The Supreme Court added that "if the welfare of the child requires the possibility of strong pain-relieving treatment, then a refusal to consent to such treatment must, at least prima facie, be a failure of the duty on the part of the parents to promote and protect the welfare of the child."
In its conclusion, the court wrote that cases of wards, "the test is to consider what a loving and considerate parent would do once apprised of all the relevant information. Such a parent would take into account the views of the child, if expressed, and the character of the child, and would make a decision as to the best interests of the child in that context."
"It is important that, while an assessment of the benefits and burdens of a treatment are relevant to the decision, that does not involve the court making judgments as to the quality of the life being lived by the patient. Where it is sought … to override a contrary parental decision in relation to a child, then it is necessary to go further and be satisfied by clear and convincing evidence that the decision of the parents is one which prejudicially affects the health and welfare of the child to such an extent that the decision of the parents can properly be described as a failure of parental duty to the child in question."
The Supreme Court wrote that as a principle in wardship cases for medical treatment "the test for admission to wardship and the test for consent to treatment is not merely the best interests of the child, but rather whether the constitutional test has been satisfied: that is, that a decision of the parents, or the absence of a decision, is a failure of duty towards the child to such an extent that the safety or welfare of the child is likely to be prejudicially affected."
It added that "Making a decision to override a parental decision, particularly a decision of conscientious, committed parents, is not merely a matter of a court's view of the medical evidence. The court should consider the nature and significance of the procedure involved, the extent to which the opinion of treating doctors is unanimous, is shared by independent experts, and the depth and conviction with which it is held."
"The decision does not involve the court making any judgement on the quality of life of a child … the test to be applied is that the court should decide what it considers that loving and considerate parents of this child would do if apprised of all the facts and evidence, and aware of the character, personality, and history of the child."
The Supreme Court did add that under Article 42A, "the means by which the place of the parents is supplied by the State should be proportionate. Accordingly, wardship orders should be limited to the relevant decision as to those aspects of medical treatment where there is reason to believe that parental approval will not be provided."