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(Family Division; Coleridge J; 10 June 2008)
The child, aged 22 months, had severe physical and mental disabilities. The child's medical condition had not been fully diagnosed, but was deteriorating in a serious way; she was not expected to reach the age of 5 years. The medical team treating the child believed that it was not in the child's best interests to carry out invasive resuscitation if that became necessary to keep her alive for a short period. The child was in the care of the local authority, but the authority, instead of exercising its own parental authority, encouraged the NHS Trust to seek a declaration from the court. The position of the mother, herself a minor, was that she was in favour of whatever the medical team wanted to do. The foster parents were not parties, but they gave evidence that at present the child's existence was worth living.
The court made a declaration that it would be lawful for the child not to receive intensive resuscitation in the event of a deteriorating illness or if she became severely unwell, and that at all times care and treatment was to be administered so as to cause her the least distress and pain, and retain the greatest dignity. The declaration was less specific than such declarations often were, because the situation in which the permission would be needed was not precisely clear. Therefore, the court attached a short joint expert's report as a guide to the medical team treating the child, to enable them to make what might be a very difficult, sensitive and finely balanced clinical judgment. An attachment of this kind might be a helpful way of guiding the medical team with care of a sick patient in cases in which the medical definitions and situations that might arise in emergencies were not necessarily capable of complete contemplation. The local authority had probably been right to take the view that its parental authority did not extend to consenting to a declaration of this kind; if in fact the local authority did have sufficient parental authority to consent to such a declaration, nonetheless it was sensible of the local authority to seek the court's view.
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