NR (A Child: Withdrawal of Life Sustaining Treatment), Re
[2024] EWHC 910 (Fam)
NR (A Child: Withholding CPR), Re
17 January 2024
[2024] EWHC 61 (Fam)
High Court
A very sick baby needs a lot of medical help to stay alive. The hospital wanted a court order saying it would be okay to not try CPR if the baby's heart stopped, as CPR might cause more pain and wouldn't likely help. The parents didn't want the order, but the judge decided it was best for the baby not to have CPR in this situation, even though the parents disagreed, because CPR would likely only cause more pain and suffering.
Key Facts
- •NR, a child born with severe disabilities and life-limiting health conditions, is in critical care.
- •King's College Hospital NHS Foundation Trust applied for declarations to withhold certain medical treatments, including CPR.
- •Parents are devout Orthodox Christians and oppose withholding CPR.
- •NR requires mechanical ventilation and has a bleak prognosis.
- •There is disagreement among medical professionals regarding the administration of inotropes and CPR.
Legal Principles
The paramount consideration is the child's best interests, viewed from their assumed point of view.
Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67, Re J (A Minor) (Wardship: Medical Treatment) [1991] Fam 33, Wyatt v Portsmouth NHS Trust [2006] 1 FLR 554, An NHS Trust v MB [2006] EWHC 507, Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017] EWCA Civ 410
Best interests are considered in the widest sense, including 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.
Re J (A Minor) (Wardship: Medical Treatment) [1991] Fam 33, Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017] EWCA Civ 410
Views of parents, clinicians, and others are considered, but none are decisive.
Re J (A Minor) (Wardship: Medical Treatment) [1991] Fam 33, Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017] EWCA Civ 410
The court must apply these principles to the specific facts, considering the child's condition, proposed treatment, and predicted outcomes.
Guy’s & St Thomas’s NHS Foundation Trust [2022] EWHC 2422 (Fam)
It is ethical to withhold or withdraw life-sustaining treatment if the treatment is medically inappropriate, no longer in the child's best interests (burdens outweigh benefits), or if a competent child refuses consent.
Royal College of Paediatrics and Child Health’s (RCPCH) document, “Making decisions to limit treatment in life-threatening conditions in children: a framework for practice”
Outcomes
The court declared it lawful to withhold CPR in the event of a cardiac arrest.
CPR is unlikely to succeed, would be burdensome and cause pain and distress, and the potential for further brain damage outweighs the benefits. The court considered the parents' wishes but ultimately prioritized NR's best interests from his perspective, concluding that he would likely prefer a more peaceful death.
The court allowed for the administration of low-dose inotropes to correct hypotension related to medication, subject to specified caps.
Low-dose inotropes were deemed to have potential benefits in preserving life without causing excessive harm.