Alder Hey Children's NHS Foundation Trust v D & Ors
[2023] EWHC 1997 (Fam)
An NHS Foundation Trust v Kwame & Ors
27 January 2023
[2023] EWHC 134 (Fam)
High Court
A boy was badly hurt and needs a machine to breathe. Doctors say he won't get better and the machine causes him pain. The judge agreed it's kinder to let him go, even though his dad disagreed. The family's feelings were important, but the judge decided the boy's comfort is most important.
Key Facts
- •Kwame, a 16-year-old boy, suffered severe hypoxic brain injury after a suicide attempt.
- •He has been on mechanical ventilation in a PICU for 20 months with no sign of improvement.
- •The NHS Trust applied for a declaration that it is not in Kwame's best interests to continue life-sustaining treatment.
- •Kwame's mother does not oppose the application, while his father does.
- •Multiple medical professionals, including those providing second opinions, concur that continuing treatment is not in Kwame's best interests.
- •Kwame's family is religious and close-knit; his faith and family relationships are important factors considered by the court.
Legal Principles
The paramount consideration is the child's welfare.
Portsmouth Hospitals NHS Trust v Wyatt and Anor [2005] EWCA Civ 1181; An NHS Trust v MB [2006] EWHC 507
There is a strong presumption in favour of preserving life, but it is rebuttable.
Portsmouth Hospitals NHS Trust v Wyatt and Anor [2005] EWCA Civ 1181; An NHS Trust v MB [2006] EWHC 507
'Best interests' encompass medical, emotional, and all other welfare issues.
Portsmouth Hospitals NHS Trust v Wyatt and Anor [2005] EWCA Civ 1181; An NHS Trust v MB [2006] EWHC 507
The court must consider the views of doctors and parents, but the child's welfare is paramount.
Portsmouth Hospitals NHS Trust v Wyatt and Anor [2005] EWCA Civ 1181; An NHS Trust v MB [2006] EWHC 507; Re A (A Child) [2016] EWCA Civ 759
The court must consider the child's ascertainable wishes, feelings, beliefs, and values.
Re A (A Child) [2016] EWCA Civ 759; Raqeeb v Barts NHS Foundation Trust [2019] EWHC 2531 (Admin)
Religion and culture are relevant factors in assessing a child's best interests.
Fixsler v Manchester NHS Foundation Trust [2021] EWCA Civ 1018
Human dignity is a key consideration.
North West London Commissioning Group v GU [2021] EWCOP 59
RCPCH guidance on withholding and withdrawing life-saving treatment in children is relevant.
Royal College of Paediatrics and Child Healthcare guidance
Outcomes
It is not in Kwame's best interests to continue mechanical ventilation.
Overwhelming medical evidence indicates no prospect of improvement, and continued treatment risks further suffering and degradation of his physical condition.
Defined limits on treatment will be set after withdrawal of ventilation to allow Kwame to die peacefully.
This ensures a humane and dignified end-of-life experience.