ARTICLE

To print this article, all you need is to be registered or login on Mondaq.com.

Abstract

An urgent application seeking a declaration for the administration of blood or blood products to a 17-year- old woman ("D1"), who is a Jehovah's Witness, in the event of a post-partum haemorrhage. The application brought by the hospital relied on the parens patriae jurisdiction in case of refusal of consent to a blood transfusion by D1.

Introduction

Mercy Hospitals Victoria brought an urgent application to seek a declaration to administer blood products to a pregnant 17-year-old young woman of the Jehovah's Witness faith in the event that blood products were needed during the lead up to birth, during labour or after her child was born. The hospital relied on the Supreme Court's parens patriae jurisdiction.1 The court looked at Dept of Health and Community Services (NT) v JWB and SMB (Marion's case) (Marion's case),2 in which the High Court described the common law in Australia with respect to the legal capacity of minors to give or refuse consent to medical treatment.[3] In the present case, the court considered the balance between Gillick competence4 and the parens patriae jurisdiction in the context of the overriding duty to do what is in the best interests of the child.

Background

At the time of the application, the first defendant (D1) was a 17-year-old woman who was 38 weeks pregnant. D1 consented to induction of labour to take place at the hospital operated by the plaintiff. She also consented that, if necessary, a caesarean section be performed to deliver her baby. D1 was of very small stature, it was her first baby and the baby was quite large, so the risk of requiring a caesarean section delivery and of associated post-partum haemorrhage was a significant one.5

D1 is an adherent of the Jehovah's Witness faith. The hospital sought her consent to the administration of blood or blood products during or after delivery, if necessary to prevent serious injury or save her life. D1 refused such consent, because such administration is contrary to her faith as a Jehovah's Witness. D1 was a minor under law and so consent was sought from D1's mother, the second defendant ("D2"), who is also an adherent of the Jehovah's Witness faith. D2 informed the hospital that, if asked, she would not provide consent to the administration of blood or blood products to D1.6

The hospital brought an urgent application to the court for a declaration:

that the [hospital] is authorised to administer to [D1] blood and/or blood products as considered reasonably necessary by her treating medical practitioners to save her life or to prevent serious injury during the course of induction of labour, labour, caesarean section and related procedures and the postnatal period in regard to her pregnancy.7

Questions for the court to answer

Five issues required determination by the court:8

what orders if any should be made to protect the identity of D1 from being disclosed to the public; given that D1 [was a minor but aged 17 years,] should the requirement in Order 15 of the Supreme Court (General Civil Procedure) Rules 2015 that she defend the proceeding through a litigation guardian be dispensed with; in its parens patriae jurisdiction, is this Court only concerned with the interests and well-being of D1 or must it also be concerned with the interests and well-being of her unborn baby, or of the baby when born; is this Court's parens patriae jurisdiction affected by the Medical Treatment Planning and Decisions Act 2016 (Vic) ("the MTPDA") or the [Human Tissues Act 1982 (Vic)] HTA; should this Court make the declarations sought?

The court briefly answered the first three of these questions. Firstly, a pseudonym order was made to protect the identities of the defendants together with a suppression order.9Secondly, the requirement of a litigation guardian was dispensed with as D1 had representation comprised of counsel and instructing solicitor. And thirdly, the court found that it was not necessary for the unborn baby to be separately represented at the hearing.10

Therefore the court focused on the remaining two questions: namely, whether the court's parens patriae jurisdiction is affected by certain statutes that provide for the making of medical treatment decisions and whether the court should make the declaration sought.11

Parens patriae jurisdiction

The parens patriae jurisdiction of the Supreme Court of Victoria is preserved by way of s 85(3) of the Constitution Act 1975 (Vic). The High Court in Marion's case illustrated that the parens patriae jurisdiction is an inherit jurisdiction to do what is for the benefit of the child.12 The court's care is a direct responsibility for those who cannot look after themselves.13

An issue in this case concerned the capacity of D1 to refuse medical treatment, that is, whether she was Gillick competent. The court noted the proposition for Gillick competence, as summarised by the High Court, as follows:

