X (A Child), Re

A court must give very serious weight to the wishes, feelings and religious beliefs of a Gillick-competent child. It must not assess whether the doctrines of the child’s religious community are right or wrong. Nevertheless, the court remains responsible for deciding the child’s best interests. In an appropriate case, particularly where there is clear evidence of a serious risk to health or life, it may authorise medical treatment despite the child’s refusal. The court should be slow and reluctant to override the child’s wishes, but must act where failure to intervene would create an impermissible risk of grave harm.

X was almost 16 and had severe sickle cell syndrome. She was a Jehovah’s Witness and, although assessed as Gillick competent, refused a further top-up blood transfusion because of her profound religious beliefs.

The hospital applied urgently for authority to administer the transfusion. The medical evidence indicated that X’s haemoglobin level had fallen sharply and that delay exposed her to potentially catastrophic consequences, including stroke and death. The hearing followed an earlier crisis and application in May 2020, reported as [2020] EWHC 1630 (Fam).

The central issue was whether the court should authorise treatment notwithstanding X’s competence, autonomy and refusal of consent.

1. The court authorised the hospital to administer the proposed top-up blood transfusion, despite X’s refusal of consent. The order did not authorise the more significant exchange transfusion.

2. The court treated the governing approach as established by In re R (A Minor) (Wardship: Consent to Treatment) [1992] Fam 11, In re W (A Minor) (Medical Treatment: Court’s Jurisdiction) [1993] Fam 64, and Re G (Education: Religious Upbringing) [2012] EWCA Civ 1233, [2013] 1 FLR 677. In the final analysis the court must make its own decision about the child’s best interests. Even where the child is Gillick competent, the court may decide not to give effect to strongly held wishes and religious beliefs.

3. The court must give careful and respectful consideration to the child’s views, including religious views, but is a secular institution and must not adjudicate on the truth, value or merits of a religious community’s doctrines. This approach was consistent with the treatment of Jehovah’s Witnesses in Re T (Minors) (Custody: Religious Upbringing) (1981) 2 FLR 239.

4. The decisive consideration was the medical evidence. X’s falling haemoglobin, clinical presentation, lung scans and pain supported the treating consultant’s assessment that delay created a very real risk of serious harm and potentially death. That risk was impermissible, notwithstanding the serious interference with X’s autonomy and religious convictions.

5. Arguments that the law required urgent reconsideration, including arguments based on the Human Rights Act 1998 and AC v Manitoba [2009] SCC 30, [2009] 2 SCR 181, were not finally analysed because of the medical urgency. The judge indicated that they should be addressed at a properly prepared hearing before any recurrent crisis.