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Children refusing treatment. The court always has the last word
  1. Robert Wheeler
  1. Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Robert Wheeler, Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK; robert.wheeler{at}

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Founded on two Court of Appeal decisions in 1992,1 2 it has been conventional wisdom that where a competent or capacitous child makes a medical decision that is likely to pose a serious risk to their health, or entail death, the court can overrule that choice. This principle applies equally (although uncommonly) to vetoing an inappropriate procedure to which the child seeks to consent. Naturally, over the intervening years there have been cases challenging those judgements, largely based on children seeking to refuse food or blood.

Recently, the case of Re X,3 a 16-year-old Jehovah’s Witness with sickle cell disease was heard in the High Court. A National Health Service Trust applied to the court for a declaration to transfuse X with red blood cells against her wishes and beliefs, in response to her present sickle cell crisis: On the clinical evidence presented to the court, this was an ‘imperative necessity’. In addition, to explore whether it was in her interests to provide further ‘top up’ transfusions during putative future admissions prior to her eighteenth birthday. Previous transfusions had been administered, made lawful by court declarations. At an earlier hearing submissions had been made on X’s behalf; to the effect that times have changed, and society’s views as to the proper balance between patient autonomy and judicial and medical paternalism have shifted. This societal adjustment, taken together with the enactment of the Human Rights Act 1998 and other legal developments had called into …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.