England and Wales High Court (Family Division) Decisions

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Cite as: [2014] EWHC 531 (Fam)

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		Neutral Citation Number: [2014] EWHC 531 (Fam)

IN THE HIGH COURT OF JUSTICE
FAMILY DIVISION

Royal Courts of Justice

13th February 2014

B e f o r e :

MR. JUSTICE KEEHAN
____________________

	BIRMINGHAM CHILDREN'S NHS TRUST	Claimant
	- and -
	B. & C.	Defendants

____________________

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____________________

MR. M. WENBAN-SMITH appeared on behalf of the Claimant.
THE DEFENDANTS did not appear and were not represented.
____________________

HTML VERSION OF JUDGMENT
____________________

MR. JUSTICE KEEHAN:

In this matter I am concerned with a small baby, A, who was born at the University Hospital Coventry and Warwickshire on 7 February of this year. The following day, it was noted that A's saturations had fallen to 77 per cent. He was therefore transferred to the special care baby unit. His saturations were there confirmed and a heart murmur was heard. Further reviews continued and A was intubated and an echocardiogram was undertaken which confirmed a diagnosis of transposition of the great arteries or other complex heart disease and restrictive septum. That was the cause of A's desaturations. There was consultation later on 8 February between the consultants of the University Hospital Coventry and Warwickshire and a consultant paediatric cardiologist at Birmingham Children's Hospital, Dr. B.

As a result of those consultations, A was transferred to the paediatric intensive care unit at Birmingham Children's Hospital in the late evening of 8 February. Further tests were undertaken after he arrived at Birmingham Children's Hospital when the diagnosis of TGA or other complex heart disease and a restrictive septum was confirmed.

On 9 February, a septostomy procedure was performed to attempt to improve A's oxygen levels temporarily while he awaited a cardiac operation. That procedure was successful. The Birmingham Children's Hospital plan for A to undergo an arterial switch operation and closure of the atrial and ventricular septal defect tomorrow, 14 February.

A's parents are B and C. They are Jehovah's Witnesses. They did not wish to take part in this hearing and application, but they have provided the court with an email in which they set out their views. They consent to A undergoing the cardiac surgery which is advised by Dr. B, but because of their religious beliefs they cannot consent to him receiving blood during the course of that surgery or subsequently, should the need arise. They helpfully and fairly set out in that email that they understand that the court may well overrule their objections based on religious beliefs and order the surgery to take place with the necessary blood transfusions. They tell me in the email that they do not want to take part in these proceedings because they do not want to make them any more complex than necessary. They will not actively try to prevent the treatment of their son, A. Nor do they actively oppose this application made by Birmingham Children's Hospital.

Very helpfully, Dr. B made himself available to give sworn evidence by telephone this morning. He confirmed that the contents of his statement of 12 February were true to the best of his knowledge and belief. He told me that if this procedure is not undertaken A has no long-term prospect of survival. He may not die immediately but he is unlikely to survive beyond babyhood. I asked him about the risks of the surgery that is proposed. He told me that the risks were relatively low. In answer to Mr. Wenban-Smith, counsel for the hospital trust, he told me that the risks of A not surviving the operation were about two per cent and the risk of damage to other organs being caused during the course of the surgery was of the order of three to five per cent. He confirms that it was his understanding that A's parents consent to the surgery but cannot consent to A undergoing blood transfusions either during or subsequent to the surgery. He told me that it was simply not possible to perform the surgery proposed without blood products being supplied to A during and possibly subsequent to the surgery. He further told me that if the proposed procedure was carried out successfully A's prospects were excellent and that he would lead a normal life.

In considering this application, I have to consider in its widest possible sense A's welfare best interests. It is plain on the evidence before me that, whilst there are risks attached to him undergoing the TGA procedure, those are minimal risks, whereas starkly, if he does not undergo the procedure, his chances of survival are extremely poor. I note and give great weight to the fact that the parents consent to A undergoing this surgery because they understand and accept that, for A to survive, there is no choice. Their objection is on the basis of their religious beliefs as Jehovah's Witnesses and they cannot consent to A receiving blood products during or subsequent to the surgery. I entirely understand and sympathise with the stance of these parents. They are to be given enormous great credit for the fact that, notwithstanding their strongly held beliefs, they do not wish to actively oppose this application; nor, for perfectly understandable reasons, do they wish to participate in this hearing.

Helpfully, they provided mobile telephone numbers in the event that I wished to speak to them, but I was told by Mr. Wenban-Smith that they would very much prefer not to have to take part in this hearing or to speak to me. I understand that and I accept it.

Standing back and looking at A's welfare best interests, I am in no doubt whatsoever that it is in his best interests to undergo the surgery that is proposed by Dr. B tomorrow. On the basis that that is my view, it is inevitable that he must receive blood transfusions during the course of or subsequent to the surgery. Accordingly, I am again of the view, notwithstanding the parents' understandable objections on religious grounds, that it is in A's welfare best interests to receive blood products both during the surgery and, if necessary, subsequent to it.

Dr. B explained that it may be that, after the surgery, A would suffer the loss of some blood. If that occurred, it would have to be replaced and it is in those circumstances that, subsequent to the surgery, he may require a blood transfusion.

Accordingly, I am content to approve the draft order presented on be half of the hospital and make the following orders, namely: (1) It is lawful and in A's best interests that he undergo urgent heart surgery to switch his great arteries, currently due to take place on 14 February 2014, which requires his blood to be passed through a heart bypass machine and a blood transfusion entailing the administration of blood and/or blood products. (2) In any other immediately life-threatening situation where it is the professional opinion of those medically responsible for A that he is in need of the administration of blood and/or blood products, it shall be lawful for him to be given such blood and/or blood products without the consent of his parents, the first and second respondents. (3) In any situation which is less than imminently life-threatening, those medically responsible for A shall consult with his parents, the first and second respondents, and will consider at every opportunity all alternative forms of management suggested by his parents to the administration of blood and/or blood products. In the event that those medically responsible for A conclude, after such consultation, that there is no reasonable alternative to the administration of blood and/or blood products, they shall be at liberty to administer such blood and/or blood products without the consent of his parents.

That is the judgment of the court.

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