... parental power to consent to medical treatment on behalf of a child diminishes gradually as the child's capacity and maturity grow and that this rate of development depends on the individual child ... A minor is, according to this principle, capable of giving informed consent when he or she "achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.14

Macaulay J considered several Australian cases where, in the exercise of the parens patriae jurisdiction, the courts have been asked to authorise the administration of blood or blood products to a minor, who along with their parent, and for reasons associated with the beliefs of Jehovah's Witnesses, have refused to give such con- sent.15

In Minister for Health v AS16 it was Pullin J's view that the paramountcy of the welfare of the child meant that protection of the child was to be elevated above all other interests, although those other interests were not to be disregarded and as such, the court ordered the child receive treatment.17

In X v Sydney Children's Hospitals Network,18 Basten JA noted that religious beliefs, particularly minority religious beliefs, are not to be disregarded because they may be deemed irrational by broader community standards; his Honour observed that religious beliefs are internationally accepted as an aspect of an individual's fundamental autonomy which the state cannot interfere with and must not disregard.19 The Court said that:

To accord a religious belief weight is not to treat it as determinative. There may be cases in which the strength with which a belief is held, and the distress which would be caused by treatment which overrode that belief, might diminish the effectiveness of the treatment[.]20

Macaulay J then considered a Canadian decision of Malette v Shulman21 (Ontario Court of Appeal), conceding that the following statement was not made in the context of the exercise of the parens patriae jurisdiction but, in the light of autonomy of choice for the "mature minor", Macaulay J deemed it helpful:

The state's interest in preserving the life or health of a competent patient must generally give way to the patient's stronger interest in directing the course of her own life... Recognition of the right to reject medical treatment cannot, in my opinion, be said to depreciate the interest of the state in life or in the sanctity of life. Individual free choice and self-determination are themselves fundamental constituents of life. To deny individuals freedom of choice with respect to their healthcare can only lessen, and not enhance, the value of life.22

Ultimately, Basten JA provided helpful guidance when considering a choice made by a child, even a child thought to be Gillick competent:

The interest of the state in preserving life is at its highest with respect to children and young persons who are inherently vulnerable, in varying degrees... Vulnerability lies at the heart of the disability identified by legal incapacity.23

Statutory framework

The following statutory provisions were considered by the court in their impact on the exercise of the court's parens patriae jurisdiction.

Human Tissues Act 1982 (Vic) (the HTA)

Section 24 of the HTA makes provision for administration of blood transfusions to children without consent. In defined circumstances, it relieves medical practitioners from criminal liability for administering a blood transfusion to a child where the consent of a parent of the child or some other person having authority to consent has been refused or not obtained. It applies where, in the opinion of a registered medical practitioner, the blood transfusion is a reasonable and proper treatment and without it the child is likely to die. A second concurring medical opinion must also be obtained or, in the case of an emergency or the unavailability of a second opinion, specified senior hospital officers may give consent. Section 24(2) provides that if a blood transfusion is administered to a child in accordance with the section, the transfusion is for all purposes "deemed to have been administered or taken with the consent of a parent of the child or of a person having authority to consent to the administration of the transfusion."

The court was informed by the hospital that it considered that it could administer a blood transfusion to D1 in the circumstances contemplated by and in accordance with the procedures outlined in s 24 and rely upon it for its own protection.24 However, the court was not convinced that it should equate the welfare of the child, as understood in the parens patriae jurisdiction, with the interests of the child as protected by the HTA. The relevant provisions of the HTA are only engaged if and when the child is "likely to die",25 and authorises lifesaving blood transfusions on medical considerations alone.26

The parens patriae jurisdiction exists so that, in appropriate circumstances, even the parents' wishes (deemed or otherwise) can be overridden. Despite the existence of s 24 of the HTA, the parens patriae jurisdiction serves a vital purpose beyond the narrower concern of that Act. The scope of the protective jurisdiction is larger, to take into account all of the welfare interests of the child — medical, spiritual, personal autonomy and identity. The two do not cover identical territory.

