2026 IEHC 341

1 [APPROVED] [REDACTED] THE HIGH COURT WARDS OF COURT [2026] IEHC 341 Record No. WOC11920 IN THE MATTER OF AN INTENDED APPLICATION FOR MINOR WARDSHIP IN THE MATTER OF:FB [A MINOR] Ex Tempore JUDGMENT of Mr Justice David Barniville, President of the High Court, delivered on 15th May 2026

1. Introduction
2. This is an application brought by the Health Service Executive (the “HSE”) for various orders in the context of minor wardship proceedings which come before me on a very urgent basis this afternoon. The proceedings concern an 8-month-old baby, named ........... (hereafter “FB”) who is currently on a children’s ward at ........................... (the “hospital”) having been admitted to the hospital yesterday. I will come to the particular circumstances of her admission in a moment.
3. The HSE’s application asks the court to give consent to, and to allow, the hospital to provide an urgent blood transfusion to FB in circumstances where she is very, very ill. She has sickle cell disease and has presented with life threatening anaemia in the 2 context of acute splenic sequestration. I will come to the evidence in a moment, but in summary it is clear that FB is at risk of significant deterioration or death if she does not receive a blood transfusion, immediately or in the very near future. She, therefore, requires such a transfusion, and the Hospital requires the authority to be able to provide such a transfusion on an immediate, urgent basis.
4. The reason why an application is being made to the court, under the court’s minor wardship jurisdiction, is that FB’s mother, JB, for religious reasons, is not in a position to, and is not prepared to consent to the transfusion for her baby. I will come to what JB has said to the Court, in the context of the application, but it is very clear that she is not prepared to provide consent, would prefer other means to be used to try and address her baby’s illness, and wants the opportunity to be able to provide care to her baby herself.
5. I heard evidence this afternoon from two doctors as well as from JB (the mother) and from Ms Maria Dillon (who is a solicitor, and who I appointed as Guardian ad Litem at the outset of the hearing this afternoon). Ms Dillon had been contacted earlier in the day, just before lunchtime, and had the opportunity of attending at the hospital at very short notice, meeting FB’s mother, and also seeing FB herself on the hospital ward. She discussed the position with FB's mother and has also spoken with Dr AH and some of the other doctors involved.
6. The Medical Evidence
7. The medical evidence that I heard this afternoon in this urgent application was from Dr AH, who is a Consultant General Paediatrician in the hospital, and I also heard evidence from Dr AD, who is a Consultant Paediatric Haematologist in Children’s Health Ireland (“CHI”).
8. In her evidence Dr AH explained that she was the consultant in charge of the particular ward on which FB was admitted. She told me that FB was admitted to the hospital at around 11:30 am yesterday morning (14 May), that she was seen a couple of hours later by the paediatric registrar and that she was presenting with what were viral-like symptoms (including coughing, vomiting, a runny nose, and so on). She had no documented high temperature, although her mother had reported that she had been quite hot.
9. On examination by the registrar, her spleen was palpable. This means that it was possible to feel her spleen, which is not a normal situation, and indicated that her spleen 3 was enlarged. The hospital is well aware of FB’s sickle cell diagnosis as she was born in the hospital. Given her age and known underlying diagnosis of sickle cell disease, there was a concern that she was presenting with a sickle cell crisis, or some other lifethreatening condition, including severe/acute anaemia or sepsis. Consequently, the hospital took FB’s situation very seriously, they took bloods and the results from the blood tests showed that her haemoglobin level was at 6.3 g/dl yesterday afternoon. This is a very low level and indicated an urgent need to act quickly.
10. Dr AH contacted the Paediatric Haematology Team in CHI and discussed the position with the Consultant Haematologist there. At that time, it was felt that FB was clinically stable and did not require an immediate blood transfusion. The concern was that FB had splenic sequestration, which is a life-threatening medical emergency where a large volume of red blood cells get caught in and accumulate in the spleen, causing very serious anaemia and enlargement of the spleen. Dr AH explained that the splenic sequestration is an ongoing process and if it continued, FB would have no reserve of haemoglobin, which is necessary to carry oxygen to her organs. Consequently, if the sequestration got any worse, she could lose her pulse, her heart could go into failure, and she could die quite quickly. Dr AH said that she was especially concerned about these consequences if FB’s haemoglobin fell below 5 g/dl, and that a transfusion is usually recommended if haemoglobin levels are below 6 g/dl. It was, therefore, necessary for FB to be admitted on an emergency basis to the hospital, and to be monitored on a regular basis.
