NHS North West London Integrated Care Board v Z & Anor

5 July 2024

[2024] EWCOP 35 (T1)

Court of Protection

A man in a permanent vegetative state had his family and doctors disagree about whether to keep him alive through artificial feeding and hydration. A judge had to decide. After hearing everyone's views and weighing the benefits of keeping him alive against the burdens of his suffering and care, the judge decided it was best to stop the artificial life support, to let him die peacefully.

Key Facts

•Z, a 70-year-old man, suffered severe anoxic hypoxic brain injury following surgery in 2021, resulting in a permanent vegetative state (PVS).
•The NHS North West London Integrated Care Board (ICB) applied for an order to withdraw clinically assisted nutrition and hydration (CANH).
•Z's wife, W, opposed the application, while his sister, a friend, and the Official Solicitor supported it.
•Z's condition involves significant burdens, including regular suctioning due to a tracheostomy, medication, and a high risk of acute events.
•Medical experts concluded that there was no prospect of recovery and that Z's life expectancy, with or without CANH, was uncertain but potentially several years.
•The court considered the views of Z's family and friends, alongside medical evidence and the relevant legal principles.

Legal Principles

Best interests decision-making for incapacitated individuals.

Mental Capacity Act 2005 (MCA 2005), s1(5), s4(5), s4(6), s4(7)

Strong presumption in favour of preserving life, but this can be rebutted.

Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67; W v M [2011] EWHC 2443 (Fam)

Withdrawal of life-sustaining treatment must not be motivated by a desire to end life.

MCA 2005, s4(5)

Holistic best interests assessment, considering medical, social, and psychological factors.

Aintree v James [2014] AC 591

CANH is a medical treatment subject to best interests determination.

An NHS Trust v Y [2018] UKSC 46

Outcomes

The court granted the application to discontinue CANH.

Balancing the burdens and benefits, the court found that discontinuation was in Z's best interests due to his PVS, lack of prospect of recovery, significant burdens of his condition and treatment, and the views of those close to him that he would not wish to continue living in this state.

NHS North West London Integrated Care Board v Z & Anor

Key Facts

Legal Principles

Outcomes

Similar Cases

NHS North Central London Integrated Care Board v PC & Ors

Hillingdon Hospitals NHS Foundation Trust v IN & Ors

AB (Withdrawal of Life-Sustaining Treatment: Delay)

NHS North Central London Integrated Care Board v XR and others (Withdrawal of Life Sustaining Treatment: Delay)

Kings College Hospital NHS Foundation Trust v X & Anor