A (A Child), Re (Rev 1)

Irreversible cessation of brain-stem function constitutes legal death in the United Kingdom, although residual neurological or spinal activity may continue. The fact that ventilation maintains circulation does not prevent the body from being legally dead. A coroner’s powers are directed to investigating the cause of death and should not ordinarily be used to intervene while a deceased body remains ventilated, particularly where that would cause avoidable distress. Where disagreement arises between clinicians and family members about continued assisted ventilation after brain-stem death, the dispute should be determined by the High Court under its inherent jurisdiction and/or parens patriae jurisdiction.

The Central Manchester NHS Foundation Trust applied for declarations concerning a 19-month-old child who had suffered catastrophic hypoxic-ischaemic brain injury after choking. Two brain-stem tests confirmed irreversible cessation of brain-stem function. The child’s father disputed that brain-stem death was equivalent to legal death and wished continued ventilation to remain possible, including for a proposed transfer to Saudi Arabia.

The Senior Coroner for Manchester asserted jurisdiction over the body and requested cessation of ventilation and removal to the mortuary. The Trust instead sought declarations from the High Court concerning death, jurisdiction and the lawful withdrawal of ventilation.

1. Death. Applying the Academy of Medical Royal Colleges’ Code of Practice and the clinical evidence, the court held that the irreversible cessation of brain-stem function established the child’s death at 10.10 am on 10 February 2015. The loss of consciousness alone would not have been sufficient. Brain-stem death was different because the child could not breathe unaided and integrated biological function would inevitably deteriorate.
2. Residual electrical activity in parts of the brain, and spinal reflex movements of the limbs, did not demonstrate consciousness, awareness or the capacity to sustain respiration. They therefore did not prevent a legal diagnosis of death.
3. Coronial jurisdiction. Section 15 of the Coroners Act 2009, read with sections 14 and 1(1), was directed to facilitating investigation of the cause of death. The court associated itself with the view in Jervis on Coroners that, although a coroner may technically have jurisdiction over a body after brain-stem death, intervention while ventilation continues should not ordinarily occur. The exception concerned organ removal where the family consented.
4. High Court jurisdiction and order. The Family Division had jurisdiction under its parens patriae and inherent jurisdictional powers to make declarations concerning the child’s body. Respect for the father’s religious and personal views could not alter the legal conclusion. The court made the declarations sought, with amendments, permitting withdrawal of ventilatory support.
5. The court further stated that any unresolved dispute between treating clinicians and family members while assisted ventilation continues should be determined in the High Court, rather than through coronial powers.

First instance decision. No prior appellate decision is stated in the judgment.