11. Repeat blood tests were taken yesterday afternoon, and her haemoglobin level was at 7.1 g/dl at 5 pm last night. However, at about midnight FB’s haemoglobin level had gone down to 5.
12. Further bloods were taken at 3 am this morning and the level was at 5.7 at that stage. As a result, Dr AH (and her team) made contact with the haematology registrar on call in CHI last night. The view was that ideally, they would transfuse FB during the night, but given that she appeared to be stable, it was decided that they would assess the position again early this morning.
13. Dr AH spoke with the Consultant Haematologist in CHI again at 9 am this morning. Her view was that her haemoglobin level was so low, that serious consideration had to be given to the question of an urgent transfusion. The view was that while she appeared to be stable, there was a very high risk that her haemoglobin level would drop precipitously and if it did there was a very high risk of collapse on the ward, with serious and potentially fatal consequences. The concern was therefore that, if the haemoglobin 4 level did drop to such a low level, it would have extremely serious consequences, including a real risk of death. Short of death, the potential consequences were also very serious including the collapse/failure of her organs, including her heart and her brain, and there would be serious damage to those organs which would be life threatening or could have life-long consequences if she were to survive. The view at that time this morning was that the only option to address the position was a transfusion.
14. The latest haemoglobin reading, as of 12:30 pm today is 5.6 g/dl, so FB is below the level of 6 g/dl which would generally indicate a requirement for a transfusion. Dr AH recommended an immediate transfusion in the course of her evidence today, and she was concerned that there was a real risk that the haemoglobin level would fall suddenly, whether today, during the night, or tomorrow. While she said she would be guided by the consultant haematology expertise available to her, it was certainly her opinion that a transfusion was required, and she felt there was a high risk that a transfusion would be needed between the next 24-36 hours, although she did say she would be guided by the specialists. She discussed the consequences if the transfusion was not carried out. I have touched on these. They include death, brain damage or serious damage to other organs, which she described as multi-organ failure with life-long consequences, with the worst-case scenario being death. It was her view that if the haemoglobin level was to drop further FB was at serious risk of these consequences, and therefore there was an immediate need for transfusion.
15. Dr AH discussed the position, with input from the haematology team from CHI, with FB’s mother, JB. They had a number of conversations this morning and it was evident that JB was not in a position (for religious reasons, particularly) to consent to the transfusion. Dr AH explained that the last thing a doctor would want to do is to go against the mother of a child’s wishes. But in this case, because of the risks and the potentially very serious consequences for FB, Dr AH has concluded that a transfusion is required. Despite explaining the position to FB’s mother, she did not change her mind and has remained opposed to a transfusion. Her opposition is principally for religious grounds, but she also believes that there may be alternative treatments available, and she wants an opportunity to provide the care for her baby herself.
16. FB’s mother did raise the possible complications arising from a transfusion as she had heard stories from other people who had received blood transfusions and had had complications and adverse reactions. Dr AH was asked about this, and whilst she said she would defer to Dr AD, the Consultant Paediatric Haematologist, she mentioned 5 some possible complications. The possible complications include the transmission of infections and an adverse reaction to the transfusion. Dr AH explained that there were very comprehensive steps taken to minimise any complications in cases of transfusions like that which is sought to be given to FB. She explained that they always used crossmatching to test the patients' blood and the donor blood in the lab and they make every effort to reduce the risks of any form of transmission of disease or any form of rejection/reaction and so on.
17. She also confirmed that, in her view, there was no alternative to a transfusion, and the use of what are being described as “minor blood products” would be of no use in this case, as in her opinion FB requires actual red blood cells in order to ameliorate her condition. In terms of whether FB may need one or more blood transfusions Dr AH stated that she hoped that FB would only require one transfusion, however, given the nature of splenic sequestration she could not guarantee this nor could she rule out the possibility of multiple transfusions being required.
