An NHS Hospital Trust v GM & Ors

In an urgent serious-medical-treatment application concerning a child, the court must determine the child’s best interests from the child’s assumed point of view. Welfare is paramount and includes medical, emotional and other welfare considerations. There is a strong but rebuttable presumption in favour of preserving life. The court must balance that presumption, the child’s integrity and autonomy, and the parents’ wishes against the likely benefit and harm of proposed treatment. The court cannot require a doctor to provide treatment which the doctor considers medically inappropriate or contrary to the patient’s interests. Where further intervention offers no benefit and carries a significant risk of harm, the court may declare it lawful and in the child’s best interests that it should not be provided.

The NHS Hospital Trust applied under the inherent jurisdiction in relation to H, a three-month-old child who had suffered catastrophic neurological injuries and whose condition had deteriorated. The Trust sought urgent declarations concerning further neurosurgical intervention, cardiac resuscitation and escalation of treatment. The parents opposed an immediate decisive order and sought further time to consider the evidence and instruct their legal representatives. The child’s guardian supported the Trust’s application. The central issues were whether the proposed treatment was in H’s best interests and whether the court had sufficient evidence to determine the scope of any treatment limitations.

1. The court recognised the strong presumption in favour of preserving life. That presumption was not irrebuttable. H’s life, personal integrity and autonomy, and the parents’ wishes and feelings were given substantial weight.

2. Applying the approach in Wyatt v Portsmouth NHS Trust [2005] EWCA Civ 118; [2006] 1 FLR 554, the court considered H’s best interests from his assumed point of view. The assessment included medical, emotional and other welfare issues. The court also relied on the principle in Re J (a minor) (wardship: medical treatment) [1991] Fam 33 that treatment choices involve the doctors and the court or parents, and that the court cannot compel a doctor to administer treatment considered contrary to the patient’s interests.

3. The medical evidence was unanimous and clear. H had suffered irreversible global brain damage. There was no neurological intervention capable of benefiting him. Further intervention, including further imaging undertaken for that purpose, exposed him to risk and was likely to cause harm without therapeutic benefit. The balance therefore manifestly favoured the Trust’s application.

4. It was declared lawful and in H’s best interests that there should be no further neurosurgical intervention and that, in the event of cardiac arrest, no form of cardiac resuscitation should be given.

5. The court declined at that stage to declare that there should be no escalation of treatment generally, including renal replacement therapy or inotropes, because the evidence was insufficient. Blood transfusions could continue. The declarations were interim, lasting until 6 pm on the following Monday, when the matter was to be reconsidered after further evidence and submissions.

First-instance decision under the inherent jurisdiction. The judgment does not state any prior appellate history.