The NHS obtains an emergency order from the High Court to provide a life-saving blood transfusion to an 11-year-old child.

We recently helped an NHS Trust obtain an emergency High Court order to provide a blood transfusion to an 11-year-old child. The parents and the child had refused to consent to the transfusion because of their religious beliefs.

The emergency medical situation

The child presented to hospital with new severe anemia. They were lethargic. Their hemoglobin (Hb) level was extremely low at 37 mg/L, while the normal range for a child is between 115 and 155 mg/L. This was the lowest Hb level the consulting pediatrician had observed in a conscious child in 20 years. Doctors said that if the child did not receive a transfusion within six hours, there was a very high risk of sudden heart failure and death.

The legal situation

Although the child was articulate and could repeat his religious beliefs to refuse the transfusion, he could not articulate the likely outcome of refusing blood. Doctors were of the opinion that the child was not Gillick competent to refuse treatment. The parents indicated that they were Jehovah’s Witnesses and met with someone from the “hospital liaison committee” of the JW community. The parents found themselves in the unimaginable position of being deeply concerned and worried about their child, but also of having a deeply held religious belief that they could not consent to the blood transfusion.

The healthcare team had spent time trying to explore other treatment options, including bone marrow. Many Jehovah’s Witnesses will accept fractions derived from major blood components such as albumin, immunoglobulins, clotting factors, etc. However, in this case, the blood component the child needed was red blood cells, which were refused.

As a result, the medical team did not obtain consent to provide the transfusion and an urgent application to the High Court was required. The family understood and appreciated that the Trust took this step.

The emergency telephone hearing

Given the emergency, the court heard evidence from the family and doctors by telephone later in the day. After a careful analysis of the best interests of the child, the order was accepted. High Court judge praised how family and medical team worked together; the family complied with the court’s decision and the child received the blood transfusion that night.

Learning areas for hospitals and doctors

1. As soon as a JW child is admitted to hospital, if blood is likely to be needed, there should be an immediate exploration of possible treatment alternatives, but always with a strong and persistent focus on what is best. for the child (if he is not competent refuse). We recommend setting a short deadline adapted to the risk for the child, so that the exploratory phase does not drift. In this case, the medical team did not seek legal advice until the third day after admission. They had found it difficult to formulate and express a firm conclusion on the need for blood transfusion. They were distracted by the fact that he was refused, that the cause of the anemia was not known and by the rarity of the situation (the consultant had never been in a similar situation before). As a result, the team had continued to gently search for an agreement, and a possible alternative treatment (which was not going to be effective in the time required), without focusing on the need for an immediate resolution.
2. The child’s wishes and feelings should be explored immediately, and their Gillick competence should be assessed and recorded. Take note of repeated religious phrases, but ask about their meaning. Focus on asking the child questions and letting them talk to gauge their understanding. Have an age-appropriate discussion about specific risks and likely outcomes, but don’t avoid asking questions about the more difficult outcomes.
3. Obtain patient/parental consent to involve the hospital liaison committee provide experienced support.
4. Inform your legal team as soon as there is a suggestion that consent may not be provided. Before a legal claim can be filed, you will need to discuss the situation with your lawyer, ensure that all legal steps have been taken, and provide written evidence in a witness statement about the specific situation, the proposed treatment, current test results, and specific risks/benefits and likely timelines. It will likely take the doctors at least two hours to gather all the information and write the statement. It will also require detailed discussions with the family. Once the application is filed, the Court will assign a hearing, based on your assessment of its urgency.

Thanks to the transfusion, a catastrophic outcome was avoided for the child, which allowed time to investigate the cause of the anemia.