A 17 year-old Jehovah's Witness who was fighting a court order to have a life-saving blood transfusion has lost an appeal just four months shy of his 18th birthday.
The religious teenager, who is being treated for Hodgkin's Lymphoma at The Sydney Children's Hospital, had threatened to rip the IV needle from his arm and said it would be akin to rape if he was given a blood transfusion while under anaesthetic.
Preserving life is at its highest with respect to children.
A Supreme Court judge ruled in April that the boy, known as X for legal reasons, had to have the transfusion but his family appealed it, arguing that he was "highly intelligent" and his maturity and competency should be enough to override the court's power.
Justice John Basten rejected the appeal on Friday morning but said the order would be removed when X turned 18 in January, allowing him to make the potentially life-or-death decision for himself.
His doctor, Professor Glenn Marshall, told the court earlier this year that X had an 80 per cent chance of dying from anaemia if he didn't have the transfusion.
"The interest of the state is in keeping him alive until that time, after which he will be free to make his own decisions as to medical treatment," Justice Basten said in his judgement.
"The interest of the state in preserving life is at its highest with respect to children and young persons who are inherently vulnerable, in varying degrees."
X has had three unsuccessful rounds of chemotherapy at a lower dose than Professor Marshall advised.
After some initial success, the cancer in his lymph nodes spread to his lungs and spleen in November last year.
X was advised to have more intense chemotherapy but, because that treatment was likely to lead to a blood transfusion, he and his parents refused.
On a whiteboard in his hospital room, X's father wrote a scripture reference to abstaining from blood.
Barrister David Bennett, QC, argued during the appeal that a child was entitled to a degree of decision making "reflective of their evolving maturity".
He referred to several overseas cases of younger Jehovah's Witnesses being allowed to refuse blood.
In most cases, the young person died like 15-year-old Joshua McAuley, who refused a blood transfusion following a car crash in England's West Midlands in 2010.
The Children's Hospital said the boy had a "cocooned upbringing" and his family had "little exposure to challenges of their beliefs from outsiders" so what they may have thought was best was not necessarily correct.
It was no clear to the appeal judges whether X might die before his 18th birthday but Justice Basten's judgement said that the state's interest was not satisfied "merely by keeping the applicant alive until his 18th birthday if the appropriate treatment to allow the continuation of his life thereafter should be given now".
The boy and his family were not in court for the decision.