Birmingham Children's NHS Trust v B & C (Rev 1)

Where a child requires urgent medical treatment, the court must determine the child’s welfare and best interests in the light of the medical evidence. Strong parental religious objections must be respected and given appropriate weight, but cannot prevent treatment where the treatment is clearly necessary to preserve the child’s life and is in the child’s best interests.

An order may authorise blood transfusions without parental consent both for the planned procedure and for later immediately life-threatening situations. Where the situation is less than imminently life-threatening, medical staff should consult the parents and consider reasonable alternatives before administering blood or blood products.

A was a newborn child with transposition of the great arteries or other complex heart disease and a restrictive septum. He required urgent cardiac surgery. His parents, who were Jehovah’s Witnesses, consented to the surgery but could not consent to blood transfusions because of their religious beliefs.

The hospital applied for orders authorising the surgery and the administration of blood and blood products during or after the operation, including without parental consent where necessary. The parents did not attend or oppose the application, but provided their views by email. The central issue was whether the proposed treatment was lawful and in A’s welfare best interests.

1. Best interests. The court considered A’s welfare and best interests in their widest sense. The medical evidence established that the proposed arterial switch operation was necessary because, without it, A had no long-term prospect of survival, whereas the risks of surgery were relatively low.
2. Religious objections. The parents’ religious objections were fully understood and given great weight. Their consent to the surgery, together with their acceptance that the surgery could not safely be undertaken without blood products, was also relevant. Their beliefs did not displace the conclusion that the treatment was in A’s best interests.
3. Authorisation of treatment. It was lawful and in A’s best interests for him to undergo urgent heart surgery requiring the use of a heart bypass machine and the administration of blood or blood products. It was also lawful to administer blood or blood products without parental consent in any other immediately life-threatening situation where the responsible clinicians considered them necessary.
4. Less urgent situations. Where a situation was less than imminently life-threatening, the clinicians were required to consult the parents and consider, at every opportunity, alternative management proposed by them. If, after consultation, they concluded that there was no reasonable alternative, they were authorised to administer blood or blood products without parental consent.
5. Orders. The draft order was approved and the stated authorisations were made.

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