I have no doubt that in a perfect world any treatment which a patient, or a patient’s family, sought would be provided if doctors were willing to give it, no matter how much it cost, particularly when a life was potentially at stake. It would however, in my view, be shutting one’s eyes to the real world if the court were to proceed on the basis that we do live in such a world. It is common knowledge that health authorities of all kinds are constantly pressed to make ends meet. They cannot pay their nurses as much as they would like; they cannot provide all the treatments they would like; they cannot purchase all the extremely expensive medical equipment they would like; they cannot carry out all the research they would like; they cannot build all the hospitals and specialist units they would like. Difficult and agonising judgments have to be made as to how a limited budget is best allocated to the maximum advantage of the maximum number of patients. That is not a judgment which the court can make. In my judgment, it is not something that a health authority such as this authority can be fairly criticised for not advancing before the court.

Mr McIntyre went so far as to say that, if the authority has money in the bank which it has not spent, then it would be acting in plain breach of its statutory duty if it did not procure this treatment. I am bound to say that I regard that submission as manifestly incorrect. Unless the health authority had sufficient money to purchase everything which in the interests of patients it would wish to do, then that situation would never ever be reached. I venture to say that no real evidence is needed to satisfy the court that no health authority is in that position.

I furthermore think, differing I regret from the judge, that it would be totally unrealistic to require the authority to come to the court with its accounts and seek to demonstrate that if this treatment were provided for B. then there would be a patient C who would have to go without treatment. No major authority could run its financial affairs in a way which would permit such a demonstration …

Such is my sympathy with the father and B herself that I have been tempted, although disagreeing with the judge’s reasoning, to leave the order which he made in being and invite the authority to reconsider the matter in the light of the judge’s conclusions. I have, however, concluded that that would be a cruel deception since I would be bound to make clear that, in my judgment, the authority could, on a proper review of all the relevant material, reach the same decision that it had already reached and I would feel obliged, expressly, to dissociate myself from the judge’s opinion that it would be hard to imagine a proper basis upon which this treatment, at least its initial stage, could reasonably be withheld. In my judgment, it would be open to the authority readily to reach that decision since it is, as I think, the decision it has already reached.

While I have, as I hope is clear, every possible sympathy with B, I feel bound to regard this as an attempt, wholly understandable but none the less misguided, to involve the court in a field of activity where it is not fitted to make any decision favourable to the patient.