In the Matter of E And In The Matter Of A Minor Aged 16 And In The Matter Of A Blood Transfusion To Which The Minor Objects And Her Parents Do Not Consent (Approved)

Factual and Procedural Background

The Plaintiff is a 16-year-old female who, at 37 weeks' gestation, was admitted to The Hospital on 8 February 2026 with reduced foetal movement. The Plaintiff has executed an Advance Healthcare Directive (AHD) expressing refusal of any red blood cell transfusion in all circumstances. The Plaintiff's parents (Parent A and Parent B) share a Jehovah's Witness faith and support the Plaintiff's refusal; they did not provide parental consent. Company A (the applicant) seeks a court order authorising all appropriate medical treatment, including blood transfusion and clotting agents, as a matter of last resort if clinically required. The matter was addressed in an ex tempore ruling delivered by Judge Heslin on 13 February 2026. A minor wardship summons has been commenced and will be adjourned to a later date.

Legal Issues Presented

1. Whether the Court should, under its minor wardship jurisdiction, give substitute consent authorising blood transfusion and related treatment for the Plaintiff notwithstanding the Plaintiff's expressed refusal and the absence of parental consent.
2. Whether the Plaintiff's Advance Healthcare Directive is legally effective given the Plaintiff's age.
3. Whether the parents' decision to refuse consent in support of the Plaintiff constitutes "parental failure" under the test articulated in In the matter of JJ such that court intervention is justified.
4. Whether the Plaintiff has capacity to refuse the treatment in issue, specifically the ability to "weigh" information.

Arguments of the Parties

Company A (Applicant) — summary of position

• Seeks an order authorising provision of all appropriate medical treatment, including blood transfusion and clotting agents, where clinically required and in the treating consultant's judgment, as last‑resort measures.
• Relies on medical evidence that a massive obstetric haemorrhage is time‑critical and may require immediate transfusion such that a court application would not be practical in an acute emergency.

Plaintiff and Parents — summary of position

• The Plaintiff refuses any red blood cell transfusion under any circumstances on religious grounds and has expressed willingness to accept cell salvage in principle.
• Parent A and Parent B support the Plaintiff's refusal and have not given parental consent for transfusion.

Guardian ad Litem — summary of position

• The Guardian ad Litem met the Plaintiff, reports that the Plaintiff is vulnerable and would find it easier if the decision were taken out of her hands, and supports the application for wardship/substitute consent to protect the Plaintiff's life and welfare.

Table of Precedents Cited

Court's Reasoning and Analysis

The Court reviewed sworn affidavits (solicitor for the applicant, treating obstetrician—Doctor A, psychiatrist—Doctor B—and the Guardian ad Litem's report). The Court found:

• The Plaintiff's AHD is not determinative because s.84(1) of the Assisted Decision Making (Capacity) Act 2015 requires a person to be 18 to make a valid AHD.
• The medical evidence (Doctor A) is uncontroverted that obstetric haemorrhage can occur unpredictably and progress rapidly; transfusion of red cells may be required urgently as part of resuscitation and delay increases risk of cardiac arrest, multiorgan failure and death. A massive obstetric haemorrhage is time‑critical such that, in an acute episode, there may not be time to bring an ex parte court application.
• Cell salvage (self‑salvage) is not guaranteed or reliably available in the obstetric context and is not a substitute for transfusion in uncontrolled substantial bleeding.
• The Plaintiff is over 16 and her views are given due weight, but there is medical evidence casting doubt on her functional capacity to refuse transfusion insofar as she may be unable "to truly weigh the information" because her judgment is clouded by religious belief.
• Under Article 42A and guided by JJ, the Court must determine whether the parents' supported refusal prejudices the child's safety and welfare. Applying JJ, the Court concluded there is clear and convincing evidence that the refusal prejudices the Plaintiff's safety and welfare to such an extent that substitute consent is warranted.
• The Court balanced competing constitutional rights (religious freedom, bodily integrity, right to life, family rights and rights of the child) and found that authorising the treatment as a proportional, last‑resort measure vindicates the Plaintiff's rights, particularly the right to life and bodily integrity.
• The Court emphasised this intervention overrides a single discrete decision and is not an admission of the Plaintiff into wardship; it exercises its minor wardship jurisdiction to provide substitute consent limited to the specific treatment at issue.

Holding and Implications

Order granted authorising the provision of appropriate medical treatment, including blood transfusion and associated measures, where clinically required as a last resort and in the treating consultant's judgment.

Implications: The Court's order provides substitute consent for the specified treatment despite the Plaintiff's expressed refusal and the lack of parental consent. The intervention is limited to overriding the discrete decision to refuse transfusion where necessary to prevent otherwise avoidable serious injury or death. The Court adjourned the minor wardship summons to a future date and characterised its action as proportionate and no more than necessary to vindicate the Plaintiff's rights; the opinion does not purport to establish a new general precedent beyond application of existing authorities.