proton Therapy Center. Wardship was discharged when the child was admitted to hospital in Prague.

2. The child’s welfare was the paramount consideration. The court also had regard to his rights under Articles 2 and 8 of the European Convention. These principles governed the decision whether to permit the proposed transfer and treatment.

3. Responsibility for decisions about a child rests primarily with the parents. Ordinarily, parents are best placed to make those decisions. The State, whether through the court or another public authority, should not interfere unless the child is suffering, or is likely to suffer, significant harm because the care provided is not what it would be reasonable to expect a parent to give.

4. The local authority’s application and the initial wardship order were justified on the evidence available on 29 August. At that stage there were reasonable grounds for believing that the child was at risk of significant harm after being removed from specialist care while requiring urgent treatment and assistance.

5. A week later, the circumstances were materially different. The parents had proposed a coherent and reasonable treatment plan, and arrangements had been made for transport, funding and treatment by medical teams in Prague. Both conventional radiotherapy and the relatively untested proton therapy were reasonable options. It was therefore not the court’s function, or that of another public authority, to interfere with the parents’ decision. The court relied on the evidence from the Prague centre that the proposed treatment plan was acceptable and that disagreement from the associated oncology unit was not anticipated.

6. The court made no determination about the wider factual disputes or the appropriateness of the European Arrest Warrant. It observed, within the family jurisdiction, that separation from the parents had not been in the child’s best interests. The final order permitted the transfer and provided for wardship to cease on admission in Prague.

No appeal is described. The judgment records that on 29 August 2014 a deputy judge of the High Court made the child a ward of court and directed that he be presented for medical treatment. Following changed circumstances and further evidence, the present court granted permission for the transfer to Prague, where wardship was discharged on admission.