A Hospital Trust v P & Ors
[2024] EWHC 313 (Fam)
A Council v An NHS Foundation Trust & Anor
26 January 2024
[2024] EWHC 874 (Fam)
High Court
A very sick baby, Z, was suffering greatly with little chance of improvement. Doctors and a court-appointed guardian all agreed that ending life support was the kindest thing. The court agreed, even though Z's parents had addiction issues and the mother was uncertain whether to make the decision.
Key Facts
- •Z, a child born in April 2022 with serious cardiac defects and other abnormalities, suffered severe hypoxic-ischemic brain damage after a tracheotomy tube dislodged.
- •Z is ventilator-dependent, suffers from drug-resistant dystonia and deafness, and has very little quality of life.
- •A multidisciplinary team unanimously concluded that Z has no quality of life and recommended palliative care.
- •Z's parents are heroin addicts with a history of fluctuating engagement with care proceedings.
- •The mother's capacity to consent to end-of-life treatment was questioned.
- •A second medical opinion supported the palliative care plan.
- •The father, lacking parental responsibility, could not formally consent.
Legal Principles
Best interests of the child are paramount in decisions regarding medical treatment.
Re A (A Child) [2016] EWCA 759 and Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67
The court must be satisfied of a parent's capacity and informed consent before relying on their decision regarding a child's medical treatment.
Mental Capacity Act 2005, section 1(2)
Inherent jurisdiction allows the court to make decisions regarding a child's medical treatment, even without parental consent, if it is in the child's best interests.
Inherent Jurisdiction
Guidance from the Royal College of Paediatrics and Child Health on withdrawing treatment in life-limiting conditions considers situations where life is limited in quantity, quality, or where there is informed competent refusal.
Royal College of Paediatrics and Child Health guidance, March 2015
Outcomes
The court granted leave to withdraw medical treatment and provide end-of-life care for Z.
The unanimous medical opinion, supported by a second opinion, concluded that Z had no quality of life and that continuing treatment was not in his best interests. The court found that the mother lacked capacity to consent and made a best interests decision.
The court considered the mother lacked capacity to consent to end-of-life treatment.
Due to the mother's non-engagement with a capacity assessment and concerns from the Local Authority, the court proceeded on the basis of a section 16 decision that she lacked capacity. Insufficient evidence existed to confirm informed consent.