A Hospital NHS Trust v LP & Anor

In an urgent best-interests application concerning life-saving treatment for a child, the court may authorise treatment where parental consent cannot be given because of religious conviction. The court must exercise its own objective judgment from the child’s assumed point of view. “Best interests” requires a broad balancing exercise, including medical, emotional, sensory and instinctive considerations. There is a strong, but rebuttable, presumption in favour of preserving life. Parental and child views must be considered, but parental beliefs are not assessed for reasonableness and cannot displace the court’s objective assessment. Where deterioration may be sudden, the court may give doctors clear authority to use blood products as a last resort when alternative treatments have been tried.

A thirteen-year-old boy sustained life-threatening injuries in a road traffic accident and was being treated in intensive care while in an induced coma. His parents, committed Jehovah’s Witnesses, could not consent to blood products because of their religious convictions, although they did not seek to obstruct treatment and accepted that transfusion might ultimately be necessary.

The Hospital NHS Foundation Trust applied urgently for authority to administer blood or clotting products if the boy’s condition deteriorated and such treatment became necessary. The central issue was whether that course was objectively in the child’s best interests, having regard to the medical evidence, the parents’ views and the child’s inferred religious views.

1. Application granted. The court authorised the treating doctors to administer blood products if required, after reasonable alternative treatments had been attempted.
2. The court’s paramount consideration was the child’s best interests. Its function was to make an independent and objective decision, rather than simply adopt the clinicians’ assessment. The best-interests inquiry was broad and included every consideration capable of bearing on the decision, including medical, emotional, sensory and instinctive factors. The court had to balance the competing considerations on the particular facts.
3. There was a strong presumption in favour of taking steps to preserve life, reflecting life’s unique value and the presumed strength of the human instinct to survive. That presumption was capable of being outweighed where treatment would produce no commensurate benefit and would impose disproportionate suffering or burdens.
4. The parents’ views had to be considered, particularly because parents may know their child well. However, the court was not required to assess whether those views were reasonable before making its objective decision. Religious conviction, like any other parental view, could not alter the court’s exclusive responsibility for determining the child’s best interests.
5. The medical evidence established a real risk of rapid, life-threatening deterioration from bleeding, low haemoglobin or abnormal clotting. There were no equivalent alternative medications. The risks of transfusion were manifestly outweighed by its benefits if deterioration occurred, and certainty about consent was necessary so that doctors could act urgently.

The order was made in the terms of the draft order. An expedited transcript was directed at public expense.