University Hospitals Plymouth NHS Trust v B (Urgent Medical Treatment) [2019] EWHC 1670 (Fam) (21 June 2019)

The application concerned the welfare of B who was 16 years old.  There was no evidence that B lacked capacity and she had good knowledge of her condition, and of the implications of not receiving insulin for the same, namely a risk of death.  B had stated a wish to die and had a history of refusing insulin, resulting in prior in-patient care.

B lived with her grandfather and he supported the decision to provide the treatment necessary to reverse her current DKA (Diabetic Ketoacidosis).  B had a difficult relationship with her mother and refused to allow the hospital services to contact her.  B had no relationship with her father.

B was admitted to hospital, with her own agreement, the day before the hearing, following her refusal to take insulin in respect of her condition - insulin dependent diabetes mellitus. Upon admission, she also agreed to blood tests and insertion of an intravenous cannula for rehydration. Tests showed markedly elevated blood sugars and ketones; in the face of these, B continued to refuse insulin. Upon rehydration, B appeared confused and vomited due to her having developed DKA, resulting in admission to the High Dependency Unit. The treating team opined that aggressive short-term treatment to control/reverse the DKA was required, to avoid serious sequelae, including death.

Given the urgency, the court decided to deal with the case on submissions without B being represented. The court accepted the Trust's view that the treatment proposed was in B's best interests and should be ordered.

The court referred to Re K, W and H (Minors) (Consent to Treatment) [1993] 1FLR 854, concluding that the court could authorise the imposition of medical treatment on an unwilling child, notwithstanding their competent refusal. The court reminded itself of Balcombe LJ observations in Re W (A minor: Consent to medical Treatment) [1993] 1 FLR 1, that:- “One must start from the general premise that the protection of the child's welfare implies at least the protection of the child's life… if the child's welfare is threatened by a serious and imminent risk that the child will suffer grave and irreversible mental or physical harm, then once again the court when called upon has a duty to intervene."

The Court went on to set out the principles applicable when determining such an application and the factors particularly weighed in favour of the application.

The full judgment can be read here.

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