AB (Withdrawal of Life-Sustaining Treatment: Delay)
[2024] EWCOP 62 (T3)
NHS North Central London Integrated Care Board v PC & Ors
23 May 2024
[2024] EWCOP 31 (T3)
Court of Protection
A severely brain-injured woman was receiving life-support. Her family was divided on whether to continue. The court decided to end life support because the woman experienced only pain and distress, with no hope of improvement. The court considered her past life and what she likely would have wanted. They prioritized her comfort and the well-being of her family.
Key Facts
- •PC, a 35-year-old woman, suffered a severe hypoxic brain injury in 2020, leaving her in a Minimally Conscious State minus (MCS-).
- •She is currently receiving clinically assisted nutrition and hydration (CANH) at the Royal Hospital for Neuro-Disability (RHN).
- •The NHS North Central London Integrated Care Board (ICB) applied to the Court of Protection to withdraw CANH, arguing it is not in PC's best interests.
- •PC's mother initially opposed the application, but the court heard evidence from multiple parties, including medical professionals and family members.
- •The court considered PC's pre-morbid personality, her current condition, and the views of her family and medical team.
Legal Principles
CANH is considered medical treatment, not basic care.
An NHS Trust v Y [2018] UKSC 46
Best interests decisions should not be dictated solely by a patient's condition.
An NHS Trust v Y [2018] UKSC 46
Professional guidance is important in end-of-life decision-making.
An NHS Trust v Y [2018] UKSC 46
Court applications are necessary when best interests decisions are finely balanced or there is disagreement.
An NHS Trust v Y [2018] UKSC 46
MCA 2005 principles for determining capacity and best interests.
Mental Capacity Act 2005
Strong presumption in favour of preserving life, but not absolute.
Aintree v James [2013] UKSC 67, Airedale NHS Trust v Bland [1993] AC 789, W v M [2011] EWHC 2443 (Fam)
Best interests must be assessed from the patient's perspective.
Aintree v James [2013] UKSC 67
The court must consider the patient's wishes, feelings, beliefs, and values.
MCA 2005 Code of Practice, M v N [2015] EWCOP 76
The views of carers and family members are relevant but not determinative.
MCA 2005, Re M (Incapacitated Person: Withdrawal of Treatment) [2017] EWCOP 19
Relevant ECHR articles: Article 2 (right to life), Article 3 (protection from inhuman or degrading treatment), Article 8 (right to respect for private and family life).
European Convention on Human Rights
Outcomes
It is not in PC's best interests to continue CANH.
The court found that PC's life offered no measurable pleasure or contentment, only pain and discomfort, and that continuing CANH would not improve her condition. The burden of her condition outweighs the benefits of continued life.
Palliative care should be implemented.
Withdrawal of CANH will end PC's suffering and allow her family to begin the healing process. A plan was established for her transfer to a hospice for end-of-life care.