King’s College Hospital NHS Foundation Trust v XY & Anor
[2024] EWCOP 68
Northumbria Healthcare NHS Foundation Trust v HX & Ors
9 September 2024
[2024] EWCOP 52 (T3)
Court of Protection
A woman suffered severe brain damage after a heart attack. Doctors said she wouldn't get better and keeping her alive on machines was pointless and possibly harmful. Even though her son wanted to keep her alive, the judge decided it was best to let her pass peacefully with palliative care.
Key Facts
- •HX, a woman in her late 40s, suffered a cardiac arrest on July 1, 2024, resulting in severe global hypoxic ischemic encephalopathy (brain damage).
- •Prior to the arrest, HX had a history of mental health problems, domestic violence, and untreated triple vessel coronary disease.
- •Medical assessments, including EEG, MRI, and Glasgow Coma Scale, indicated severe and irreversible brain injury with a poor prognosis.
- •There is no prospect of significant recovery, and continued life support is considered futile and potentially harmful.
- •The Trust sought court approval to withdraw life-sustaining treatment (Clinically Assisted Nutrition and Hydration - CANH) and initiate palliative care.
- •HX's son, CX, opposed the application, seeking more time for potential recovery.
- •Multiple medical experts supported the Trust's recommendation.
Legal Principles
Best interests determination under the Mental Capacity Act 2005 (MCA 2005).
MCA 2005, sections 1(5), 1(6), 4, 15, 16
The court's inquiry focuses 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
No single element of s.4 MCA 2005 has priority; the widest sense of welfare must be considered.
Aintree v James [2013] UKSC 67
Patient's wishes and feelings are important but not determinative in best interests assessments.
Aintree v James [2013] UKSC 67, Northern Care Alliance NHS Foundation Trust v KT [2023] EWCOP 46
Strong presumption in favour of preserving life, but can be displaced if contrary to best interests.
Aintree v James [2013] UKSC 67, University Hospitals Birmingham NHS Foundation Trust v HB [2018] EWCOP 39
Precise diagnosis of VS or MCS is less crucial than the certainty of the trajectory of change and prognosis.
NHS Cumbria CCG v Rushton [2018] EWCOP 41, Royal College of Physicians Guidance ‘Prolonged Disorders of Consciousness’
The court must consider the patient's past and present wishes, feelings, beliefs, and values.
MCA 2005, s.4(6), (7)
Outcomes
It is not in HX's best interests to continue life-sustaining treatment (CANH and mechanical ventilation).
Overwhelming medical evidence demonstrates irreversible brain damage with no prospect of meaningful recovery. Continuing treatment is considered futile and potentially harmful. While HX's wishes are unclear, the evidence does not support continued life support in her current condition. A palliative care pathway is deemed to be in her best interests.
Palliative care is to commence.
This will allow a peaceful end-of-life process, enabling the family's involvement, in contrast to the potential for a traumatic death from a further cardiac arrest during weaning from ventilation.