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Family Law

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Court of Protection Practice and Procedure Conference 2016

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07 JAN 2014

MEDICAL TREATMENT: Re TM (Medical Treatment) [2013] EWHC 4103 (Fam)

(Family Division, Holman J, 17 December 2013)

The 7-year-old child was born prematurely, she had cerebral palsy and a number of related medical and developmental complications. She was cared for at home by her mother and her father also played an active part in her life. One of the complications of the child's condition was that she was unable to swallow and needed nutrition and hydration via a nasogastric tube. She also suffered from a problem with the way her stomach absorbed nutrients and also required feeding directly into her intestine

At the suggestion of the treating clinicians the child underwent a gastrostomy whereby a tube was inserted directly into her abdomen for the purposes of hydration and nutrition and in addition a peripherally inserted central catheter was also inserted into her neck for the same purposes.

When the first PICC had to be removed due to infection the parents became resistant to a further device being fitted and also more generally resistant to procedures being performed at Great Ormond St Hospital where the child had always received treatment. Tension developed in what had previously been a good working relationship between the parents and hospital staff.

Following a particular episode the mother was excluded from the hospital and a stalemate arose in relation to further treatment. A without notice application was made to the court and the judge granted a declaration that it was in the child's best interests for a further PICC to be inserted and an order was made preventing the child from being removed from the hospital.

When the matter returned the main issue for determination was whether the proposed treatment suggested by the hospital should be authorised. The clinicians wished to replace the child's current gastrostomy with a gastrojejunal tube which would reach into the intestine, as opposed to terminating in the stomach, with the hope that the child would be more adequately nourished and hydrated. If that were possible then the PICC could be removed. The hospital also sought permission to carry out further gastrointestinal investigations to ascertain why the stomach was not functioning normally.

The judge found that it was unhesitatingly in the best interests of the child to undergo the proposed treatment on the basis of the evidence before the court. The procedures potentially carried considerable advantages to her and few, if any, disadvantages. Declarations to that effect were granted. The mother's request that a particular doctor take no further part in treatment was refused but otherwise by the time of the final hearing the parents were substantially in agreement with the view of the treating clinicians. 


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