X (A Child)

In determining medical treatment for a minor, the court must make its own objective assessment of the child’s best interests. Best interests has a wide meaning and requires the court to balance all relevant medical, emotional, sensory and instinctive considerations. There is a strong but rebuttable presumption in favour of preserving life. The child’s and parents’ views must be considered and given appropriate weight, but they do not determine the outcome where the treatment is objectively necessary and welfare considerations require it. Religious convictions receive respectful consideration, but the court does not adjudicate on their validity. A Gillick-competent child’s wishes may therefore be overridden where treatment is in the child’s best interests.

Barking, Havering and Redbridge University Hospitals NHS Trust applied urgently for permission to give X, aged nearly 15, a red blood cell transfusion. X had severe sickle cell disease and an acute chest crisis, with falling haemoglobin, increasing oxygen requirements and a life-threatening risk of hypoxia. X and her mother, both committed Jehovah’s Witnesses, withheld consent on religious grounds, although neither would resist treatment ordered by the court.

The central issue was whether the transfusion was objectively in X’s best interests despite her and her mother’s conscientious refusal.

1. Application granted. The Trust was permitted to transfuse X with red blood cells.
2. The court’s paramount consideration was X’s best interests. It had to exercise an independent and objective judgment, considering the matter from the assumed perspective of the patient. The principles were adopted from Cardiff and Vale University Health Board v T (A Minor) [2019] EWHC 1671 (Fam).
3. Best interests had to be understood in its widest sense. The assessment was not mathematical, but required the court to balance all conflicting considerations, including medical, emotional, sensory and instinctive factors. The strong presumption in favour of preserving life was rebuttable where the burdens of treatment or continued life outweighed its benefits.
4. The court considered the nature and prospects of the proposed treatment, the medical evidence, the views of X and her mother, and X’s age and understanding. X’s religious beliefs were genuine and deserving of respect, but the court’s decision involved no judgment on their validity. Her wishes were not determinative because the welfare benefits of life-saving treatment carried greater weight.
5. X was gravely ill and likely to deteriorate without immediate transfusion. Specialist medical opinion supported the proposed treatment, and its benefits manifestly outweighed its risks. Transfusion was therefore objectively and manifestly in her best interests.