The High Court directed that a five-year-old boy in its wardship proceed with recommended curative intent treatment for very high risk neuroblastoma, to begin as soon as possible. Mr Justice Kelly, President of the High Court, delivered the judgment on 22 October 2019 after the boy’s parents disagreed over whether treatment should continue.
The boy’s mother supported treatment, while his father sought palliative management or a delay until after Christmas. The treating oncologist said waiting until 2020 would mean palliative intent because the tumour could become active again and harder to control. The hospital brought the wardship application after efforts to secure agreement failed.
The treatment recommended by the Dublin oncologist, a colleague and an outside paediatric oncology expert involves high-dose chemotherapy and stem-cell rescue, with further treatment if appropriate. The judgment records that the experts considered there to be a realistic possibility of cure, while the prognosis remained poor. The treating consultant estimated a 2–3% mortality risk from the high-dose treatment and described likely significant side effects. The proposed course could last a year if completed.
The court also considered the boy’s views, obtained through a consultant clinical psychologist. He said he did not want more chemotherapy and wanted to avoid hospital, sickness and discomfort. The psychologist told the court that, at five, he lacked the capacity to weigh treatment risks and benefits and did not understand the possibility of becoming seriously ill or dying without treatment. The judge gave his views due consideration but found he lacked the maturity and insight to understand his position.
Applying the child’s best interests as the paramount consideration, Mr Justice Kelly concluded that treatment should proceed. He cited the strong presumption in favour of preserving life, the unanimous medical recommendation and the realistic possibility of cure. He also found that starting the first month-long phase promptly could mean no treatment during Christmas, addressing one of the father’s concerns.
The order was not a direction to continue treatment regardless of its effects. The judgment said treatment would be carefully monitored and reviewed, and should cease if it proved ineffective or the boy could not tolerate it. The court directed that the recommended treatment begin as soon as possible to reduce the risk of the tumour becoming active again.