Y NHS Foundation Trust v AN & Anor

Factual and Procedural Background

The applicant, a NHS Foundation Trust ("the Trust"), brought an urgent out-of-hours application concerning a 16-year-old minor ("AN") diagnosed unexpectedly with acute leukaemia on 5 February 2024. AN, an intelligent young person preparing for GCSE exams, initially discharged herself from hospital against medical advice with parental support, despite understanding the seriousness of her condition. Following further medical assessments and confirmation of an aggressive form of blood cancer (Precursor B cell Acute Lymphoblastic Leukaemia), the Trust sought the court’s intervention to require AN's immediate inpatient admission for urgent treatment.

Medical experts, including a Consultant Haematologist ("Dr X") and a psychologist ("Dr Z"), provided evidence that AN lacked capacity to refuse treatment due to her inability to accept the diagnosis and the associated risks. The application was heard remotely after midnight on 10 February 2024, with submissions from counsel for the Trust, AN’s mother (joined as second respondent), and the Official Solicitor acting as Advocate to the Court due to the absence of Cafcass representation. The court was asked to determine whether it was necessary to intervene under its inherent jurisdiction to protect AN’s welfare.

Legal Issues Presented

1. Whether the court should exercise its inherent jurisdiction to override the wishes of a capacitous minor refusing or delaying urgent medical treatment.
2. How to balance the minor’s autonomy and expressed wishes against the preservation of life and best interests in the context of serious, life-threatening illness.
3. The appropriate application of welfare principles and capacity assessments in medical treatment decisions involving minors approaching adulthood.

Arguments of the Parties

Applicant's Arguments

• AN requires immediate inpatient admission to commence treatment for acute leukaemia, including intravenous fluids and steroids, to prevent life-threatening complications.
• AN currently lacks capacity to make informed decisions about her treatment due to denial of her diagnosis and risks.
• Delaying treatment or managing AN at home risks serious deterioration, including kidney failure and uncontrolled infection, potentially leading to death within days or weeks.
• The Trust does not propose physical or chemical restraint but seeks an order preventing AN from leaving hospital to ensure life-saving treatment is administered.

Second Respondent's (AN’s Mother) Arguments

• Supports AN’s wish to remain at home for a short period to come to terms with her diagnosis.
• Expressed acceptance of a delayed admission option involving outpatient steroid treatment and daily monitoring, despite medical risks.

Table of Precedents Cited

Court's Reasoning and Analysis

The court applied established legal principles governing the exercise of inherent jurisdiction over minors, focusing on three stages: fact-finding, necessity of intervention, and welfare assessment. The facts were undisputed: AN has acute leukaemia requiring urgent inpatient treatment to prevent life-threatening complications. Medical evidence demonstrated that AN, although intelligent and articulate, was not accepting her diagnosis and the consequences of delaying treatment, leading to a conclusion that she lacked capacity to make this specific medical decision.

The court carefully balanced AN’s autonomy and expressed wish for more time at home against the risks to her life and health. While the law respects the views of mature minors, it does not require the court to accept treatment refusal that will likely result in death or severe harm. The court acknowledged the traumatic circumstances and AN’s understandable desire to delay treatment but found that the preservation of life and prevention of serious harm outweighed the autonomy interest here.

The court considered medical evidence that outpatient steroid treatment without inpatient monitoring posed significant risks, including kidney failure and uncontrolled infection, and that immediate inpatient admission was necessary to safely commence therapy. The court was reassured that no physical or chemical restraint would be used but that AN would be prevented from leaving hospital to ensure treatment compliance.

The court also took into account procedural safeguards, including the involvement of the Official Solicitor as Advocate to the Court and directions for a further hearing within days to review AN’s position and representation.

Holding and Implications

The court GRANTED the NHS Foundation Trust’s application for an order requiring AN to remain admitted in hospital to commence urgent inpatient treatment for acute leukaemia.

This decision directly compels AN’s continued hospital stay to receive life-saving treatment despite her expressed wish to delay. It confirms the court’s protective role under inherent jurisdiction to override the treatment decisions of capacitous minors when refusal or delay poses a serious risk of death or severe harm. No broader precedent beyond the application of established principles was created; the ruling is fact-specific to the immediate health risks faced by AN.