Alder Hey Children's NHS Foundation Trust v D & Ors
[2023] EWHC 1997 (Fam)
NR (A Child: Withdrawal of Life Sustaining Treatment), Re
23 April 2024
[2024] EWHC 910 (Fam)
High Court
A very sick child needs a breathing machine to stay alive. Doctors believe that continuing treatment is causing more harm than good. The parents disagree. A judge decided that it’s best for the child to stop the treatment, even though it means the child will likely die, as the child’s suffering is too great.
Key Facts
- •Four-year-old NR, born with severe disabilities and life-limiting health conditions, including significant brain malformation, is on invasive ventilation following two cardiac arrests.
- •The hospital trust applied for a declaration to lawfully withdraw life-sustaining treatment, supported by the child's guardian but opposed by the parents.
- •The parents sought an adjournment to explore the possibility of transferring NR to a hospital abroad, which was refused by the court.
- •NR's condition involves brain malformation, epilepsy, cleft lip and palate, bilateral anophthalmia, and recurrent sepsis.
- •Medical evidence suggests NR's life expectancy is no more than six months, with no prospect of improvement.
- •The parents believe NR has awareness and responds to their presence, while medical professionals indicate severely limited awareness.
- •The court considered medical evidence, parental wishes, ethical principles, and relevant case law in its determination.
Legal Principles
The paramount consideration is the child's best interests in their widest sense, encompassing medical, social, and psychological factors.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67
There's a strong presumption in favour of preserving life, but it can be displaced if other considerations outweigh it.
In Re J (A Minor) (Wardship: Medical Treatment) [1001] Fam 33; Wyatt v Portsmouth NHS Trust [2006] 1 FLR 554; An NHS Trust v MB [2006] EWHC 507
Parental wishes are relevant but don't override the child's best interests.
Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017] EWCA Civ 410
The court must consider the parents' Article 8 rights (family life) and Article 9 rights (freedom of religion).
Gard and Others v the United Kingdom - 39793/17; Raqeeb v Barts NHS Foundation Trust [2019] EWHC 2531 (Admin)
Harm can be caused to a person even if they are not consciously aware of it.
Parfitt v (1) Guy's and St Thomas' Children's NHS FT (2) Knight [2021] EWCA Civ 362
Outcomes
The court granted the Trust's application to discontinue life-sustaining treatment.
The burdens of NR's condition and treatment significantly outweigh the benefits. Continued treatment is futile and causes harm without improving his condition. The court weighed medical evidence, parental wishes, and ethical considerations, concluding that discontinuing treatment is in NR's best interests.
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