J (Blood Transfusion: Older Child: Jehovah’s Witnesses), Re

Before reaching adulthood, a capacitous young person’s refusal of medical treatment may be overridden under the court’s inherent jurisdiction. The governing principle remains welfare in the widest sense, assessed from the young person’s perspective. The court must balance preservation of life and personal autonomy, without treating either as automatically decisive.

The assessment should consider the young person’s age, maturity, intelligence and understanding, the nature and full risks of treatment and non-treatment, the reasons for the decision, and the likely quality of life if treatment preserves life. A small risk of death does not itself create an obligation to authorise treatment. Respect for a mature child’s religiously motivated decision must be substantive and may, on the facts, determine the outcome.

University Hospitals Plymouth NHS Trust applied for an anticipatory declaration that it would be lawful and in J’s best interests for clinicians to administer whole blood or primary blood products if required during or after planned surgery.

J was aged 17 years and 7 months and was a Jehovah’s Witness. He consented to the surgery but refused blood products, relying on sincerely held religious beliefs and an advance decision. The medical evidence established a very small risk of serious bleeding, but potentially fatal consequences if blood products were withheld. The central issue was whether the court should override J’s informed refusal while he remained a child.

1. Jurisdiction and approach. The court had jurisdiction under its inherent jurisdiction over minors to determine whether a young person’s refusal of medical treatment should prevail. The approach described in Re E & F required the court to establish the facts and risks, determine whether medical intervention was necessary, and then undertake a welfare assessment from the young person’s perspective.
2. Legal framework. A person aged 16 or over may consent to medical treatment under section 8 of the Family Law Reform Act 1969, but that provision does not confer an equivalent right to refuse treatment immune from the court’s jurisdiction. Under section 24 of the Mental Capacity Act 2005, J’s advance decision was not legally binding because he was under 18.
3. Welfare assessment. Welfare remained the overriding principle. The court had to balance the preservation of life and personal autonomy, giving proper weight to the factors that mattered in J’s individual circumstances. These included his age and maturity, intelligence and understanding, the nature and risks of the proposed treatment and its refusal, the reasons for his decision, and the prospective quality of life if treatment preserved his life.
4. The possibility that blood products might save J’s life did not automatically require authorisation. The risks of surgery were very small, while J’s refusal was clear, informed, mature, authentic and rooted in his religious faith. Administering blood products against his wishes would foreseeably cause profound psychological, spiritual and personal harm and substantially diminish the quality of any life thereby preserved.
5. The application was refused. It was declared lawful and in accordance with J’s best interests for clinicians not to administer whole blood or primary blood products, even if clinicians considered transfusion capable of preserving his life or preventing severe permanent injury. If J later consented before the procedure, clinically indicated treatment could be provided.