High Court Rules on Withdrawal of Life-Sustaining Treatment for Two-Year-Old with Irreversible Brain Injury

Citation: [2024] EWHC 313 (Fam)
Judgment on

Introduction

The High Court of Justice family division handed down a decision in the case of A Hospital Trust v P & Ors [2024] EWHC 313 (Fam), focusing on the profoundly challenging issue of whether life-sustaining treatment should be withdrawn from a two-year-old girl, ‘P’, who had suffered irreversible and devastating brain injury. The case underscores the legal and ethical dilemmas that occur at the intersection of medical capability, parental rights, and the best interests of a child under UK law.

Key Facts

P, a two-year-old child, suffered a serious brain injury leading to a state of persistent unconsciousness. The medical consensus was that P would never recover and her condition would only deteriorate. The treating hospital, supported by medical experts, sought declarations to withdraw life-sustaining treatment and implement a palliative care regime. Both parents hoped for recovery but recognized the weight of medical evidence and ultimately deferred to the court’s decision.

The court’s analysis rested on firmly established principles governing medical treatment decisions in cases involving minors. They include the best interests of the child as the paramount consideration, the presumption in favor of preserving life, and the acceptance that this presumption can be rebutted when the burdens of life-sustaining treatment outweigh the benefits.

Mrs Justice Knowles cited key precedents to construct her judgment:

  • Best Interests of the Child: Reflecting the principles laid out in cases such as In Re J (A Minor) (Wardship: Medical Treatment) [1991] and Aintree University Hospital NHS Foundation Trust v James [2013], the judge placed P’s best interests at the forefront, inclusive of medical, emotional, sensory, and psychological welfare.

  • Presumption in Favor of Preserving Life: The judge considered the ‘strong presumption’ in favor of life preservation, acknowledging that this fundamental instinct must be critically examined against the practical reality of the child’s quality of life and potential suffering, as drawn from Wyatt v Portsmouth NHS Trust [2006] and An NHS Trust v MB [2006].

  • Views of Parents and Expert Testimony: The case took into account the parents’ views, recognizing the emotional weight but also their potential bias due to the distressing nature of the circumstances. The court was not bound by the clinical assessments of the doctors but had to form its own view, as emphasized by cases such as Kirklees Council v RE and others [2015] and Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017].

  • Withdrawal of Treatment: The court referenced principles from Aintree, focusing on whether it would be lawful to give or withhold treatment, stating that if treatment is not in the best interests, it would be lawful and indeed obligatory to withdraw it, ensuring the child’s welfare in the widest sense.

Additionally, the implications of the European Convention on Human Rights were considered, including P’s right to life (Article 2), the right to private and family life (Article 8), and the right to thought, conscience, and religion (Article 9).

Outcomes

The court, applying these principles, granted the Trust’s application, declaring that it was not in P’s best interests for life-sustaining treatment to continue and that it was in her best interests for a palliative care regime to be implemented.

Conclusion

In A Hospital Trust v P & Ors, the court navigated the delicate balance between the preservation of life and the delivery of a dignified death, emphasizing the best interests of the child within the wider context of her welfare. The judgment serves as a somber reminder of the intrinsic value of life and the complexities faced when considering its cessation in a legal context. The articulation of this case offers guidance for handling similar issues with sensitivity, respect for the family’s religious and emotional bearings, and adherence to established legal standards. The judgment underscores the critical role of the judiciary in making such profound decisions where medical evidence and ethical concerns converge.