NHS North West London Integrated Care Board v Z & Anor
[2024] EWCOP 35 (T1)
NHS North Central London Integrated Care Board v XR and others (Withdrawal of Life Sustaining Treatment: Delay)
14 November 2024
[2024] EWCOP 66 (T3)
Court of Protection
A man in a permanent vegetative state, with no family, needed a court decision on whether to continue feeding him through a tube. Doctors agreed that continuing was causing more harm than good, so the judge decided to stop the feeding. The judge also pointed out problems with how long it took to make the decision and suggested improvements to prevent this happening again.
Key Facts
- •XR, a 62-year-old man, suffered a severe hypoxic ischaemic brain injury in 2017.
- •He is in a permanent vegetative state (VS) with no prospect of recovery.
- •The NHS North Central London Integrated Care Board (ICB) applied to the Court of Protection to discontinue clinically assisted nutrition and hydration (CANH).
- •XR has no known family or friends.
- •There were significant delays in making a best interest decision due to systemic issues at the Royal Hospital for Neuro-disability (RHN).
- •The medical evidence indicated significant burdens associated with continued CANH, outweighing any potential benefits.
Legal Principles
Decisions regarding life-sustaining treatment must be made in the patient's best interests.
Mental Capacity Act 2005 (MCA 2005), s1(5)
There is a strong presumption in favor of preserving life, but this can be displaced by evidence that continued treatment is contrary to the patient's best interests.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67; An NHS Trust v Y [2018] UKSC 46
Decision-makers must consider all relevant circumstances, including the patient's past and present wishes, feelings, beliefs, and values.
MCA 2005, s4(6)
The MCA 2005 Code of Practice provides guidance on best interests decision-making, including around life-sustaining treatment.
MCA 2005, s42; Code of Practice
If the MCA provisions are followed and there is agreement on best interests, court application may not be necessary. However, court application is appropriate if there is a finely balanced decision, differing medical opinions, or lack of agreement amongst those interested in the patient's welfare.
An NHS Trust and others v Y [2019]
Outcomes
It is not in XR's best interests to continue receiving CANH.
The burdens of continued treatment significantly outweigh the benefits given XR's permanent vegetative state, lack of prospect of recovery, and the significant daily care interventions required. XR's wishes and feelings are unknown and could not be ascertained despite efforts.