Best interests in serious medical treatment cases
6th March, 2019
Manchester University Hospital NHS Foundation Trust v M (1) and OA (2) (2019)
This recent case, which was heard in the Royal Courts of Justice last week, highlights the clinical and legal intricacies which often arise in the context of applications for serious medical treatment for seriously ill children. Here, the High Court granted Manchester University Hospital NHS Foundation Trust’s application for an order authorising serious medical treatment for a young child whose parents were opposed to it, and who was subject to an interim care order.
M, a 13-month-old girl, was born with end-stage renal failure and was the subject of an interim care order. The Court had previously authorised the removal of an infected peritoneal dialysis catheter and the insertion of a new one. However, the infection was more severe than anticipated and extensive scarring impeded the insertion of a new catheter. Peritoneal dialysis was recommenced but M was retaining fluid, risking respiratory difficulties and high blood pressure, and repositioning of the catheter became impossible.
At the hearing on 27 February 2019, the Court considered evidence from M’s treating clinician, a Consultant Paediatric Nephrologist, who advised that there were two options, namely to: (1) perform haemodialysis or (2) adopt a palliative care plan with no further renal replacement therapy to be provided. Whilst the latter would entail symptomatic treatment with feeds and medication only, the former would require a procedure under general anaesthetic to site the haemodialysis catheter into a large venous vessel in M’s neck or groin, which would enable her blood to be cleaned and fluid removed in the hope that a renal transplant would ultimately be possible. The Consultant recommended haemodialysis as being in M’s best interests and advised that this was her only real chance of survival. He confirmed that if haemodialysis was not pursued, then M would die within a matter of weeks. The Consultant did however acknowledge the possibility that other clinicians might adopt a different clinical course and that the risk of fatality for M was higher than it would be for many other children.
The Trust accordingly sought an order authorising the provision of the serious medical treatment outlined above. However, M’s parents, who experienced mental health issues, opposed the Trust’s Application. They had a profound faith and believed entirely in the power of prayer and that M’s problems were spiritual as well as medical.
Decision of the High Court
Following careful consideration of the evidence, including the multiple significant risks attendant upon haemodialysis being performed, the Court granted the Trust’s Application and agreed with the treating Consultant’s assessment that haemodialysis was in M’s best interests. The Court held that whilst there is a balance to be struck between pursuing treatment which carries risks and following a palliative care plan, it would be premature to confine M’s treatment to palliative options when there were real prospects of improving her situation. As to the wishes of M’s parents, the Court was satisfied that their primary objection was predicated on the strength of their faith and it was emphasised that, notwithstanding their beliefs, the Court’s role was to determine where the child’s best interests lay.
This recent decision highlights the clinical and legal intricacies which often arise in the context of applications for serious medical treatment for seriously ill children, particularly where parental wishes run contrary to the recommendations of the clinicians involved in the child’s day-to-day care and treatment. The decision also demonstrates the importance of the treating clinicians’ views in allowing the Court to make a careful assessment of the child’s best interests with reference to the available treatment options. Indeed the Court in the present case was greatly assisted by detailed reports from M’s treating Consultant in which he meticulously analysed the available options in order to justify his conclusions as to M’s best interests.
The full Judgment can be accessed by clicking here.
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Please note that this briefing is designed to be informative, not advisory and represents our understanding of English law and practice as at the date indicated. We would always recommend that you should seek specific guidance on any particular legal issue.
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