The Medical Treatment Planning and Decisions Act 2016 (Vic) (the MTPDA)

The MTPDA came into force on 12 March 2018. Relevantly, one of its main purposes was to provide for a person to execute an advance care directive (ACD) that gives binding instructions or expresses the person's preferences and values in relation to the person's future medical treatment.27

Section 17 of the MTPDA requires that any witness to an ACD must certify that the person giving it appeared to have "decision-making capacity" in relation to each statement and, in particular, appeared to under- stand the nature and effect of each statement in the directive.

Decision-making capacity is defined in s 4 to require that the person be able to:

understand the information relevant to the decision and the effect of the decision; retain that information to the extent necessary to make the decision; use or weigh that information as part of the process of making the decision; communicate the decision and the person's views and needs as to the decision in some way...

However, even if a child gave an instructional ACD to refuse consent for a blood transfusion, s 24 of the HTA would still permit a hospital to administer blood in an emergency in order to save the child's life without rendering the hospital criminally liable. Indeed, providing s 24 was complied with, the procedure would be deemed to have taken place with the parents' consent.

The court noted that, for children to make an ACD to effect or limit the court's parens patriae jurisdiction in relation to children, three things should be noted:28

it would take the clearest language to displace the Court's jurisdiction, and no such clear language exists; there is no statement made under s 85(5) of the Constitution Act to repeal, alter or vary s 85(3) of the Act which confers the Court's parens patriae juris- diction; and in the Second Reading Speech introducing the Bill to Parliament, the Minister for Health expressly stated that the Bill would not remove the parens patriae jurisdiction of this

In this case, no ACD was certified for D1, thus none was in force. Therefore, there was no need to consider if and to what extent a binding ACD should affect the court's exercise of its protective jurisdiction.29

Evidence

The hospital filed two affidavits of Simon John Cooke – the affidavits exhibited various passages of D1's medical and social work records and a report prepared by Dr Jacqueline van Dam, the Director of Maternity Services at the hospital. Mr Cooke's affidavit also disclosed that Dr van Dam had arranged for D1 to be examined by Associate Professor Campbell Paul, a consultant infant and child psychiatrist at the Royal Children's Hospital, Melbourne, on 28 August 2018 in order to establish his opinion about the capacity of D1 to refuse her consent to the administration of blood or blood products in the course of, or following, the birth of her baby.30

Also exhibited to the affidavits were two partially completed ACDs signed by D1, some information pro- vided to D1 about ACDs and the report of Associate Professor Paul. Associate Professor Paul and Dr van Dam were called to give evidence and were both cross-examined.31 D1 and D2 declined to give any evidence at the application, however D2, through an interpreter during final submissions, made several state- ments to the court that were in the nature of evidence.32

D1

D1 was born overseas on 26 August 2001. D1 arrived in Australia in 2009 as an 8-year-old with her family as refugees. Her parents subsequently divorced and D1 lived with her mother and her six siblings. D1 informed the hospital that her pregnancy was planned with her former partner, with whom she had no contact with for 2 months prior to presenting to the hospital.33

In early March 2018, D1 was 12 weeks pregnant and she booked the birthing of her baby with the hospital. At this time D1 was 150 cm tall and weighed 44 kg. Dr van Dam reported her to be a "very small built girl".34

During D1's pregnancy she had been receiving some support from a refugee support agency and from the student wellbeing staff at her school. D1 was continuing with her studies and was focused on her exams until they were completed in mid-June 2018. On 2 July 2018, it was reported that D1 had passed her year 10 exams.35

By 9 July 2018, social work records revealed that a person from D1's maternity support group was informed by D1 that she and her family were Jehovah's Witnesses and accordingly, did not believe in blood transfusions. There was no reference to this in the medical records. Social work records dated 31 July 2018 revealed that D1 was advised "as a priority" to organise an appointment with either a midwife or an obstetrician to discuss an advance care plan because of the impact her religious beliefs could have on the health of her and her baby. On 1 August 2018, the social work records revealed that the above was reiterated to D1 again.36

On 7 August 2018, the social work records confirmed that D1 would not receive blood products and D1 was again advised to organise a obstetric appointment.37 On 7 August 2018, the medical records for the first time made reference to D1 being a Jehovah's Witness — by which time D1 was 34.6 weeks pregnant. The medical records stated:

