NHS North Central London Integrated Care Board v PC & Ors
[2024] EWCOP 31 (T3)
AB (Withdrawal of Life-Sustaining Treatment: Delay)
30 October 2024
[2024] EWCOP 62 (T3)
Court of Protection
A woman severely injured in 2015 has been in a permanent unconscious state ever since. Doctors and most family members agree continuing life support is no longer in her best interests due to the burdens of her condition. The court agreed, ordering that life support be withdrawn. The case also highlighted failings at the hospital for delaying making this decision.
Key Facts
- •AB, a 50-year-old woman, suffered a subarachnoid haemorrhage in 2015, resulting in a prolonged disorder of consciousness (PDOC) and minimally conscious state (MCS minus).
- •She has been in a specialist nursing home for nearly nine years, entirely dependent on others for care and receiving clinically assisted nutrition and hydration (CANH).
- •The NHS North West London Integrated Care Board applied to the Court of Protection to determine whether continuing CANH is in AB's best interests.
- •The Royal Hospital for Neuro-disability (RHN) and some family members believe that continuing CANH is not in AB's best interests.
- •AB is represented by the Official Solicitor; her sister and son are also parties to the application.
- •There were significant delays in initiating a best-interest review, due to systemic failures within the RHN.
- •Medical evidence indicates that AB's condition is permanent, with no prospect of improvement and a likely life expectancy of 3-4 years with CANH, or 1-3 weeks without.
- •Most family members believe that ceasing CANH aligns with AB's wishes, while one son expresses a preference for a 'natural' course.
- •The RHN has implemented significant systemic changes to address previous delays in best-interest decision-making.
Legal Principles
Decisions regarding a person lacking capacity must be made in their best interests.
s1(5) MCA 2005
The focus is on whether treatment is in the patient's best interests, not on withholding or withdrawing it.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67
CANH is a medical treatment amenable to best-interest determination.
An NHS Trust v Y [2018] UKSC 46
There's a strong presumption in favour of preserving life, but this can be displaced by evidence that continuing life-sustaining treatment is contrary to best interests.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67, W v M [2011] EWHC 2443 (Fam)
Decision-makers must not be motivated by a desire to bring about death.
s4(5) MCA 2005
Best interests assessments must consider all relevant circumstances, past and present wishes and feelings, beliefs and values, and views of carers and interested parties.
s4(6), s4(7) MCA 2005, MCA 2005 Code of Practice
Best interests analysis should consider the patient's welfare in the widest sense (medical, social, psychological), treatment prospects, likely outcomes, and the patient's (or likely) attitude to treatment.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67
Outcomes
Withdrawal of CANH is in AB's best interests.
The significant and increasing burdens of AB's condition and treatment outweigh the presumption of maintaining life. AB has no quality of life, and continuing treatment exposes her to unpleasant and undignified experiences.