Cardiff and Vale University Health Board v T (A Minor) (Urgent Blood Transfusion)

When a child lacks capacity and parental consent to proposed medical treatment is absent, the court may authorise treatment if it is objectively in the child’s best interests. The court must exercise its own independent judgment. The child’s best interests are paramount and include medical, emotional, sensory and other relevant considerations. There is a strong, but rebuttable, presumption in favour of preserving life. Parental views, including religious convictions, must be considered, but their reasonableness is not separately assessed. They are relevant only insofar as they illuminate the child’s welfare or the child-parent relationship. The court may authorise treatment recommended by the treating team, but cannot require doctors to undertake an alternative procedure contrary to their professional judgment.

The applicant health board sought urgent permission to administer blood transfusions to T, a three-and-a-half-week-old child with serious congenital conditions, cardiac failure, infection risk, anaemia, falling blood pressure and ventilator dependence. T’s mother, a committed Jehovah’s Witness, had not given clear consent, and no consent had been given by his father. T lacked capacity and was not represented at the urgent hearing. The central issue was whether transfusion was objectively in T’s best interests despite the absence of parental consent and the mother’s religious objections.

1. Application granted. The court authorised the health board to administer blood transfusions to T and listed the matter for further consideration on the return date.
2. The court’s jurisdiction arose because T lacked capacity and there was disagreement between those with parental responsibility and the treating doctors. A parent with parental responsibility may consent to treatment, but the court may make a declaration that treatment should proceed where it is in the child’s best interests. The court cannot compel doctors to perform an alternative procedure against their professional judgment, following the principles stated in Re A (Children) (Conjoined Twins: Surgical Separation) [2001] 2 WLR 480, Re B (A Minor) (Wardship: Medical Treatment) (1982) 3 FLR 117 and An NHS Trust v MB [2006] EWHC 507 (Fam).
3. The governing test was the child’s objective best interests. The court had to consider the proposed treatment, its nature, prospects and likely outcome, the strong presumption in favour of preserving life, the views of the doctors and parents, and the child’s own views where relevant. The assessment was fact-specific and required the court to balance all considerations rather than follow the doctors’ clinical assessment automatically.
4. The mother’s views were considered with respect, but the court was not required to assess their reasonableness. Religious conviction, loving concern and an irrational view of medical science were treated in the same legal manner: parental wishes could not displace the court’s independent assessment of the child’s welfare. The court relied on the approach in An NHS Trust v MB [2006] EWHC 507 (Fam), endorsed in Re A (A Child) [2016] EWCA 759.
5. On the evidence, T was gravely ill and transfusion was capable of addressing his cardiac failure, cardiac-arrest risk, anaemia, falling blood pressure and infection-related vulnerability. The treatment reflected multidisciplinary medical consensus. The benefits of transfusion overwhelmingly outweighed its risks, and it was objectively and manifestly in T’s best interests.