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Re R (A Minor) (Wardship: Consent to Treatment) (1991) - Study Guide
This case explores the complex issue of consent to medical treatment for minors, particularly when a Gillick-competent child refuses treatment their parents wish to pursue.
I. Facts of the Case:
  • R: A 15-year-old girl with a fluctuating mental disorder, experiencing periods of lucidity and severe psychotic episodes (violent, suicidal).
  • Initial Situation: Voluntarily in local authority care, then placed in an adolescent psychiatric unit due to worsening condition.
  • The Conflict: During lucid periods, R refused medication prescribed to manage her psychosis, despite her parents and the psychiatric unit believing it necessary.
  • Legal Action: The local authority initiated wardship proceedings, seeking court authorization to administer medication against R's wishes.
II. The Court of Appeal's Decision:
The Court of Appeal affirmed the High Court's power to authorize medical treatment for a minor ward, even if that minor is Gillick-competent and refuses treatment.
III. Lord Donaldson MR's Key Argument ("The Keyholder Analogy"):
Lord Donaldson's central analogy, while later rejected, is crucial to understanding the initial ruling:
  • Consent as a "Key": Consent is not an obligation to treat, but rather a prerequisite. It "unlocks the door" to treatment.
  • Multiple "Keyholders": In cases involving minors, there can be multiple individuals with the power to consent. Parents typically hold a concurrent right to consent alongside the child.
  • Concurrent Powers: If multiple individuals have the power to consent, only a unanimous refusal will prevent treatment. A Gillick-competent child (or one over 16) possesses the power to consent, but this power exists alongside that of parents/guardians.
  • "Master Key": The parents' consent can potentially override a Gillick-competent child's refusal (the "master key"). This element is highly contentious.
IV. Criticism and Subsequent Developments:
  • Criticism of the Analogy: Lord Donaldson MR later acknowledged the flaws in his "keyholder" analogy, finding it overly simplistic and misleading.
  • Re W: In a subsequent case (Re W), Lord Donaldson abandoned the keyholder analogy in favour of a different legal framework (the "legal flak jacket"). Details of this alternative framework are not provided in the text.
V. Key Concepts and Terms:
  • Gillick Competence: The capacity of a minor to understand medical treatment and make informed decisions about their own healthcare, regardless of their age.
  • Wardship: A legal process where the court takes responsibility for the welfare of a minor.
  • Concurrent Powers: The simultaneous existence of the right to consent in multiple parties.
VI. Study Questions:
  1. Explain the keyholder analogy. What are its strengths and weaknesses? Why did Lord Donaldson later reject it?
  2. How does this case relate to the concept of Gillick competence? Does it diminish or enhance the rights of Gillick-competent children?
  3. What are the ethical implications of allowing parental consent to override a Gillick-competent child’s refusal of treatment? Consider the potential for abuse or misjudgment.
  4. What are the potential implications of the court having the power to order treatment against a competent minor's wishes? What safeguards should be in place to protect the child's best interests?
  5. Research the "legal flak jacket" approach mentioned in the comment section. How does it differ from the keyholder analogy?
This study guide provides a structured approach to understanding the complexities of Re R. By carefully considering the facts, the court's decision, the reasoning behind it, and the subsequent criticisms, you will gain a much stronger grasp of this important case in medical law. Remember to consult additional resources to deepen your understanding of the relevant legal principles.


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