At 4 o’clock on a Friday afternoon most working people are thinking about going home and enjoying the weekend ahead. But that isn’t necessarily the lot of a High Court Judge. At that time on the 21st of June last Mr Justice MacDonald was contemplating something rather more serious. Something, in fact, that could quite literally be a matter of life and death.
He had been required to decide whether it was in the best interests of a three and half week old baby to be treated by way of blood transfusion, in circumstances where consent for such treatment was not forthcoming from the baby’s mother, who is a committed and conscientious Jehovah’s Witness.
The baby had been born with a serious congenital disorder, which could cause him to suffer cardiac failure, amongst other conditions. In fact, on the very morning of the hearing he had suffered a cardiac arrest, making the matter extremely urgent. He was being treated in an intensive care unit, where the doctor asserted that he required blood transfusions to improve his heart and lung function with a view to increasing the chances of weaning him off of a ventilator, and to help stabilise him and improve his cardiac function and reduce the risk of further cardiac arrests (amongst other reasons). The medical evidence was that without a transfusion the boy’s life was “at very significant risk.”
The mother objected to these steps, on the basis of her religious beliefs as a committed Jehovah’s Witness. A representative of the Jehovah’s Witness Hospital Liaison Committee had asked doctors to consider alternative, non-blood based, products to treat the boy, but the Health Board indicated that, in the current circumstances and given the boy’s particular difficulties, treatments alternative to that of blood transfusion, and capable of providing the same relief, were not available.
No consent to the treatment had been given by the boy’s father.
In these circumstances the Health Board sought the permission of the court to administer blood products to the boy.
Mr Justice MacDonald was entirely satisfied that it was in the boy’s best interests to receive treatment by way of blood transfusion. His reasons for this were as follows:
- The boy was gravely ill. His conditions rendered urgent action a priority.
- Each of the conditions that threatened his life could, on the evidence before the court, be ameliorated by administering a blood transfusion or transfusions.
- The medical evidence before the court was clear that without a transfusion the boy’s life was at very significant risk.
- There is a strong presumption in favour of taking all steps to preserve life.
- The treatment proposed had been recommended following a multi-disciplinary consideration of the case, and represented the consensus of reasonable medical opinion.
- Lastly, any risks attendant on treatment were manifestly outweighed by the benefits of such treatment.
Mr Justice MacDonald had, of course, given careful thought to the views of the mother. However, he was satisfied that any sustained view on the part of the mother that the boy should not have a blood transfusion did not, irrespective of the genesis of that view, act to alter the court’s conclusion that such a course of action was objectively and manifestly in his best interests.
In the circumstances, he was satisfied that, in the particular circumstances of the case, the balance fell overwhelmingly in favour of the use of blood transfusions, and he therefore gave permission for the treatments to be administered.
I have often commented here about the very difficult decisions that our family judges face every day, and this case is just the latest in a long list which confirm that.
You can read the full judgment here. In the above summary of the case I have not gone into the legal background, of how the court has jurisdiction to make such decisions in relation to a child in the face of parental objections, and of the principles which the court must follow when making the decisions. For those who are interested, these matters are summarised in paragraphs 12 to 18 of the judgment.