SW notes advise [D1] is Jehovah's Witness. [D1] and mother confirmed this and will decline any blood products. Require OBS appointment to complete advance care directive/ refusal of treatment form and arrange anaesthetic referral.38

On 10 August 2018, the medical records noted that D1 attended with D2 to discuss D1's treatment in light of her religious beliefs. The records indicated that D1's brother was included in the conversation by telephone. D1 was asked to have an open discussion with her family and clergy and to put clearly in writing a plan for the blood products she would or would not accept in the event of hypovolemia or volume resuscitation.39 D1 was asked to return for review on 15 August 2018.

On 15 August 2018, D1 consulted Dr van Dam; D1 was then 36 weeks pregnant. In attendance at this appointment were D1, D2 and a person from D1's Jehovah's Witness community named "Jill". According to the medical records, the discussion about blood products was postponed, as D1 was "not ready to discuss". Dr van Dam informed D1 that she would need to give specific instructions in relation to what specific products or procedures she would accept. D1 was given written information about ACDs and a form to fill out which outlined her ACD. Dr van Dam noted the need to review the option of having a child psychologist present.40

On 22 August 2018, D1 was then 37 weeks pregnant. The medical records were silent as to any further discussion relating to the ACD. The notes stated that the baby was measured as being on the 88th percentile for growth.41

Dr van Dam's report

In her report, Dr van Dam stated that she had to prompt D1 several times to inform the midwife about her religious beliefs regarding blood or blood product transfusions. Dr van Dam also pointed out to D1 that she had not completed the part on her registration form that required details about her religion.42

Dr van Dam's report outlined observations made about D1:43

D1 was very quiet and polite and appeared to rely on Jill and her mother to answer questions and when asked directly, referring to them before answering.

An interpreter was offered to D1, as her mother required an interpreter for complex discussions. It was also noted that D1 wrote on the hospital's paperwork that her preferred language was a language other than

D1 was informed of the risks of bleeding in labour as well as the implications of a large amount of blood loss, including death. D1 gave only one answer repeatedly: "I do not want blood".

Dr van Dam was not satisfied that D1 had thought the issues through or grasped the gravity of the

At their first consult on 15 August 2018, Dr van Dam felt that D1 was not sufficiently prepared to have a discussion about ACDs as she had not yet read or considered any of the paper- work given to her by the midwife the week before— all pertaining to blood and blood products.

Dr van Dam was not satisfied that D1 was aware of the different products (including which were blood and which fractions of blood, etc.) in circumstances in which blood or blood products might be offered. Dr van Dam postponed further blood product discussion to 22 August 2018 and ensured that an interpreter would be

Dr van Dam outlined questions D1 needed to consider and gave her a printed list of these. D1 was reminded several times by the social worker in the week between these two visits (on 15 and 22 August 2018) to attempt to complete or think about the questions — D1's answer was that she was busy and would get to

The ACD was then part-completed by her on 21 August and D1 brought this along to the 22 August 2018

Dr van Dam held the opinion that the ACD completed at home did not reflect D1's way of speaking or her writing style and seemed to have been completed with the assistance of

Dr van Dam believed D1 to be of average intellect, but immature. Dr van Dam noted that D1 passed year 10 exams and was planning to return to school in

Dr van Dam's impression of D1's understanding of the nature and consequence of her refusal of blood transfusion in a life-threatening situation including the consequences for herself, her family and her child was limited. D1 believed (naïvely) that all would be well and that if anything happened she would be protected by her faith. There appeared to be a clear component in her discussions of wanting to please both her mother and Jill when refusing blood.

