Plymouth Hospitals NHS Trust v YZ & Ors

In an urgent medical-treatment application concerning a child, the court’s paramount consideration is the child’s best interests. The court must exercise its own independent judgment from the patient’s assumed point of view and weigh all relevant medical, emotional, sensory and instinctive considerations. A strong, but rebuttable, presumption favours steps to preserve life. The child’s views must be given appropriate weight, but a child under 16 who is Gillick competent may have that decision overridden where treatment is in the child’s best interests. Exceptionally, the court may determine an urgent application outside normal court hours where delay would jeopardise necessary treatment, although sufficient time should ordinarily be allowed for representation and a properly convened hearing.

Plymouth Hospitals NHS Trust applied urgently for declarations that YZ, aged 14, lacked capacity to consent to investigation and treatment for a suspected paracetamol overdose, and that treatment, proportionate restraint and any resulting deprivation of liberty were lawful and in her best interests.

YZ’s account of the quantity ingested was inconsistent. Medical evidence indicated a risk of serious liver damage or death if a toxic dose had been taken and treatment was delayed. YZ resisted blood testing and treatment, while the Trust faced a rapidly closing treatment window. The central issues were whether the court should intervene urgently, whether the proposed testing and treatment were in YZ’s best interests, and how her fluctuating views and possible Gillick competence should be treated.

1. Urgency and procedure. The application was suitable for determination out of hours because the evidence indicated a possible toxic overdose, serious or fatal consequences, and an imminent expiry of the optimum treatment window. Although decisions of this gravity should ordinarily be heard during normal court hours with representation for the child and parents, exceptional urgency justified proceeding on counsel’s submissions.
2. Best interests. The court’s task was to exercise its own independent judgment, considering the matter from YZ’s assumed point of view. The assessment was broad and fact-specific. Relevant considerations included the nature and invasiveness of the blood tests and possible infusion, their prospects and benefits, the risks of liver damage or death, YZ’s fluctuating views, the views of her mother and medical staff, and the possibility that external pressures or emotional difficulties affected her objections.
3. Preservation of life. The strong presumption in favour of taking steps to preserve life was particularly compelling where YZ might have taken a toxic dose and the opportunity for effective treatment was about to end. The proposed testing and treatment had manifest benefits if an overdose had occurred, despite their invasive nature and the possible need for proportionate restraint.
4. Competence and consent. The evidence concerning YZ’s Gillick competence was equivocal. In any event, the court concluded that the proposed intervention was in her best interests. The court’s orders authorised blood testing, treatment if required, and minimum necessary measures to facilitate treatment while minimising distress and preserving dignity.
5. Outcome. The orders were granted. The subsequent blood test showed no paracetamol in YZ’s system, so further treatment was unnecessary. The court also observed that medical staff should seek court intervention sufficiently early where consensual treatment may fail.

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