EQ, Re

Where parents and treating clinicians disagree about medical treatment for a child lacking capacity, the court must make an independent and objective decision based on the child’s best interests. Welfare is considered in the widest sense and may include medical, emotional, sensory and instinctive considerations, together with the treatment’s effect on the parents and family. The court must balance potential benefits and risks qualitatively rather than mathematically. The decision is fact-specific. Where delay may materially reduce the prospects of a beneficial outcome or expose the child to additional procedures, an adjournment for further investigations may itself be contrary to the child’s best interests.

The case concerned an application by Moorfields Eye Hospital NHS Foundation Trust regarding surgery for EQ, a baby with bilateral congenital cataracts. EQ’s mother opposed surgery because of her own difficult experience of childhood cataract treatment and its complications. The court considered medical evidence about the benefits of early intervention, the risks of surgery, and the consequences of delay. The central issue was whether surgery should be authorised immediately, whether the application should be dismissed, or whether the matter should be adjourned for further tests.

1. The court was required to exercise its own independent and objective judgment because EQ lacked capacity and a dispute had arisen between the treating doctors and her mother. The governing question was EQ’s best interests under Children Act 1989, s.1.
2. Best interests were to be assessed in the widest sense. Relevant considerations included medical, emotional, sensory and instinctive factors, the views of the doctors and family, and the effect of the decision on EQ’s mother and wider family. These considerations could not be weighed mathematically, and the assessment was necessarily fact-specific.
3. The medical evidence established that early surgery offered a materially greater prospect of useful vision because of the critical developmental period for vision. The risks, including glaucoma, had to be balanced against that potential benefit. The mother’s concerns about the lack of lens protection were honestly held but were not supported by the medical evidence.
4. An adjournment for further testing was refused. It would cause delay, might lead to additional general anaesthetics, and created uncertainty about whether surgery could be performed during the Christmas period. The court therefore concluded that immediate surgery was in EQ’s best interests.
5. The application was granted and surgery was authorised.