18. I next heard evidence from Dr AD, who is a Consultant Paediatric Haematologist in CHI. She is aware of FB’s case and her history, and she has been providing assistance to the paediatric team in the hospital and has been consulted in relation to the crisis situation which has arisen. She explained to me what is meant by splenic sequestration and believes that what FB is undergoing at the moment is acute splenic sequestration. Dr AD also explained that during splenic sequestration haemoglobin levels can fall precipitously at any time, creating an extremely serious and acute risk of death. She agreed with Dr AH’s explanation of the consequences and development of splenic sequestration and explained that this is one of the most serious and fatal complications of sickle cell disease. She described the risk here as being “a significant” or “very serious risk of death” were there not to be a transfusion. Short of death she mentioned other potential consequences of acute anaemia. But she said quite frankly that the most common outcome of the acute splenic sequestration FB is experiencing is death.
19. Dr AD was asked about the threshold for transfusion in terms of the haemoglobin level, she confirmed that the recognised haemoglobin level which would require a blood transfusion is 6 g/dl (or below), not just in the standards applied in this country, but in all the international guidelines of which she is aware. She also confirmed that her understanding is that since around 3 am, and certainly since 12:30 pm today, FB’s haemoglobin level is below
20. It is Dr AD’s opinion that a transfusion will be required immediately or almost immediately. 6
21. She explained that there is no treatment for acute splenic sequestration and as a result the doctors can only deal with the consequences of the splenic sequestration and that is why the transfusion of blood is necessary to stabilise and improve FB’s critical situation. She was very concerned that at any time FB’s haemoglobin level could fall quite dramatically and quite precipitously and that is why she was supporting an immediate transfusion for FB where her haemoglobin was less than 6 g/dl and particularly in the context of acute splenic sequestration.
22. Dr AD also addressed the potential side effects of transfusion, as this was clearly a concern of FB’s mother, JB, and she felt that whilst it may be the case that JB has heard of adverse reactions from jurisdictions other than Ireland, she felt that the position in the Irish setting is quite different. She explained that all measures are taken to ensure the safety of the transfusion and to minimise the risk of complications such as infection or a rejection of the donor blood. She explained that doctors do not undertake transfusions lightly as there is a risk of an adverse outcome, but those risks were described by Dr AD as being “vanishingly rare” and “infinitesimal”. Dr AD stated that in her 15 years or so as a consultant haematologist she has never seen a transfusion infection and she stated that the risks were “exquisitely small”. She also explained that the manner in which the transfusion would take place in the case of a small baby with sickle cell disease, would be very specific and all measures would be taken to prevent the risk of transfusion reaction or rejection. While she accepted that there are some risks of adverse consequences, she stated that they were very rare and must be weighed against the very serious risk of death in this case, without a transfusion.
23. Dr AD also explained that she had had a discussion with FB’s mother this morning, where she explained what the risks were, but also that they were very rare, and how they could be ameliorated by steps such as detailed crossmatching. Even in the event of some form of allergic reaction, she explained that that could be treated through the usual anaphylactic medication. She explained that they would be very cautious and careful in terms of the transfusion for a tiny baby like FB, and would be using small volumes of blood, in order to ameliorate the various risks.
24. When asked if it was possible or likely that FB would require further transfusions, Dr AD explained that it was difficult to say. She stated that they would be monitoring the situation very carefully but would have to wait and see how it developed, and that the need for further or repeated transfusion was certainly not out of the bounds of possibility. She explained that in being cautious and careful about how to transfuse a 7 baby with the condition that FB has, small amounts of blood would be transfused, and that may lead to a requirement for further transfusions in the future. But in her opinion, an immediate transfusion is appropriate and required in this case.
25. Dr AD was also asked whether there were any non-blood alternatives that could be tried in FB’s case. Dr AD explained that there were other cases where synthetic products were used but in this case the use of non-blood products was not appropriate, and, in any event, they take time to enable the body to respond, and there is no time in this case. She confirmed that an immediate transfusion of blood is required.
