Re C (A Minor) (Medical Treatment)

JurisdictionEngland & Wales
Judgment Date1998
Date1998
CourtFamily Division

Child – Medical treatment – Child aged 16 months suffering from fatal disease – Requiring artificial ventilation when suffering respiratory arrest – Doctors of opinion that in event of further respiratory arrest ventilation should not be reintroduced – Parents unable to agree to this course – Hospital trust applying for order giving leave for child to be treated as advised by consultant responsible for child.

The child, now aged 16 months, suffered from a fatal disease: spinal muscular atrophy, type 1. As a result of this condition she suffered respiratory arrest from time to time and had to be put on ventilation. She was currently on ventilation in intensive care in hospital. Her condition was so severe that life-sustaining treatment simply delayed death without significant alleviation of suffering. The doctors caring for her had come to the conclusion that it was not in her best interests to continue indefinite ventilation which would produce increasing distress to her and that when ventilation was withdrawn it should not be reintroduced in the event of further respiratory arrest. The doctors’ view was that such treatment would be futile and subject the child to further suffering without conferring any benefit. The parents did not believe that it was within their religious tenets to stand aside and watch another person die when their intervention could prevent that death. They were therefore unable to consent to the proposed course of treatment the doctors recommended. Both the doctors and the parents sought independent expert advice. Three experts agreed with the course proposed by the child’s doctors. The hospital trust therefore sought an order to the effect that leave be given to treat the child as advised by her consultant paediatric neurologist, such treatment to include the withdrawal of artificial ventilation and non-resuscitation in the event of a respiratory arrest and palliative care to ease the suffering and permit her life to end peacefully.

Held – No doctor could be required by the court or by the parents to treat a child. The decision whether to treat was dependent upon the exercise of the doctor’s professional judgment, subject only that, save in exceptional cases usually of emergency, he had the consent of someone who had authority to give that consent. In the present case the parents, although agreeing that the child should be taken off ventilation, were seeking to insist that she should be replaced on ventilation despite the doctors’ unwillingness to do so if she should suffer respiratory arrest. That would be tantamount to requiring the doctors to undertake a course of treatment

they were unwilling to do and the court could not consider making an order that would require them to do so. On the evidence, it was in the best interests of the child that she be taken off ventilation and that it should not be reintroduced if she should suffer a further respiratory arrest. Therefore an order would be made in the terms sought.

Cases referred to in judgment

J (a minor) (medical treatment), Re[1992] 2 FCR 753, [1993] Fam 15, [1992] 4 All ER 614, [1992] 3 WLR 507, CA.

J (a minor) (wardship: medical treatment), Re [1991] FCR 370, [1991] Fam 33, [1990] 3 All ER 930, [1991] 2 WLR 140, CA.

R (a minor) (wardship: consent to treatment), Re[1992] 2 FCR 229, [1992] Fam 11, [1991] 4 All ER 177, [1991] 3 WLR 592, CA.

Orginating summons

By originating summons the applicant, the hospital trust, applied to the High Court for an order under its inherent jurisdiction granting leave to treat the young child, C, who was suffering from a fatal disease as advised by a consultant paediatric neurologist, such treatment to include the withdrawal of artificial ventilation and non-resuscitation in the event of a respiratory arrest and palliative care to ease the child’s suffering and permit her life to end peacefully, following the mother and father’s refusal to give consent to such treatment. The hearing took place and judgment was given in chambers. The case is reported with the leave of Sir Stephen Brown P. The facts are set out in the judgment.

Angus Moon (instructed by Hempsons, Manchester) for the hospital trust.

Lindsey Kushner QC (instructed by Alexander Harris, Manchester) for the parents.

Michael Nicholls of the Official Solicitor’s department as amicus curiae.

SIR STEPHEN BROWN P.

Little C (as I shall call her) was born on 3 July 1996. She is now 16 months of age. She suffers from a dreadful fatal disease, spinal muscular atrophy, type 1. It is known in short as SMA 1. This is a tragic case. She came into hospital first in March of this year. She then weighed 7 kg. She now weighs only 5 kg. When she came into hospital in March she remained only for a few days and was then allowed to go home, but she came back in July, and briefly stayed in hospital. She went with her parents to Israel in October 1997 and was there for two weeks. When she was there, she was put on ventilation, and returned as an emergency case to this country after two weeks. She has been in hospital in intensive care since that time and is on ventilation. This is known as intermittent positive pressure ventilation which is designed to support her own breathing.

She is seriously disabled. The disease means that she is seriously emaciated. She has little movement of her feet and no other movement in

her legs. She does not have what is termed anti-gravity movement in her arms, and is in what the doctor responsible for her care terms as a ‘no chance’ situation. That is a phrase which appears in a publication of the Royal College of Paediatrics and Child Health issued in September 1997 entitled ‘Withholding or Withdrawing Lifesaving Treatment in Children, a Framework for Practice’. It defined the ‘no chance’ situation as—

‘where the child has such severe disease that life-sustaining treatment simply delays death without...

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