Supreme Court of Victoria authorises a life-saving stem-cell treatment for a 15-year-old patient

The Supreme Court of Victoria has authorised the Royal Children’s Hospital to administer a stem cell transplant to increase the likelihood of survival for a 15-year-old girl against the objections of both the child and her mother.

In issue

• Whether the Supreme Court of Victoria should exercise its parens patriae jurisdiction to authorise the Royal Children’s Hospital (RCH) to administer a haematopoietic stem cell transplant (HSCT) to increase the likelihood of survival for a 15-year-old girl against the objections of both the child and her mother.

The background

In around August 2024, shortly after going into remission for B-cell acute lymphoblastic leukaemia, a 15-year-old female patient developed a secondary type of leukaemia called therapy related myeloid Neoplasm (t-MN).

The patient’s treating team at RCH recommended that she undergo HSCT as curative treatment. The medical evidence indicated that without the treatment, the patient’s likelihood of long-term survival was as low as 5%, and that there were no other curative treatment options available. The treatment team considered that the risks associated with undergoing a HSCT for this particular patient were on the lower end of the scale.

Both the patient and the patient’s mother opposed the HSCT treatment. The reasons for both the patient and patient’s mother objecting to the treatment included, among other things, that:

• 'the treatment is worse than the cancer' and the patient is 'just exhausted'
• the patient found her experiences at RCH to be distressing and this had impacted her ability to trust the advice of her treating team
• there were several potentially serious risks and side effects associated with the HSCT, including infertility, dysfunction of organs, and risk of the underlying disease relapsing
• the patient would be isolated, as she would need to spend at least six weeks in the RCH and miss an extensive period of schooling which would cause her to suffer academically and have an impact on her social development and wellbeing, and
• the patient has previously suffered severe complications from other treatments received to date.

The patient also expressed frustration and anger towards her treating team at the RCH, advising that she did not feel as though she had a strong therapeutic relationship with any of her treating practitioners and that they did not respect her autonomy.

While the patient's mother did acknowledge that she was a religious person and she did have religious beliefs, the patient made it clear that her refusal to consent to the treatment was not based on any cultural or religious reasons. On this point, His Honour indicated that while he did take the mother's religious views into account when considering this application, greater weight was given to the relevant medical evidence and opinions provided.

Although the RCH had contacted the patient’s father regarding the treatment, and he had provided his consent for the patient to undergo the treatment, given that it later emerged that the patient had been estranged from her father and had not had any contact with him for several years, both the RCH and the Court did not place significant weight on the provision of his consent.

The RCH ultimately disagreed with the patient and her mother’s objections and held significant concerns that the decision to reject the HCST was not in the patient’s best interests and would cause the patient to suffer harm.

The RCH accordingly made an urgent application to the Court under the Court’s parens patriae jurisdiction (which is enlivened where there is a disagreement between a parent and a medical practitioner or hospital with respect to vital or life-saving treatment) for authorisation to lawfully administer the treatment to the patient.

Various medical practitioners involved in the treatment of the patient held the opinion and provided evidence to support the conclusion that the patient did not have the maturity to make an informed decision as to whether to consent to a HSCT, and that her ability to process the relevant information was eroded by her feelings of frustration and anger.

Relevant principles

Under the parens patriae jurisdiction, the Court is placed in a position to act as the 'supreme parent' of a child and must exercise that jurisdiction in the manner in which a wise, affectionate, and careful parent would act for the welfare of the child. In exercising its powers under this jurisdiction, the Court must take a holistic view and consider what is in the child’s best interests, even in circumstances where the child’s parent has made it clear that they object to the provision of treatment.

Where a child’s capacity and maturity is advanced, the Court will have regard to the child’s ‘Gillick competence’, that is, whether the child is considered to have 'sufficient understanding and intelligence to enable him or her to understand fully what is proposed'.¹

In the context of proposed medical treatment, the Court must weigh the risks of the proposed treatment against the consensus of the medical opinions and available evidence.

The decision at trial

Her Honour [Tsalamandris J] held that:

1. the patient did not have Gillick capacity, considering that the patient’s anger with her treating team at the RCH was impeding upon her capacity to sensibly evaluate the clear advice being given to her
2. undergoing the treatment was in the patient’s best interests, particularly when having regard to the medical opinions, and
3. on that basis, the Court authorized RCH to administer the HCST treatment to the patient.

Implications

The following implications can be taken from this case:

1. while the Court will take into consideration objections from both the patient and the patient’s parent to the treatment, that parental authority is subject to limitation, whereby a court may override those objections where they consider the medical treatment to be necessary, lifesaving and within the child’s best interests
2. when undertaking an assessment of Gillick competence, the intellectual understanding of a child will not be sufficient to establish that they are capable of making an informed decision with respect to medical treatment. Rather, a court will only be satisfied that a child has sufficient understanding, and is therefore competent, where the child demonstrates that they not only have intellectual understanding, but also that they are emotionally mature and are not being unduly influenced by their current mental state or experience, and
3. the Court will place significant weight on and be persuaded by expert evidence and medical opinions when considering whether or not to grant the administration of treatment to a child.

Royal Children’s Hospital v HH [2026] VSC 197

¹ Marion’s Case (1992) 175 CLR 218, 237–8 (Mason CJ, Dawson, Toohey, and Gaudron JJ approving Gillick)