26. The Evidence of the GAL, Ms Dillon
27. Ms Maria Dillon, GAL, also gave evidence. She explained the circumstances in which she was engaged late this morning and how she attended at the hospital and met FB’s mother and discussed the position with her. She also met FB, who she described as “a beautiful baby” who appeared bright and engaged. But it was Ms Dillon’s understanding, having spoken to the doctors at the hospital, that this situation is timesensitive, critical and extremely urgent. It was Ms Dillon’s opinion in her position as GAL, that it would not be in FB’s best interest that she would be permitted to deteriorate further and get to a situation where she might require resuscitation and urgent admission to the Intensive Care Unit on the basis of her not getting a transfusion that she clearly requires on the basis of the medical evidence. Ms Dillon made the point that clearly JB’s religious views should receive the utmost respect, but they should not be the reason why FB does not receive the urgent life-saving treatment which the medical evidence clearly indicates she requires. Ms Dillon strongly supports the application for the Court making an order that would allow the doctors to carry out an immediate transfusion.
28. The Mother’s Views
29. I also heard from JB, and I am very grateful to JB for making herself available for this very urgent hearing, and for cooperating with the hearing and relaying her views to me at this very difficult and stressful time. JB was very anxious that the doctors would consider other options before proceedings with a transfusion. She outlined that it was not obvious that FB was very sick as she appears quite stable. She felt that if she were permitted to care for FB, she felt that FB’s blood levels would go up. She also mentioned that she was considering the use of alternative medicines which she felt might lead to an increase in her haemoglobin or blood levels. She wanted the 8 opportunity to consider other options before a transfusion was considered or carried out. She was also doubtful as to whether her baby was in a crisis situation and felt that it could be that FB just had the flu and needed rest. She wanted other options to be tried, and she said that if she was allowed to take care of FB herself, she felt that FB would be fine, and she wanted the opportunity to take care of her baby.
30. It has not been possible to make contact with FB’s father, but JB mentioned that she has spoken to him and he wants the best care possible for FB. JB said she told the father that she could provide FB with good care.
31. Findings of Fact
32. That is the evidence. I accept the evidence of Dr AH and Dr AD that FB is in a crisis situation as a result of likely acute splenic sequestration. I am satisfied, on the evidence I have heard, that the only treatment that can be provided to address that crisis situation is a blood transfusion. Without a transfusion, it is at least very possible, if not likely that FB will die. I fully accept the position of FB’s mother, JB, that she cannot consent to, and does not wish for, FB to receive a blood transfusion. JB is a member of the Jehovah’s Witness community, where blood transfusions are an anathema to members of that religious group. In those circumstances, she is not in a position to consent and does not agree with the transfusion.
33. I am very satisfied on the evidence that a transfusion is very likely to be immediately or almost immediately required in light of the serious potential for a rapid and precipitous fall in FB's haemoglobin level. It has fallen precipitously before. It is currently, at the most recent test as of 12:30 pm today, at 5.6 g/dl, which is below the threshold indicative of a requirement to transfuse.
34. I am also satisfied that on the evidence, all measures that can be taken, and all care that can be exercised, will be taken and exercised in relation to the transfusion itself. I completely accept the evidence of Dr AH and Dr AD in that respect. While there are potential complications and risks arising from any form of treatment, I am satisfied the risks are, as Dr AD described them “vanishingly rare” or “infinitesimal”. Those risks, including potential infection, reaction or rejection, are minimal and when weighed against the high risk of death if the transfusion does not take place, it leads me to conclude that there is only one outcome to this application, at least medically, I will come to the legal position in a moment, and that is to carry out a transfusion. Certainly, in medical terms, the doctors in the hospital require the court to consent, and the making 9 of an order, to allow them to transfuse on an urgent basis, and indeed to carry out further transfusions if necessary.
35. The Legal Position
36. I will come very briefly to the legal position. Mr McGuinness BL opened the case law to me. The leading case which deals with an issue such as this is In the Matter of JJ [2022] 3 IR
37. The judgment of four members of the court (O’Donnell, Dunne, O’Malley and Baker JJ.) delivered on the 22 January 2021 sets out very clearly the principles to be applied in a situation like this, where the parents of the child, or in this case the parent, is not supportive of either the withdrawal of treatment or the administration of treatment and what is to happen in that situation and the approach that is to be taken.
