Cambridge University Hospitals NHS Foundation Trust v Mother of E & Anor

Once the court’s jurisdiction is invoked in relation to serious medical treatment for a child, it must exercise its own independent and objective judgment by applying the child’s best interests as the paramount consideration. The assessment concerns welfare in its widest sense. It includes the nature and prospects of the treatment, its likely outcome, the child’s attitude, and the views of those concerned with the child’s welfare. Benefits and burdens must be evaluated qualitatively; a balance sheet must not be treated as an arithmetical exercise. A real prospect of cure may justify treatment carrying serious and permanent disadvantages, where the overall balance favours treatment.

The Trust sought a declaration that low-dose craniospinal radiotherapy was in E’s best interests. E had recurrent grade 3 medulloblastoma following surgery and could not undergo further chemotherapy. Medical evidence established a substantial prospect of cure, with further life-extension even if cure was not achieved, but also significant short-term effects and permanent neuropsychological damage. E’s mother opposed treatment because of its burdens, uncertain outcome and her experience of earlier chemotherapy. The child’s guardian supported treatment. The central issue was whether radiotherapy was in E’s best interests.

1. Applicable approach. The court’s role is the same whether doctors or parents seek, or oppose, treatment. Once jurisdiction is invoked, the court must make its own independent and objective decision applying the best-interests test. The court incorporated the relevant principles stated in An NHS Trust v MB [2006] EWHC 507 (Fam) and The NHS Trust v A [2007] EWHC 1696 (Fam).
2. The welfare assessment must be broad and patient-specific. In accordance with Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67, the court considered E’s welfare in the widest sense, the nature and burdens of radiotherapy, its prospects of success, the likely outcomes, E’s probable attitude, and the views of her mother, guardian and treating clinicians.
3. A benefits-and-burdens balance sheet may assist analysis, but it is not an arithmetical exercise. The value of life, pain, suffering and cognitive impairment cannot be reduced to numerical units. The court must weigh the considerations qualitatively.
4. On the evidence, radiotherapy offered a 50 per cent prospect of cure and normal life expectancy, together with a significant prospect of extending E’s life even without a lasting cure. The predictable burdens included distress, sickness, hair loss, lethargy and permanent neuropsychological damage, including an expected reduction in IQ. Nevertheless, the prospect of cure and additional life outweighed those disadvantages in E’s overall interests.
5. It was accordingly declared that it was in E’s best interests to undergo low-dose craniospinal radiotherapy. The declaration was in principle. The precise hospital and treatment arrangements were left to agreement between the mother and the treating clinicians, with liberty to apply if further judicial determination became necessary.