Manchester University Hospital NHS Foundation Trust v M & Anor

When deciding whether a medical procedure should be undertaken for a child, the court must focus on the child’s best interests. Parental faith and objections must be properly considered, but may receive limited weight where the medical case is compelling and the proposed treatment offers substantial benefits to the child’s health, development and prospects of leaving hospital. The court should not allow time to be lost seeking parental agreement where underlying difficulties impair the parents’ ability to evaluate the medical issues. Where the advantages of treatment are clear and no cogent contrary argument exists, the court may authorise the procedure.

The NHS Trust sought authorisation for a gastroscopy procedure for M, a 15-month-old child with severe renal disease who remained dependent on haemodialysis and had difficulty tolerating oral feeding. A previous application concerning haemodialysis had been determined in an earlier judgment, [2019] EWHC 468 (Fam). The proposed gastroscopy would permit safe overnight pump feeding, improve nutrition, reduce vomiting and aspiration risks, and support M’s eventual discharge from hospital.

Both parents objected, relying in part on their religious faith and their belief that previous postponements indicated that the procedure was unnecessary. The central issue was whether the procedure was in M’s best interests.

1. Application granted. The court authorised the gastroscopy procedure because its advantages were clear and compelling. It would enable safe continuous pump feeding, improve nutritional delivery, reduce the risks associated with vomiting and aspiration, support M’s growth and development, and create an opportunity for her to return to life outside hospital.
2. The court’s paramount focus was M’s best interests. The medical team were coordinated and unanimous in supporting the procedure. The evidence established that direct progression to oral feeding was not presently achievable and that gastroscopy was an important interim measure.
3. The parents’ faith and objections were recognised and taken seriously. However, in the circumstances, they were not given significant weight because they did not outweigh the compelling medical case for treatment. The court’s assessment was directed to M’s welfare rather than the parents’ sincerely held beliefs.
4. The court recorded that both parents had mental health difficulties which made evaluation of some medical issues harder. It held that time should not be lost attempting to secure parental agreement where such underlying difficulties existed. The parents were encouraged to work cooperatively with the medical team in M’s future treatment.
5. The procedure was therefore authorised as being plainly in M’s best interests.