NHS North West London Integrated Care Board v Z & Anor
[2024] EWCOP 35 (T1)
Hillingdon Hospitals NHS Foundation Trust v IN & Ors
21 July 2023
[2023] EWCOP 32
Court of Protection
A man was in a coma with no chance of getting better. Doctors wanted to stop life support, but his family didn't. A judge decided it was kinder to let him go peacefully, even though the family was sad. The judge made sure the family's privacy was protected while also allowing some information about the case to be shared.
Key Facts
- •IN, a 55-year-old man, suffered a severe pontine haemorrhagic stroke resulting in a coma lasting over six months.
- •Hillingdon Hospitals NHS Foundation Trust sought to withdraw IN's Clinically Assisted Nutrition and Hydration (CANH).
- •IN's family opposed the withdrawal, believing he would want to be kept alive.
- •IN lacked capacity to make decisions about his treatment.
- •Medical evidence indicated irreversible coma with no prospect of recovery.
- •Two expert medical opinions supported the withdrawal of CANH.
- •IN died on 24 July 2023, before the planned withdrawal of CANH.
Legal Principles
CANH is medical treatment.
An NHS Trust v Y [2018] UKSC 46
Best interest decisions should not rely solely on condition categorization.
An NHS Trust v Y [2018] UKSC 46
Professional guidance is crucial for best interest decisions, including second opinions.
An NHS Trust v Y [2018] UKSC 46
Court involvement is necessary if best interests are finely balanced or there's disagreement.
An NHS Trust v Y [2018] UKSC 46
Best interests decisions must consider the patient's welfare in the widest sense.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67
The burden of proof for discontinuing life-sustaining treatment lies with the applicant.
R(Burke) v GMC (OS Intervening) [2005] QB 424
All reasonable steps should be taken to prolong life unless treatment is futile, overly burdensome, or there's no prospect of recovery.
Mental Capacity Act 2005 Code of Practice
Best interests checklist must be applied, considering past wishes, beliefs, values, and views of interested parties.
Mental Capacity Act 2005, s4
Outcomes
Withdrawal of CANH is in IN's best interests.
IN's irreversible coma, lack of prospect for recovery, burdens of continued treatment, and absence of benefit outweighed the presumption of preserving life.
Tracheostomy to remain in situ during CANH withdrawal.
To avoid distress to the family and staff by preventing IN's struggling for breath.
Transparency Order varied.
Balancing Article 8 (right to private and family life) and Article 10 (freedom of expression) rights; reporting restrictions on IN and family remain, but restrictions on hospital and clinicians lifted 7 days after IN's death.
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