38. The Supreme Court endorsed the use of the minor wardship jurisdiction to address the situation. It felt that that was an appropriate procedure by which to have the issue determined. It also made very clear that the child and the parents have rights under article 42A of the Constitution. Article 42A.2.1° provides that “In exceptional cases, where the parents, regardless of their marital status, fail in their duty towards their children to such extent that the safety or welfare of any of their children is likely to be prejudicially affected, the State as guardian of the common good shall, by proportionate means as provided by law, endeavour to supply the place of the parents, but always with due regard for the natural and imprescriptible rights of the child.”
39. Mr McGuinness BL took me through some of the relevant paragraphs of the JJ judgment. The position is well summarised in para. 177 where the principles are set out. Many of the principles are applicable to the decision I have to make on this urgent application. There the Supreme Court summarised the principles as follows: “(i) A child has rights under the Constitution both individually as a person, and collectively as a member of a family. (ii) In most cases, the parents of a child under 16 years of age may agree on his or her behalf to a course of treatment proposed, or to the withholding of 10 treatment, and may provide positive consent to the administration of treatment where that is necessary to permit the treatment to be carried out. (iii) The Constitution recognises the benefits to a child of being a member of a family. The dynamics of relationships are sensitive and important and should be upheld where possible, as a child benefits, in multiple ways, from being a member of a family. (iv) In cases of disagreements between doctors and parents as to medical treatment, it may be necessary to distinguish between consent to treatment and the withholding of treatment. (v) In the case of the provision of consent to treatment, parents may be acting both as family members and parents, and as substitute consent providers. In such circumstances, the rights of the child have particular weight. (vi) The withholding of treatment to a child does not necessarily require parental consent to be lawful if it is based on a properly made decision as to the best medical interests of the child and it would be contrary to medical ethics to provide the treatment. However, it may be prudent in cases of dispute to seek a determination from a court that such a proposed course is not unlawful. In practice, the question of consenting to some treatment or withholding other treatment will often be interlinked and treated as a general issue of medical treatment, and if the wardship jurisdiction is invoked, the issue can be determined in a single set of proceedings. (vii) In the absence of a specific statutory procedure to resolve disputes as to the future treatment of a child, wardship jurisdiction may be used to determine if the court, in performance of the State’s duty under Article 42A, should supply the place of the parents and provide, in the particular circumstances, consent to treatment. (viii) The commencement of wardship proceedings may permit, at an early stage and before the making of a formal order taking a child into wardship, the making of protective orders, if necessary, and the procurement of independent evidence, if thought desirable by the court. A child should not 11 be admitted to wardship without full hearing and argument. In cases where the objective of the procedure is to permit the consideration of the question of whether the court should supply the place of parents in relation to the consent to medical treatment, the test for admission to wardship and the test for consent to treatment is not merely the best interests of the child, but rather whether the constitutional test has been satisfied: that is, that a decision of the parents, or the absence of a decision, is a failure of duty towards the child to such an extent that the safety or welfare of the child is likely to be prejudicially affected. It will, therefore, be convenient to deal with the decision to admit to wardship and the decision as to whether to supply the place of parents at the same time, and at the end of the proceedings. (ix) Making a decision to override a parental decision, particularly a decision of conscientious, committed parents, is not merely a matter of a court’s view of the medical evidence. The court should consider the nature and significance of the procedure involved, the extent to which the opinion of treating doctors is unanimous, is shared by independent experts, and the depth and conviction with which it is held. The court should, at all times, consider the possibility that the decision is one within the permissible range of family decisions. (x) The procedure is not a lis inter partes, but is rather an inquiry. It is not, therefore, a case for a standard or onus of proof. However, the court should only make the order sought when there is clear and convincing evidence establishing that the constitutional test is met, and where an opportunity has been afforded to test that evidence. 12 (xi) The decision does not involve the court making any judgement on the quality of life of a child. The test is not what decision the judge would themselves make in the situation, and a judge should be careful to avoid imposing the judge’s own, perhaps strongly held, views on the situation. Nor should the court hypothesise as to what the child in question might wish to do if that child had all the knowledge available, and the maturity to consider it. Instead, the test to be applied is that the court should decide what it considers that loving and considerate parents of this child would do if apprised of all the facts and evidence, and aware of the character, personality, and history of the child. (xii) If it is established by clear and convincing evidence that the decision of the parents is one which prejudicially affects the safety or welfare of a child, then exceptionality is not a separate requirement before the court may supply the place of parents. (xiii) Article 42A requires that the means by which the place of the parents is supplied by the State should be proportionate. Accordingly, wardship orders should be limited to the relevant decision as to those aspects of medical treatment where there is reason to believe that parental approval will not be provided. (xiv) Even where a child is admitted to wardship, and the consent is provided for treatment, it may be appropriate to provide that such consent only becomes operative if, having been given the opportunity to do so, parents refuse their own consent. (xv) Particularly in cases which do not involve a single emergency decision, but rather a consent to a care plan, it will normally be appropriate to provide for review within a relatively short period and, if necessary, further reviews at regular intervals.”
