Y NHS Foundation Trust v AN & Anor

When exercising the inherent jurisdiction in relation to a minor aged 16 or 17 who wishes to delay necessary medical treatment, the court must establish the facts, decide whether intervention is necessary, and then make a welfare assessment.

The court must give substantial weight to the young person’s wishes and autonomy. Those wishes are not decisive where delay creates a serious and imminent risk of death or grave irreversible harm. The assessment balances personal autonomy against preservation of life and must focus on the individual’s welfare, including the quality of life and the consequences of treatment or non-treatment.

An NHS Foundation Trust applied urgently under the inherent jurisdiction concerning AN, aged 16, who had been diagnosed with acute leukaemia. AN wished to receive treatment but sought several further days at home before admission. The Trust’s evidence was that immediate inpatient treatment was necessary because of the risks of infection, tumour-cell breakdown, kidney damage and delay to chemotherapy.

AN’s parents supported her wish to return home. The court considered whether intervention was necessary and whether AN’s welfare required an order keeping her in hospital despite her expressed wishes.

1. Application granted. The court ordered that AN remain in hospital so that urgent inpatient treatment could commence. The Trust did not seek authority to use physical or chemical restraint.
2. The court adopted the three-stage approach in E & F (Minors: Blood Transfusion) [2021] EWCA Civ 1888: establish the facts, determine whether intervention is necessary, and make the decisive welfare assessment.
3. The factual risks were clear and serious. Delay would expose AN to infection, inadequate monitoring, kidney complications from steroid treatment and a likely delay to chemotherapy. The court also considered that a further hearing could not take place for several nights, making postponement unsafe.
4. AN was intelligent, articulate and had expressed a wish to be treated, although she wanted time before treatment began. Her wishes and those of her parents were given serious weight. They did not, however, outweigh the immediate risks to her life and health.
5. Following the approach in Re W (A Minor) (Medical Treatment: Court’s Jurisdiction) [1993] Fam 64 and Re X (A Child) (No.1), the court concluded that welfare required intervention. The balance fell comfortably in favour of immediate admission and treatment.
6. The matter was directed to return for review on 14 February 2024, with updated evidence.