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High Court rules that baby must have cataract surgery.

Gill Honeyman appeared for the child in the medical treatment case of Re EQ [2016] EWHC 3418 (Fam) which was heard by Mr Justice Francis on 14th December. The case concerned a 13 week old baby who had developed dense congenital cataracts in both eyes shortly after birth, but after being discharged from hospital. The diagnosis was confirmed by Moorfields Hospital on 1st November and the recommendation was that the cataracts should be removed in two separate operations under general anaesthetic.

The medical evidence was that if surgery took place within a ten week window of the cataracts appearing, there was a 66% chance of EQ achieving an outcome of half of normal vision by the age of six, although there was a 10% chance of her developing glaucoma and 70% chance that she would have a squint. If that window was missed the chances of reasonable sight “fell off a cliff” according to the consultant ophthalmic surgeon, Miss Adams. Put simply, the child’s brain would not be able to develop the ability to learn how to see.

Very sadly the mother had been born with the same condition, and had undergone similar surgery at only five days of age; subsequent research has established that such early surgery brings with it a higher risk of a poor outcome. She developed glaucoma and other complications and has had a very difficult life as a result. Her written and oral evidence vividly described the pain and suffering that she has endured. Miss Adams’ evidence was that her experience was exceptionally rare.

The mother did not agree to EQ undergoing the surgery, for entirely understandable and child-centred reasons. She did not want her daughter to undergo the pain and difficulty that she has had to contend with. She also argued that her own sight impairment had not prevented her from leading a normal life and that EQ would be able to lead a free and independent life without the risk of surgery. She had indicated however that she would probably have consented to the surgery if it could be guaranteed that EQ would not develop complications.

Mr Justice Francis made it plain that he did not view the mother as “someone with a disability” or start with the proposition that “her life-because she is blind- is any worse than the life of a sighted person.” He paid tribute to the way in which the mother and maternal grandmother conducted themselves and was completely satisfied that their opposition to the surgery was “founded completely in their desire to do what is best for EQ.” He underlined that although he found that the mother was not able to be objective because of her life experiences, he did not criticise her for it. He took into account in his objective welfare analysis the undoubted effect on the mother if she was “worrying all the time about the possibility that EQ may develop difficulties following surgery.”

Having considered the risks and benefits to EQ, the clear conclusion was that it was in EQ’s best interests to have the surgery. The mother had assured the court that however strongly she opposed the surgery, she would accept the court’s decision and co-operate fully with the necessary preparation for surgery and the requirements for on-going aftercare and the court had no doubt that she would do everything she could to protect her baby from complications.

No doubt anyone reading the judgment would share Mr Justice Francis’ heartfelt hope that the surgery, scheduled to take place in the days following the judgment, would be a success.

Gill Honeyman

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