Who should have the ultimate say over a child's medical treatment? A series of high-profile withdrawal of care cases have highlighted the full extent of the courts’ authority to make decisions on behalf of children in the medical context. In both the Charlie Gard and Alfie Evans litigation, the courts have made clear that they have the power to make medical decisions for children at the point that child's welfare is engaged. All courts involved in both cases affirmed the orthodox position that the threshold for judicial intervention in disputes about medical care of children is the welfare of the child, often referred to as the “best interests” approach (referring to both the threshold and the test applied to determine what should be done). While no new point of law has been decided in these cases, they are important in that they confirm just how expansive the inherent jurisdiction of the courts in such cases is, extending as far as to prevent parents from removing their child to another jurisdiction to pursue alternative treatment. In this paper, we argue that the current threshold for intervention is too low. We argue that prima facie decision-making authority about a child's medical care should rest with the child's parents, affording them the ability to choose between the range of medical options available. This authority should yield only where the parents’ decision carries a “serious risk of significant harm” to the child, at which point the court then has the authority to intervene. When it does so, the court should then apply the best interests approach.

中文翻译：

---

父母权利、最大利益和重大伤害：谁应该对儿童的医疗拥有最终决定权？

谁应该对孩子的医疗拥有最终发言权？一系列备受瞩目的撤回护理案件凸显了法院在医疗背景下代表儿童做出决定的全部权力。在 Charlie Gard 和 Alfie Evans 的诉讼中，法院已明确表示，他们有权在涉及儿童福利时为儿童做出医疗决定。两案涉及的所有法院都确认了司法干预儿童医疗纠纷的门槛是儿童福利的正统立场，通常被称为“最佳利益”方法（指门槛和适用的测试）来确定应该做什么）。虽然在这些案件中没有决定新的法律点，它们很重要，因为它们证实了法院在此类案件中的固有管辖权有多么广泛，甚至可以防止父母将其孩子转移到另一个管辖区以寻求替代治疗。在本文中，我们认为当前的干预门槛太低。我们认为，关于儿童医疗保健的初步决策权应由儿童的父母决定，使他们能够在可用的医疗选择范围内进行选择。只有当父母的决定对孩子造成“重大伤害的严重风险”时，该权力才应让步，此时法院有权进行干预。这样做时，法院应采用最佳利益法。