At the consultation on 15 August 2018, Dr van Dam asked D1 why she didn't carry the usual Jehovah's Witness card that states the refusal of blood products. Jill replied on behalf of D1, stating that D1 had not yet been baptised and was not recognised by the church to be able to carry the card. Dr van Dam asked D1 why she had not completed her religious preference on her registration form, and Jill answered for D1 again, stating that D1 had only started her religious studies and was not yet comfortable stating that on the form.44

Dr van Dam was concerned that D1 did not have the understanding or conviction to refuse the blood in case of dire emergency. Dr van Dam then arranged for D1 to be assessed by Associate Professor Paul.45

Dr van Dam, in her report, identified the risks associated with bleeding during pregnancy; in D1's case being that it is her first baby and a big baby and the labour will possibly be long or obstructed with a retained placenta.46 Dr van Dam identified that, in the event of a post-partum haemorrhage, the following options were available to a patient:47

oxytocin or other drugs that may slow down the bleeding

whole blood

blood products, such as:

plasma

platelets

cryoprecipitate

surgical solutions to stopping bleeding can be a laparotomy or a hysterectomy

The court noted evidence from Dr van Dam (whether in a report or as part of oral evidence is unclear) that a 20% loss of total blood volume triggers the need for blood volume resuscitation, as the patient will begin to show signs of hypovolemic shock. Some symptoms, Dr van Dam explained, can be treated by infusion of clear fluids and volume expanders — but those products do not assist in the transport of oxygen. Transfusion with whole blood and blood products allows replacement not only of the volume but also the oxygen carrying and clotting factors in the blood. Ongoing blood loss without replacement of blood will leave to multi-organ failure and ultimately, death.48

Associate Professor Paul's report

Associate Professor Paul is a consultant child and adolescent psychiatrist at the Royal Children's Hospital. He saw D1 for 2 hours on 28 August 2018, speaking with her alone extensively.49

D1 informed Associate Professor Paul that she had attended the Jehovah's Witness church since she had been in a refugee camp with her family overseas. D1 continued to attend Sunday school at the church whilst living in rural Victoria, but in recent years had attended once or twice a week including taking formal bible studies.50 D1 informed Associate Professor Paul that she was not yet baptised, but especially liked reading bible stories.

D1 told Associate Professor Paul she had been in a relationship with the father of her child for some months before becoming pregnant; D1 also said she was happy to become pregnant. D1 knew that having sex before marriage was against the values of the Jehovah's Witness community. Although D1 had broken the community rules she said she might be forgiven if she was remorseful.51 D1 reiterated to Associate Professor Paul a number of times, and in writing, that she did not want to receive any blood or blood products during the course of her pregnancy or delivery, even if there were very serious complications and even if she might die without them.52

Associate Professor Paul considered D1 was lucid and fully coherent. He did not believe D1 had any significant ongoing mental health disorder.53 He examined her attitude towards potential treatment with human blood products. He said D1 willingly completed the ACD in his presence with no pressure from others; D1 was very clear in a statement both written and verbal that should she become acutely ill during pregnancy or delivery and require emergency treatment she would refuse any human blood products.54In support of her refusal, D1 went on to quote the part of the bible that refers to the eating or drinking of blood being prohibited, and her desire to make Jehovah happy, stating she would rather die than receive blood products.55

Associate Professor Paul asked D1 to consider the potential impact on her baby if there were serious complications during labour. D1 said she had not thought about it; but went on to say that "if the baby has to die, she has to die".56

Associate Professor Paul believed that D1 had "a clear and consistent belief that she must not receive human blood products", although she told him that she held her beliefs freely. He expressed that it could be possible that D1 was to "some degree" dependent on her family and community in making decisions about her life so as to accord with the Jehovah's Witness' values and beliefs.[57] This was especially so in the circumstances where D1 had transgressed a major rule not to have a sexual relationship before marriage. Associate Professor Paul thought D1 might have been unduly dependent on her community and feel the need to comply with its strict religious values given her present circumstances.

Associate Professor Paul expressed three important views about D1:58

he was uncertain [whether] D1 had been able to fully weigh up all of the information relevant to making a decision to refuse human blood products in an emergency; he did not believe D1 had given due consideration to the impact of her refusal of blood products and her possible death upon the life of her baby, and the impact of that upon the baby's father and others in her family; and he did not believe D1 had considered the impact upon her child of being deprived of its mother for the rest of its life or of the possible disability her baby might experience in the course of her labour if she was compromised by not having access to blood

In light of the above factual matrix and aforementioned legislative requirements, Associate Professor Paul was asked to witness D1 completing an ACD made under the MTPDA.[59]Ultimately he felt unable to witness D1's ACD.60

D2's final submission statements

Despite not giving oral evidence, through an interpreter in final submissions, D2 made several statements to the court that were in the nature of evidence. D2 was not tested on them.

