Re P (Medical Treatment: Best Interests)

Approved Judgment

Mr. Justice Johnson:

1.I will call him 'John' although that is not his real name. He was born on 18th October 1986, so he is sixteen years and ten months old. He is ill. It seems possible that in the course of their treatment the doctors will need to administer blood or blood products. John steadfastly objects. He is, and as I understand it throughout his life has been, a staunch and committed Jehovah's Witness. This, at least in my experience, has been an unusual hearing. So often these applications are made to a judge by telephone, sometimes in the middle of the night, with no opportunity to explore properly the feelings and wishes of the young person concerned, still less to hear any argument or submissions in the matter. So it seemed to me somewhat ironic that Mr. Daniel on the parents' behalf submitted that because happily the immediate crisis for John has passed, the order sought by the NHS Trust need not be granted. The matter could be deferred until an emergency arose and, as I responded to Mr. Daniel, until the judge had to deal with the application without the advantage of the representation before me this afternoon.

John has been represented by counsel instructed on his behalf by CAFCASS Legal and by solicitor and counsel instructed by John directly.

The medical problem arises because John has inherited a condition called hypermobility syndrome. I have had a medical explanation of the causes and consequences of that abnormality. Amongst other symptoms there is a tendency to bleed because of the fragility of the patient's blood vessels. There can be complications because of bleeding caused by the rupture of a major blood vessel such as the aorta. Nonetheless a large proportion of patients survive with a relatively normal life span. Happily, from the medical evidence before me, it would seem that John's main problems are mechanical in the sense that they relate to his joints and poor co-ordination and matters of that kind. However, an emergency arose on Monday of this week, 11th August 200John was admitted to hospital at 7 o'clock that morning. The thought was that John had suffered a ruptured aorta. John and his parents jointly, and I wish to emphasise, independently, expressed to the treating doctors their objection to the use of blood or blood products. The doctors felt it right to accede to those views because at that point the conclusion was that the operation that would be necessary to cure what was then a suspected ruptured aorta would be very dangerous and unlikely to be successful. In the words of the Consultant Chest and General Physician treating John: "It was therefore felt that a blood transfusion at this stage may well have been a futile gesture. Transfusion was therefore withheld due to the apparent futility."

The crisis seems to have passed but the risk remains. The cause of John's current difficulties remains unidentified. Again in the words of the doctor: "John's condition remains rather precarious, although he is stable and therefore investigations such as endoscopy and colonoscopy are not yet appropriate. He has a massively distended colon. There is no evidence of any blood loss into the abdomen from an aortic rupture or other similar cause and therefore the bleeding that is observed would appear to have been within his gut." So although there is no evidence of serious on-going bleeding the doctors have not been able to identify the underlying problem that caused the acute episode last Monday. Accordingly, the...