“… the factors that really matter in the case before it, gives each of them proper weight, and balances them out to make the choice that is right for the individual at the heart of the decision” ([52]). I am conscious that the risk of intra-operative or post-operative serious haemorrhage in this case is said to be “very small”; this is of obvious comfort to J and his family, and to me, but it nonetheless is a risk. J is aware, his parents are aware, as indeed I am aware, that there are irreparable and disproportionate consequences for J in the event that he suffers a severe haemorrhage in the operation or in the post-operative period, and blood products are not administered. I also bear much in mind the description which Mr R gave about his own distress as a surgeon if he found himself powerless to save J’s life if he began to bleed severely on the operating table. But I remind myself that if this operation were to be taking place in six months’ time or thereafter, this court would have no jurisdiction to interfere with this patient’s choice, and nor would the doctors. J has articulated clearly his opposition to this type of treatment, and has done so from a place of understanding and maturity. While the inherent jurisdiction offers “protective power” over children and young people (Re E & F at [46]), I am conscious that I should not exercise an overly protective or paternalistic authority over this responsible young man, when I am satisfied that he knows clearly and convincingly what he wishes in respect of the upcoming operation, can clearly articulate his choices, and can explain his reasoning. Welfare: Every decision concerning medical treatment for children and young people must turn upon its own facts; “[t]he court needs to focus on the factors that really matter in the case before it” (Re E & F at [71]). In all cases, the paramount concern of the court is to make a decision in the best interests of the individual subject young person, looked at in its widest sense. I have found this to be an extremely finely balanced decision which directly and poignantly engages the “two transcendent factors” referred to in Re E & F, namely the preservation of life and personal autonomy. It is plain that the subject young people in Re E & F felt “aggrieved” ([5]) that their views were overridden, and I am satisfied that J would feel the same. Even though the body of case law to which I have been referred has generally concluded with a decision in favour of treatment, I am conscious that “that is not the invariable outcome” (per Re E & F at [65]). To be faithful to the rich seam of pronouncements in this area I wish to emphasise that judicial ‘respect’ for the ‘views of the mature child’ is not a tokenistic mantra; it must be given true meaning, and where appropriate, full effect. To some degree this is demonstrated by the decisions of Moor J in A South East Trust v AGK[2019] EWFC 86 and to the decision of Cohen J in A Teaching Hospitals NHS Trust v DV (A Child)[2021] EWHC 1037 (Fam) , where the objections of young people to the administration of blood products held sway. However, the distinguishing feature between those cases and this is that in AGK and DVno significant opposition was offered by the medical profession to the minor’s objections. J is only a matter of weeks away from being an adult as a matter of law. He has limited – but nonetheless evolving – experience of mature decision-making; he has first-hand experience of the death of someone of whom he was fond. He already shows many attributes of adulthood. I found him to be an impressive young man with clear thoughts and expression. I am satisfied that he knows his own mind, and is aware of the risks to which he is exposing himself in declining blood products in the unlikely event that they would be needed in this operation. J’s clear and unequivocal decision in this regard, and his reasoning, are rooted in his faith; I respect his well-recognised right underArticle 9 of the ECHR to manifest and observe his religion. The Applicants recognise that J’s beliefs about blood products are “long held and considered”