NHS North Central London Integrated Care Board v PC & Ors
[2024] EWCOP 31 (T3)
PC, Re
31 July 2024
[2024] EWCA Civ 895
Court of Appeal
A woman was severely brain-damaged and in a permanent vegetative state. Doctors and a court decided it was kinder to stop life support, even though her family disagreed. The appeals court agreed with the decision, saying the woman was suffering greatly and there was no chance of her getting better.
Key Facts
- •PC, a 31-year-old woman, suffered a severe hypoxic brain injury in 2020, leaving her in a Minimally Conscious State minus (MCS-).
- •Her condition is considered permanent with no prospect of improvement.
- •A best interests meeting initially reached consensus to withdraw CANH (clinically assisted nutrition and hydration).
- •PC's mother, MC, later opposed the withdrawal of CANH.
- •The Court of Protection was asked to determine whether withdrawing CANH was in PC's best interests.
- •Professor Wade, a leading expert, initially supported withdrawing CANH, but later revised his views on pain experience in PDOC (Prolonged Disorder of Consciousness) patients.
- •The judge refused an application to adjourn for further neurological assessments.
Legal Principles
The Court of Protection has a duty to restrict expert evidence to that which is necessary to resolve the issues in the proceedings (CPR 2017, r.15.3(1)).
Court of Protection Rules 2017
In best interests decisions, the sanctity of life is not absolute and life-sustaining treatment can be withdrawn if not in the patient's best interests.
Aintree Hospital NHS Trust v James [2013] UKSC 67
Every patient and case is different and must be decided on its own facts. There is no need for general principles beyond the overarching best interests test.
Aintree Hospital NHS Trust v James [2013] UKSC 67
Outcomes
Permission to appeal was refused on all four grounds.
The judge's decision was deemed correct; the assessments were adequate, the judge did not conduct his own assessment of pleasure, the issue of 'covert consciousness' was not relevant given the evidence, and the judge properly considered the sanctity of life and burden of care.
The judge's order that it is not in PC's best interests to receive CANH, and that it is in her best interests to discontinue CANH and receive palliative care, was upheld.
PC's condition is permanent with no prospect of improvement, she experiences significant distress, and continuing CANH offers little benefit against significant burdens.