Court Decision Upholds Best Interests in End-of-Life Care Dispute

Citation: [2023] EWCOP 57
Judgment on


In the matter of The NHS Foundation Trust v K & Ors [2023] EWCOP 57, the Court of Protection delivered a judgment concerning the best interests of a young person, identified as K, in relation to her medical treatment. K, suffering from a rare neurological condition and lacking capacity, became the subject of proceedings initiated by an NHS hospital trust. The case raised significant questions around end-of-life care and the principles enshrined in the Mental Capacity Act 2005.

Key Facts

The NHS Foundation Trust sought court declarations regarding the continuation or cessation of K’s medical treatment. K’s condition prompted repeated hospital admissions requiring invasive respiratory support. Her treating doctors viewed her as nearing the end of life and advocated for palliative care.

The challenge arose in involving K’s family in discussions about end-of-life care, leading the Trust to commence proceedings. Two main options were considered: the continuation of current treatment with an oral tracheal tube in intensive care, or a move to palliative care following the extubation. A third option, a tracheostomy, was debated but not favored by the treating team.

K’s family, particularly her sister B, struggled with the prospect of K’s passing and believed in the possibility of her recovery. B contended that K was being discriminated against due to her disability and argued for her transfer to another hospital.

The judgment drew upon several legal principles and preceding case law to establish a framework for decision-making:

  1. Best Interests: Central to the court’s decision was the application of section 4 of the Mental Capacity Act 2005, which mandates a comprehensive appraisal of the individual’s best interests, taking into account their welfare in the widest sense. The court must consider the person’s past and present wishes, feelings, beliefs, values, and any other factors they would likely consider if able (subsection 6).

  2. Value of Life: The case reaffirmed the principle that there is a strong presumption in favor of preserving life as dictated by cases such as Aintree University Hospital NHS Foundation Trust v James and W v M. However, the persistence of life is not absolute, and situations may arise where it is no longer in a person’s best interests to receive life-sustaining treatment.

  3. Burden of Proof: In line with R(Burke) v GMC, the burden of proving that discontinuing life-sustaining treatment aligns with a person’s best interests rests with the party proposing to withdraw it, here the Applicant Trust.


The court found in favor of Option 2, concluding that a regimen of palliative care without re-intubation constituted the best interests of K. The judge determined that the tracheostomy, while extending life, would inflict significant discomfort and necessitate ongoing sedation or restraint, outweighing its prospective benefits.

The evidence indicated that K’s deterioration since Dr. O’s assessment shifted the balance of considerations against the tracheostomy. Thus, while preserving life was a weighty consideration, K’s projected profound distress and minimal potential for quality interaction rendered the prospect of prolonged life via tracheostomy not in her best interests.


The judgment in The NHS Foundation Trust v K & Ors illustrates the complexities inherent in end-of-life medical decisions within the scope of the Mental Capacity Act 2005. This case underscores the judiciary’s role in scrutinizing a patient’s circumstances to ensure decisions are made aligning with their best interests, welfare, and intrinsic human dignity. The principle that life should be preserved is potent yet not paramount, especially when prolonged treatment might bring more burden than benefit to the patient. The court’s approach exemplifies a sensitive and thorough application of legal standards to emotionally charged and morally complex situations.

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