An update from a regular series written by Mr Robert Wheeler, director, department of clinical law, where he considers various aspects of clinical law that our nursing staff, medical staff and other professions rely on when caring for patients.

Following the decision in Re J [2024] EWHC 1034 (Fam), it became evident that the English courts would in very limited circumstances allow a child to refuse blood transfusion (1). In that case, the refusal of a nearly-18-year-old Jehovah’s Witness to accept blood transfusion in the event of bleeding during an elective pyeloplasty was accepted as determinative. This was the first time that such a refusal in childhood was ratified by an English court (2). The surgical field for elective pyeloplasty was benign; the court was told that the likelihood of bleeding was ‘very low’. The judge noted that J was ‘…only a matter of weeks away from being an adult as a matter of law…having limited but nonetheless evolving experience of mature decision making…after the death of someone he was fond…already showing many attributes of adulthood. I am satisfied that he knows his own mind…J’s clear and unequivocal decision in this regard, and his reasoning, are rooted in his faith.’

In Re JPMB [2026] EWHC 1361 (Fam) a court adopted the reasoning In Re J and accepted that a child of 16 years and 2 months may also refuse blood in surgical circumstances. JP, a Jehovah’s Witness, had presented as an emergency with a clinical diagnosis of acute appendicitis. The Health Authority applied to the High Court seeking an urgent declaration that it was lawful and in JP’s best interests to receive an intraoperative transfusion of blood or blood products should that be required during appendicectomy. The court was also told that JP was already responding to intravenous antibiotics and showing signs of improvement; nonetheless, JP took ‘…the view that he would like an appendicectomy.’ The court was told that this was a ‘… matter of very considerable urgency…and that the need for a blood transfusion is extremely unlikely’. JP made his position very clear to the court; ‘that he would not accept…blood, unless it was his own blood.’ Taking all the circumstances together, and acknowledging JP’s evident capacity to make this decision, HHJ Cohen made an order that it was ‘…lawful and in JP’s best interests not to receive blood products against his wish(es).’ The case was unusual, since on the facts it would have been plausible and reasonable to offer a non-operative approach to (ostensibly) uncomplicated appendicitis in the first instance, thus avoiding the need for an extemporary hearing, reducing the ‘urgency’ of the situation. But at the very least, the decision sets a precedent for a successful capacitous refusal of blood in a child in whom capacity has only been presumed for two months, given the 16^th birthday threshold for that presumption provided by the Mental Capacity Act 2005.

Very recently, this has become part of academic history. In September 2026 the Jehovah’s Witnesses (3) announced that individual Witnesses would now decide for themselves whether or not to accept or donate main blood components; this decision ‘…To receive or donate separate blood components, namely red cells, white cells, plasma or platelets, was now a matter of personal conscience.’ The Witnesses’ ban on the receipt of whole blood transfusion is unchanged.

But plainly the ability, with the patient’s consent, to administer blood components will assist in the physiological management of Jehovah’s Witnesses. It seems plausible that this will reduce the frequency of litigation in capable children’s practice; and perhaps make it more likely that adult Witnesses will agree to component transfusion.

To what extent this will lead individuals or families to reflect upon previous decisions, in relation to the consequences of their previous compliance with the refusal of hitherto banned blood products, remains to be seen.

Mr Robert Wheeler
Department of clinical law
October 2026

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