D2 told the court that she believed:61

... D1 would suffer psychological harm by being forced to have a blood transfusion; being forced to have a blood transfusion would be like having violence done to her, or being raped; she is not convinced there may not be side-effects from a blood transfusion; she wants to do the right thing by Jehovah; she, D2, has herself had 9 children — including one by caesarean section — without a blood

The court's observations of D1

The evidence relied upon was taken from the affidavits of Mr Cooke, the medical and social work records of the hospital in the report of Dr van Dam and the report of Associate Professor Paul and oral evidence given at the hearing.62 The court, after considering the evidence, made the following observations about D1:

D1 is at least of average intellect for her age and capable of processing information and making informed decisions. It is not suggested that she is conspicuously intelligent for her age or advanced in her thinking. 63

Doubt was cast upon her maturity as she just turned 17 years old. Dr van Dam characterised her as "immature" and Associate Professor Paul was silent on that 64

Dr van Dam and Associate Professor Paul expressed reservations about D1's understanding of the nature and consequence of the refusal of a blood transfusion in a life-threatening situation. Dr Van Dam thought her understanding was "limited". Associate Professor Paul did not believe D1 had considered or given due consideration to those In short, he was not certain that she had completely understood the full implication and complexity of the impact of her decision. 65

Several factors combined to cast doubt on the maturity and solidity of D1's personal adherence to the principles of the Jehovah's Witness 66

A matter for consideration was the extent to which D1's choice reflected a deeply held faith conviction that is part of who she is and thus deserved to be weighed heavily in the The court noted the following points: 67

Associate Professor Paul thought D1 had expressed a clear and consistent belief that she must not receive human

D1 had been a member of the Jehovah's Witness faith since a young child and her involvement had recently

D1 was not yet a baptised member of the Jehovah's Witness

D1 did not immediately volunteer her religion to the hospital or make objection to taking blood during the early stages of her antenatal care.

D1's attention to discussing and making a choice about her medical treatment were not her top

Associate Professor Paul expressed that, in various ways, D1 felt dependent on her faith community due to a sense of gratitude for its past support but, more subtly, because of her awareness of her past transgressions of the community's beliefs and

As a result of these various considerations, the court found it difficult to be confident that D1's expressed choices were the product of an independently formed, carefully considered and long-held adherence to the tenets of the Jehovah's Witness faith.

Conclusion

At the time the judgment was handed down D1 had turned 17 less than a week beforehand.68 The court noted that evidently, s 24 of the HTA was not at that time engaged and as such the court reminded the parties that, the parens patriae jurisdiction at this time invoked, enjoyed a wider purview regarding the interests of the child beyond mere physical survival.69 The critical issue for the court to decide was whether it considered that the expressed view of D1 and her mother, D2, should be allowed to direct the hospital in its medical treatment should an emergency arise and D1's life was put at stake without a blood transfusion.70

The court considered D1's level of maturity, her understanding of what her best interests are, whether she had sufficient understanding and intelligence to enable her to understand fully what is proposed and the consequences of her decision and what her beliefs are.71 Ultimately, the court was not satisfied that D1 had a sufficient understanding of the consequences of her choice. The court was further not convinced that D1 had based her choice on a "maturely formed and entrenched religious conviction."72

The court thought it appropriate that any declaration be made upon the undertakings that the hospital agreed to give; accordingly the court ordered:73

UPON the plaintiff undertaking to use all strategies other than the transfusion of blood or blood products which in the opinion of D1's treating medical team are reasonably available and clinically appropriate with the aim of attempting to avoid D1's death or serious injury, ... that the plaintiff is authorised to administer to D1 blood and/or blood products as considered reason- ably necessary by two registered medical practitioners to save her life or to prevent serious injury during the course of induction of labour, labour, caesarean section and related procedures and the postnatal period in regard to her current

For a judgment of only 24 pages, this decision packs a punch in reiterating the far-reaching parens patriae jurisdiction for the ultimate protection of children, and children against their own interests in light of Gillick competence. For those in the medical and legal professions, it serves as a reminder of the important and complex balance between a medical practitioner's duty of care and the observation of religious rights of patients; it also reminds readers that applications of this kind are not taken lightly and there must be a bona fide risk to the patient for an application of this kind to be heard.

