1. Role of the Courts in Clinical Decision-Making on End-of-Life Care of a Neonate
Calvin Ho JSD MSc LLM Advocate & Solicitor
Yong Loo Lin School of Medicine

2. Re T (A Minor) [1997] 18 month-old Life-threatening liver defect
Needed liver transplant
Donor = good prospect of success
Parents
No liver transplant
Baby 3 week-old baby had surgery, unsuccessful
Pain, distress
18 months old boy suffered from life-threatening liver defect. Needed liver transplant and prospect of success was good if donor found.
Parents – both experienced healthcare professionals – refused to consider a liver transplant.
Baby at the age of 3 weeks had undergone surgery, which had caused much pain and distress, was unsuccessful.

3. CA (Butler-Sloss LJ) Parents’ decision not to treat – accepted
Court – considers the welfare of the child
Prolonging life was not the sole objective
A loving parents’ decision not to treat a child who suffered from a life threatening disease stood, and was not to be interfered with as their assessment of what was in the child’s best interests.
Court must consider the paramount welfare of the child and not whether the parents might be unreasonable. (An argument that the Court should not interfere with the reasonable decision of a parent was rejected.)
Presumption in favour of prolonging life was not the sole objective, and should not be required at the expense of other considerations that might be in the child’s best interests.

4. Exception to the Objective Test?
There is a scale
Consideration on a case by case basis
General principles
‘All these cases depend on their own facts and render generalisations – tempting though they may be to the legal or social analyst – wholly out of place. It can only be said safely that there is a scale, at one end of which lies the clear case where parental opposition to medical intervention is prompted by scruple or dogma of a kind which is patently irreconcilable with principles of child health and welfare widely accepted by the generality of mankind; and that at the other end lie highly problematic cases where there is genuine scope for a difference of view between parent and judge. In both situations it is the duty of the judge to allow the court’s own opinion to prevail in the perceived paramount interests of the child concerned, but in cases at the latter end of the scale, there must be a likelihood (though never of course a certainty) that the greater the scope for genuine debate between one view and another the stronger will be the inclination of the court to be influenced by a reflection that in the last analysis the best interests of every child include an expectation that difficult decisions affecting the length and quality of its life will be taken for it by the parent to whom its care has been entrusted by nature.’

5. Guidance: Royal College of Paediatrics and Child Health
Parental Responsibility
Role of the Courts
Best interests
Reference: Larcher V, et al. Arch Dis Child 2015;100(Suppl 2):s1–s23. doi: /archdischild
Role of the Courts:
Independent and objective judgment, taking into account likely quality of future life for child, intolerability of treatment or outcome, relevant clinical considerations, pain or suffering, pleasure a child may derive.
Best interests:
Not purely confined to considerations of best medical or clinical interests, but include other medical, social, emotional and welfare factors.
High degree of probability that it is in the best interests

6. Please note that the references to the law are to illustrate legal principles and not to be seen as legal advice

7. THANK YOU

8. The following presentation is taken from the LCPC Symposium 2016: When Caring Never Stops – Meeting the Needs of Vulnerable Babies