A.C. v. Manitoba (Director of Child and Family Services), 2009 SCC 30 (2009)

Docket Number:31955
 
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SUPREME COURT OF CANADA

Citation: A.C. v. Manitoba (Director of Child and Family Services), 2009 SCC 30

Date: 20090626

Docket: 31955

Between:

A.C., A.C. and A.C.

Appellants and

Director of Child and Family Services

Respondent

- and -

Attorney General of Manitoba, Attorney General of

British Columbia, Attorney General of Alberta and Justice for Children and Youth

Interveners

Coram: McLachlin C.J. and Binnie, LeBel, Deschamps, Abella, Charron and Rothstein JJ.

Reasons for Judgment:

(paras. 1 to 122)

Concurring Reasons:

(paras. 123 to 161)

Dissenting Reasons:

(paras. 162 to 239)

Abella J. (LeBel, Deschamps and Charron JJ. concurring)

McLachlin C.J. (Rothstein J. concurring)

Binnie J.

Note: This document is subject to editorial revision before its reproduction in final form in the Canada Supreme Court Reports.

______________________________

a.c. v. manitoba (director of child and family services)

A.C. et al. Appellants v.

Director of Child and Family Services Respondent and

Attorney General of Manitoba, Attorney General of

British Columbia, Attorney General of Alberta and Justice for Children and Youth Interveners

Indexed as: A.C. v. Manitoba (Director of Child and Family Services)

Neutral citation: 2009 SCC 30.

File No.: 31955.

2008: May 20; 2009: June 26.

Present: McLachlin C.J. and Binnie, LeBel, Deschamps, Abella, Charron and Rothstein JJ.

on appeal from the court of appeal for manitoba

Constitutional law - Charter of Rights - Liberty and security of person - Fundamental justice - Medical treatment - Child under 16 years of age refusing blood transfusions because her religion requires that she abstain from receiving blood - Transfusion necessary to avoid severe consequences to child's health - For child under 16, provincial child and family services legislation authorizing court to order treatment that it considers in best interests of child - For child 16 and over, no medical treatment can be ordered by court without child's consent unless court satisfied that child lacks ability to understand relevant information or consequences of treatment decision - Whether legislation arbitrary because it deprives children under 16 of opportunity to demonstrate capacity - Whether legislation infringes child's liberty and security interests in manner contrary to principles of fundamental justice - Canadian Charter of Rights and Freedoms, s. 7 - Child and Family Services Act, C.C.S.M. c. C80, s. 25(8), (9).

Constitutional law - Charter of Rights - Equality rights - Discrimination on basis of age - Child under 16 years of age refusing blood transfusions because her religion requires that she abstain from receiving blood - Transfusion necessary to avoid severe consequences to child's health - For child under 16, provincial child and family services legislation authorizing court to order treatment that it considers in best interests of child - For child 16 and over, no medical treatment can be ordered by court without child's consent unless court satisfied that child lacks ability to understand relevant information or consequences of treatment decision - Whether legislation infringes child's equality rights - Canadian Charter of Rights and Freedoms, s. 15 - Child and Family Services Act, C.C.S.M. c. C80, s. 25(8), (9).

Constitutional law - Charter of Rights - Freedom of religion - Child under 16 years of age refusing blood transfusions because her religion requires that she abstain from receiving blood - Transfusion necessary to avoid severe consequences to child's health - For child under 16, provincial child and family services legislation authorizing court to order treatment that it considers in best interests of child - For child 16 and over, no medical treatment can be ordered by court without child's consent unless court satisfied that child lacks ability to understand relevant information or consequences of treatment decision - Whether legislation infringes child's freedom of religion - If so, whether infringement justifiable - Canadian Charter of Rights and Freedoms, ss. 1, 2(a) - Child and Family Services Act, C.C.S.M. c. C80, s. 25(8), (9).

Status of persons - Child protection - Care while under apprehension - Court order authorizing treatment - Maturity - For child under 16, provincial child and family services legislation authorizing court to order treatment that it considers in "best interests" of child - For child 16 and over, no medical treatment can be ordered by court without child's consent unless court satisfied that child lacks ability to understand relevant information or consequences of treatment decision - Whether young person under 16 entitled to demonstrate sufficiency of maturity in medical treatment decisions - Interpretation of "best interests" standard - Child and Family Services Act, C.C.S.M. c. C80, s. 25(8), (9).