Footnotes

1Mercy Hospitals Victoria v D1 [2018] VSC 519; BC201808208 at [4].

2 Dept of Health and Community Services (NT) v JWB and SMB (Marion's case) (Marion's case) (1992) 175 CLR 218; 106 ALR 385; 6 AJFL 97; 15 Fam LR 392.

3Dept of Health and Community Services (NT) v JWB and SMB (Marion's case) (Marion's case) (1992) 175 CLR 218; 106 ALR 385; 6 AJFL 97; 15 Fam LR 392.

4"Gillick competence" is in relation to Gillick v West Norfolk & Wisbech Area Health Authority [1986] AC 112; [1985] 3 All ER 402; [1985] 3 WLR 830.

5Above n 1, at [1].

6Above n 1, at [2].

7Above n 1, at [3].

8Above n 1, at [6].

9Above n 1, at [7].

10Above n 1, at [8].

11Above n 1, at [9].

12Above n 1, at [45].

13 Above n 2, (1992) 175 CLR 218 at 259; above n 1, at [45].

14Above n 1, at [47] citing above n 2, (1992) 175 CLR 218 at 237.

15Above n 1, at [48].

16Minister for Health v AS (2004) 29 WAR 517; 33 Fam LR 223; [2004] WASC 286; BC200409491.

17Above n 1, at [50].

18X v Sydney Children's Hospitals Network (2013) 85 NSWLR 294; 304 ALR 517; [2013] NSWCA 320; BC201313311.

19Above n 1, at [52].

20Above n 18, at [65].

21Malette v Shulman (1990) 72 OR 2d 417.

22Above n 1, at [54].

23Above n 1, at [56].

24Above n 1, at [60].

25In this case, the court was only asked to consider D1 as the child, not also D1's unborn child. It is worth noting that whilst the court in this case did not take into account the risks to the child about to born, there is precedent where, in the jurisdiction of parens patriae, the court has been asked to make determi- nations about care that may be required for the unborn child to receive upon it being born. See Re Sydney Children's Hospital Network [2018] NSWSC 1259; BC201807123.

26Above n 1, at [62].

27Above n 1, at [65].

28Above n 1, at [67].

29Above n 1, at [68].

30Above n 1, at [10].

31Above n 1, at [11].

32Above n 1, at [38].

33Above n 1, at [13].

34Above n 1, at [14].

35Above n 1, at [15].

36Above n 1, at [16].

37Above n 1, at [16].

38Above n 1, at [17].

39Above n 1, at [18].

40Above n 1, at [19].

41Above n 1, at [19].

42Above n 1, at [21].

43Above n 1, at [22].

44Above n 1, at [23].

45Above n 1, at [23].

46Above n 1, at [24].

47Above n 1, at [25].

48Above n 1, at [25].

49Above n 1, at [28].

50Above n 1, at [29].

51Above n 1, at [30].

52 Above n 1, at [31].

53Above n 1, at [32].

54Above n 1, at [33].

55Above n 1, at [34].

56Above n 1, at [34].

57Above n 1, at [35].

58Above n 1, at [36].

59Above n 1, at [26].

60Above n 1, at [37].

61Above n 1, at [38].

62Above n 1, at [12].

63Above n 1, at [40].

64Above n 1, at [41].

65Above n 1, at [42].

66Above n 1, at [43].

67Above n 1, at [43].

68Above n 1, at [13].

69Above n 1, at [72].

70Above n 1, at [73].

71Above n 1, at [73]–[74].

72Above n 1, at [76].

73Above n 1, at [78].

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.