Regional New South Wales health officials have won a court order authorising them to give a blood transfusion to a Jehovah's Witness toddler if needed in surgery.
The Supreme Court has been told the girl, three, who can only be referred to as JI, is in need of two surgical procedures.
Justice Trish Henry, when handing down her judgement on Thursday, outlined a range of medical issues impacting the child.
"JI was born with a range of serious medical conditions, including renal abnormalities, cardiac defect and developmental problems and is dependent on tube feeding which requires regular replacement," Justice Henry said.
The justice said due to their religious beliefs the child's parents did not consent to the use of blood.
"The plaintiff's application has been brought as JI's parents are Jehovah's Witnesses," she said.
"In accordance with their beliefs, they have not consented to JI receiving blood or blood product transfusions in connection with the proposed surgeries."
The justice said the court could legally intervene in some circumstances.
"The power of the court under that jurisdiction to make orders, including where the parents of a child have not consented to medical treatment, is well established," Justice Henry said.
"On such an application, the overriding criterion to be applied by the court is the best interests and welfare of the child.
"The role of the court on an application such as this is to exercise an independent and objective judgement so as to balance the advantages or disadvantages of the medical procedure under consideration."
The court was told the medical team was "sensitive" to the parent's wishes, despite seeking to have their desires vetoed.
"They have considered and will continue to take steps to exhaust all alternative treatments, and will adopt a blood conservation strategy in the course of the surgeries and as part of JI's recovery," the court heard.
"Despite this, the evidence from her treating specialist is that it may be clinically necessary to treat JI with blood and/or blood products in connection with the surgical procedures to manage the risk of damage to her health, including the risk of death."
Parents wishes considered
Justice Henry concluded that authorising the use of blood, if needed, was in the best interests of the child.
She said the parents cooperated in the ongoing medical treatment of JI.
"Relevant to this application, the parents have consented to JI undergoing two surgeries that JI's treating specialist and medical team at the hospital have recommended," Justice Henry said.
She said the court took into account the parents' strongly held convictions.
"However, based on the medical evidence and the submissions advanced by the parties it was clearly in JI's best interests and welfare to authorise the proposed treatment in advance of her upcoming surgeries," she said.
Suppression and non-publication orders mean the child, her family, doctors, nurses and the hospital cannot be identified.
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