C was admitted to hospital when she was 14 years, 10 months old, suffering from lower gastrointestinal bleeding caused by Crohn's disease. She is a devout Jehovah's Witness and, some months before, had signed an advance medical directive containing her written instructions not to be given blood under any circumstances. Her doctor believed that internal bleeding created an imminent, serious risk to her health and perhaps her life. She refused to consent to the receipt of blood. A brief psychiatric assessment took place at the hospital on the night after her admission. The Director of Child and Family Services apprehended her as a child in need of protection, and sought a treatment order from the court under s. 25(8) of the Manitoba Child and Family Services Act, by which the court may authorize treatment that it considers to be in the child's best interests. Section 25(9) of the Act presumes that the best interests of a child 16 or over will be most effectively promoted by allowing the child's views to be determinative, unless it can be shown that the child does not understand the decision or appreciate its consequences. Where the child is under 16, however, no such presumption exists. The applications judge ordered that C receive blood transfusions, concluding that when a child is under 16, there are no legislated restrictions of authority on the court's ability to order medical treatment in the child's "best interests". C and her parents appealed the order arguing that the legislative scheme was unconstitutional because it unjustifiably infringed C's rights under ss. 2(a), 7 and 15 of the Canadian Charter of Rights and Freedoms. The Court of Appeal upheld the constitutional validity of the impugned provisions and the treatment order.

Held (Binnie J. dissenting): The appeal should be dismissed. Sections 25(8) and 25(9) of the Child and Family Services Act are constitutional.

Per LeBel, Deschamps, Charron and Abella JJ.: When the young person's best interests are interpreted in a way that sufficiently respects his or her capacity for mature, independent judgment in a particular medical decision-making context, the constitutionality of the legislation is preserved. Properly construed to take an adolescent's maturity into account, the statutory scheme strikes a constitutional balance between what the law has consistently seen as an individual's fundamental right to autonomous decision making in connection with his or her body, and the law's equally persistent attempts to protect vulnerable children from harm. The "best interests" standard in s. 25(8) operates as a sliding scale of scrutiny, with the child's views becoming increasingly determinative depending on his or her maturity. The more serious the nature of the decision and the more severe its potential impact on life or health, the greater the degree of scrutiny required. The result of this interpretation of s. 25(8) is that young people under 16 will have the right to demonstrate mature medical decisional capacity. This protects both the integrity of the statute and of the adolescent. [3][22] [30][114]

Mature adolescents have strong claims to autonomy, but these claims exist in tension with a protective duty on the part of the state that is justified by the difficulty of defining and identifying "maturity". Any solution to this tension must be responsive to its complexity. Where a child under 16 comes before the court under s. 25 of the Child and Family Services Act, it is the ineffability inherent in the concept of "maturity" that justifies the state's retaining an overarching power to determine whether allowing the child to exercise his or her autonomy in a given situation actually accords with his or her best interests. But "best interests" must in turn be interpreted so as to reflect and respect the adolescent's developing autonomy interest. The more a court is satisfied that a child is capable of making a truly mature and independent decision on his or her own behalf, the greater the weight that must be given to his or her views when a court is exercising its discretion under s. 25(8). If, after a careful analysis of the young person's ability to exercise mature and independent judgment, the court is persuaded that the necessary level of maturity exists, the young person's views ought to be respected. [95]

In assessing an adolescent's maturity in a s. 25(8) "best interests" analysis, a judge should take into account the nature, purpose and utility of the recommended medical treatment and its risks and benefits; the adolescent's intellectual capacity and the degree of sophistication to understand the information relevant to making the decision and to appreciate the potential consequences; the stability of the adolescent's views and whether they are a true reflection of his or her core values and beliefs; the potential impact of the adolescent's lifestyle, family relationships and broader social affiliations on his or her ability to exercise independent judgment; the existence of any emotional or psychiatric vulnerabilities and the impact of the adolescent's illness on his or her decision-making ability. Any relevant information from adults who know the adolescent may...

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