Key Facts
- •NR, a 3-year-old boy with severe brain malformation, survived for months after withdrawal of life-sustaining treatment (invasive ventilation) following a court order.
- •The court initially authorized the withdrawal of treatment based on medical evidence predicting imminent death.
- •NR's unexpected survival and progress led to his parents' application to remove the 'ceilings of treatment' (restrictions on further medical interventions).
- •The court's previous decisions involved withholding CPR and other treatments.
- •The case raises questions about the reliability of medical prognoses and the role of the court in making advance decisions about medical treatment.
Legal Principles
A child's best interests are the paramount consideration, encompassing medical and non-medical factors.
Well-established principles in cases concerning withdrawal of life-sustaining treatment
There is a strong presumption in favour of preserving life, but this can be displaced if other considerations outweigh it.
Well-established principles in cases concerning withdrawal of life-sustaining treatment
The views of parents, clinicians, and others are considered, but none are decisive.
Well-established principles in cases concerning withdrawal of life-sustaining treatment
Courts should exercise caution in making open-ended declarations about treatment for seriously ill children, as circumstances may change.
Portsmouth Hospitals NHS Trust v Wyatt [2005] 1 WLR 3995; Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67
Outcomes
Discharge of all previous declarations permitting the withholding of CPR and other treatments.
The significant improvement in NR's condition and the uncertainty surrounding future circumstances make the previous declarations inappropriate. The court should not provide a detailed decision-making flowchart for future uncertain situations. It is better to leave these decisions to clinical judgment in consultation with the parents.