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Supreme court rules Manitoba law constitutional

OTTAWA -- A Manitoba law that forced a blood transfusion on a young Jehovah's Witness is constitutional, Canada's top court ruled today. But in a 6-1 decision, the Supreme Court of Canada said the courts must take into account the maturity and de...

OTTAWA -- A Manitoba law that forced a blood transfusion on a young Jehovah's Witness is constitutional, Canada's top court ruled today.

But in a 6-1 decision, the Supreme Court of Canada said the courts must take into account the maturity and decision-making capacity of minors before ruling on enforced treatment.

"Since the act itself acknowledges ... that mature minors 16 and over are presumed to be of sufficient capacity to make their own treatment decisions, it is 'arbitrarily unfair or based on irrational considerations' to deny mature minors under 16 the opportunity of demonstrating what in the case of the older mature minors is presumed in their favour," said the majority decision, written by Justice Rosalie Abella.

The case involved a young Jehovah's Witness, identified only as A.C., who received a court-ordered blood transfusion in 2006.

She was 14 when she was admitted to a Winnipeg hospital with internal bleeding.

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A.C. and her parents refused a transfusion on religious grounds because they believe the Bible forbids ingesting blood.

The high court said mature minors should be given a chance to show they are capable of making medical decisions, although the courts can still override them in life-or-death cases.

Abella said the government did not show that the arbitrary cutoff at age 16 and its potential harm to the rights of mature minors are justifiable, nor did it demonstrate that they advance "the state's interest in protecting the health of immature minors."

"The care and protection of children is a pressing and substantial legislative objective that is of sufficient importance to justify limiting a Charter right," Abella wrote.

"However, the impugned procedure under s. 25 of the Act is not rationally connected to that objective."

The decision negates the arbitrary rule setting age 16 as the cutoff, but judges must weigh age and maturity as only part of their consideration, setting those against the imminence and magnitude of the threat on a case-by-case basis. The judges awarded the girl her costs.

Chief Justice Beverley McLachlin wrote a concurring decision with the same conclusion, supported by different reasons, while Justice Ian Binnie dissented, saying the law is unconstitutional and that mature minors should be allowed to make medical decisions, period.

Several similar refusals of medical treatment by Jehovah's Witnesses have made headlines in recent years. But this is the first time the top court has weighed in.

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A.C. can't be identified because of the prior involvement of child-welfare officials. She is described in court records as an A student and an avid reader.

She also suffers chronic gastro-intestinal inflammation from Crohn's Disease. There is no cure for the painful condition, but it can be eased through surgery and drugs.

A.C. was 14 when she arrived at a Winnipeg hospital April 12, 2006, with internal bleeding from her bowel.

Four days later, she suffered another internal bleed that the attending physician deemed a serious risk. Dr. Stanley Lipnowski concluded that without a blood transfusion, there was "immediate danger as the minutes go by, if not death, then certainly serious damage."

A.C. and her parents instead requested iron and other drug alternatives to boost her body's production of red blood cells.

A.C. was assessed by hospital psychiatrists who said she had the capacity to make medical decisions.

But lawyers for Manitoba's Child and Family Services argued the province's legislation allows the court to take over care in the "best interests" of a child under the age of 16 when a life is at risk.

Manitoba's Court of Queen's Bench issued an order allowing doctors to give A.C. three units of blood -- forced treatment that the girl's lawyers say breached her rights to equality, freedom of religion and security of the person.

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The Manitoba Court of Appeal unanimously upheld the imposed transfusion. It cautioned, however, against forcing medical care on a minor when there's little hope of success.

Today's judgment is expected to help balance the competing interests of "mature minors" against the state's goal of protecting children.

A.C.'s lawyers argued parts of Manitoba's Child and Family Services Act that allow courts to overrule the wishes of children under 16 in their "best interests" are unconstitutional.

They stressed that several provinces, including Ontario, allow capable patients of any age to decide their own treatment without state intervention.

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