A Health Board v AZ & Ors

In an application concerning termination of a pregnancy in a child lacking Gillick competence, the court must apply a two-stage process. First, two registered medical practitioners must be satisfied that the statutory conditions in Abortion Act 1967, section 1, are met. Secondly, the court must decide whether termination is in the child’s best interests and may provide substituted consent.

The best-interests assessment must consider all material factors, including the physical and mental-health consequences of continuation, childbirth and termination. The question is which available course is the least bad option for the child. Applications should be made urgently and supported by medical, psychological, safeguarding and care-plan evidence.

A Health Board applied for declarations that termination of AZ’s pregnancy, and the removal of placental tissue for forensic testing, were in her best interests. AZ was aged 11 and had become pregnant following rape. She initially wished to continue the pregnancy, but by the final hearing she, her parents and her guardian supported termination.

The court considered whether the statutory conditions for lawful termination were met, whether termination was in AZ’s best interests, and what procedural guidance should apply in future childhood-pregnancy cases.

1. Statutory threshold. The evidence of two consultant obstetricians established that the pregnancy had not exceeded 24 weeks and that continuation involved a greater risk of injury to AZ’s physical or mental health than termination. Section 1(1) of the Abortion Act 1967 was therefore satisfied. The statutory assessment was the first stage; if it had not been satisfied, the application would have ended.
2. Best interests. The second stage required the court to evaluate all material factors and decide whether termination was in AZ’s best interests. The assessment concerned AZ, not the foetus. The court weighed the substantial physical risks of continuing the pregnancy and childbirth, including risks arising from AZ’s age and small anatomy, against the risks of surgical termination and the mental-health consequences of either course.
3. The court concluded that neither outcome was good, but that continuation presented considerably greater risks. Those risks included trauma associated with a pregnancy conceived by rape, possible deterioration in mental health, the likely removal of the baby at birth, and serious physical consequences of childbirth. Termination was therefore declared to be in AZ’s best interests and should occur promptly.
4. The court also declared that placental tissue could be taken for forensic testing. It gave procedural guidance: applications should be made as soon as practicable where competence, consent or best interests are uncertain; the child should be joined and represented urgently; evidence should address section 1, competence, all available options, risks and benefits, consequential orders and a detailed care plan; and the final hearing should ordinarily occur within seven days.
5. Where parental responsibility has been called into question or parental positions have repeatedly changed, a best-interests declaration should ordinarily be preferred to reliance on parental consent as the procedural basis for treatment.

First-instance decision of the High Court (Family Division). The judgment states no appellate history.