40. I applied those principles in a recent judgment in a case called In the Matter of DE [2025] IEHC 604, delivered on the 29 October
42. I am satisfied that in applying those principles in this case, in light of the evidence that I summarised earlier, it is very clear to me that I should make the orders now sought by 13 the HSE on this application. I am satisfied that applying the test, which is that the Court must decide what a loving and considerate parent or parents of a child would do if apprised of all of the facts and the evidence and if aware of the character, personality and history of the child. I am satisfied that in applying that test that I should make the orders sought. I am satisfied that it is established in this case by clear and convincing evidence that the decision of FB’s mother, JB, is one which prejudicially affects the safety, welfare and indeed the life of FB and, therefore, it is necessary and appropriate that this Court should supply the place of FB’s parent, JB, and of her father on the particular issue that has arisen, namely, whether FB should be transfused.
43. I am also satisfied that this is a case in which I consider not only the best interests of the child, which in this case is clearly in favour of transfusion, but I am also satisfied that the decision in this case by FB’s mother, to refuse consent, is a failure of duty towards FB for the purpose of the Constitution to the extent that the safety, welfare and life of FB is likely to be prejudicially affected on the evidence, as there is a real risk that she will die if she does not receive the transfusion.
44. For those reasons, therefore, I propose to make the orders sought by the HSE.
45. The Orders
46. Firstly, I note that a Minor Wardship Summons was to be issued and returnable before the Court today. I, therefore, grant the HSE the appropriate liberties to have the Minor Summons Issued and returnable before the Court now (at 2:40 pm on 15 May).
47. I will stress these orders are on a very limited basis for a very limited purpose, and I am in no way critical of FB’s mother JB for the decision that she has made. To describe it as a “failure” as I have done, and as the Constitution says, is not intended to be meant in a pejorative sense or impugning the care that FB’s mother, JB, generally provides to her daughter in all other respects. It is focused solely, and concerns solely, the consent to the transfusion.
48. First, I make an order pursuant to Section 45 of the Courts (Supplemental Provisions) Act 1961 that the proceedings herein be heard otherwise than in public.
49. Second, I have already appointed Maria Dillon as Guardian Ad Litem of the minor at the outset of the hearing.
50. Third, I make an order that the minor, FB, be taken into wardship to permit the exercise of the Court’s jurisdiction in wardship only in respect of the granting of an Order that 14 the Clinical Director of the hospital, the medical and nursing staff of the hospital, their servants or agents, may provide the minor with the following additional medical treatment namely the transfusion/administration of packed red blood cells, platelets, plasma, white blood cells or other blood products which are considered medically necessary by her treating clinicians and associated medical procedures including canulisation and such repeat transfusion/administrations as are considered medically necessary.
51. Fourth, I make an order that the minor, FB, remain in the hospital until medically discharged by her treating consultants in said hospital.
52. Fifth, I will make an order that the parents of the minor, be appointed joint guardians of the person and of the fortune of the said minor in wardship.
53. I will review the matter on Friday 5 June
54. I will grant the parties liberty to apply and I will reserve the Guardian ad Litem’s costs.
55. Finally, I would like to thank Dr AH, Dr AD and Maria Dillon (GAL) for dealing so urgently with this case. I want to also renew my thanks to JB for her commitment and cooperation with this process today. Lastly, I would also like to express my best wishes for FB, and I sincerely hope her treatment goes well. Postscript
56. Since delivering this judgment, I have been informed that the blood transfusion has taken place and baby FB is recovering well. I once again extend my thanks and best wishes to the parties involved.