An NHS Trust v Child B & Ors

When authorising medical treatment for a child, the court’s paramount consideration is the child’s welfare and best interests. Parents’ wishes and religious objections must receive very great respect, but remain subordinate to welfare. The court must balance the benefits and risks of the proposed treatment against the risks of withholding it. Where clinically indicated treatment avoids a real, even if small, risk of death, that risk may outweigh comparatively minor treatment risks.

An NHS Trust made an emergency application concerning a very young child who had suffered severe burns. The treating consultant considered skin grafting urgently necessary and advised that blood transfusions might be required because of blood loss during the procedure. The child’s parents, who were devout Jehovah’s Witnesses, opposed blood transfusions on religious grounds. The court had to determine whether skin grafting should proceed with authority for blood transfusions if clinically indicated.

1. The court granted the NHS Trust’s application and authorised skin grafting and blood transfusions for the child if clinically indicated.
2. The medical evidence established that early skin grafting was in the child’s best interests. Delay increased the risks of bleeding, infection, graft failure and sepsis.
3. A blood transfusion was not expected to be necessary, but there was a small risk that it would be required. If the child’s haemoglobin fell sufficiently, the evidence showed a real risk of serious illness or death without transfusion. There was no alternative to blood where transfusion was clinically required because of blood loss.
4. In assessing welfare, the court had to weigh the parents’ wishes, opinions and views. Following the approach stated by Ward LJ in In re A (Children) (Conjoined Twins: Surgical Separation) [2001] Fam 147, those wishes deserved very great respect but were subordinate to the child’s welfare.
5. The risks associated with transfusion, including adverse reaction, infection and reaction to preservatives, were substantially less serious than the risk of death arising if transfusion were clinically indicated but unavailable. The child’s welfare therefore required authority for transfusion despite the parents’ deeply held religious objections.