An NHS Foundation Trust v T

Where parental consent is unavailable or cannot be given, the court may exercise its inherent jurisdiction to authorise medical treatment for a child. The controlling consideration is the child’s best interests, assessed on the medical evidence and the circumstances of the case. Treatment may be authorised despite the absence of parental consent where it is overwhelmingly in the child’s best interests and necessary to protect the child from serious harm. The order may be qualified by requiring consultation with the parents and use of the treatment only where clinically indicated and no clinically appropriate alternative exists. The order is made under the inherent jurisdiction rather than Children Act 1989, section 8.

The NHS Foundation Trust applied for authority to administer blood or blood products to a two-year-old child suffering from a low blood platelet count and a suspected disorder affecting bone-marrow production. The child’s Jehovah’s Witness parents could not consent to the proposed treatment for religious reasons, but did not oppose the application and left the decision to the court. The court considered the medical evidence, the parents’ views, the child’s representation, and the need for reporting restrictions. The central issue was whether treatment could lawfully be authorised without parental consent and, if so, under which jurisdiction.

1. The court was satisfied on the medical evidence that the child would require blood or blood products from time to time to prevent a serious deterioration in health. The inability to provide the treatment could have very serious and possibly fatal consequences.
2. The child’s best interests were decisive. Having considered the medical evidence and the parents’ views, the court concluded that it was overwhelmingly in the child’s best interests to receive the treatment when clinically required.
3. It was necessary for the court to make the decision in place of the parents because parental consent could not be given. The parents’ religious objections were fully acknowledged, but did not prevent authorisation of treatment required to protect the child’s health.
4. The order authorised the treating doctors to administer blood or blood products notwithstanding the absence of parental consent, provided that the treatment was clinically indicated. Treatment was to follow consultation with the parents and was to be used only where there was no clinically appropriate alternative.
5. The order was made under the inherent jurisdiction of the court, not under section 8 of the Children Act 1989. The Trust was given permission to bring the application.

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