HK (Serious Medical Treatment) (No.2)

In determining a child’s best interests in relation to serious medical treatment, the court must consider the child as a whole. That includes the right to life, the importance of preserving life, the child’s suffering, the prospects of recovery, and the interests and perspectives of the parents. Where the evidence establishes that invasive treatment offers no realistic prospect of recovery and causes or prolongs suffering, the balance may decisively favour a carefully specified programme of non-invasive and palliative care. Interim declarations may be made pending a fuller hearing where the evidence justifies immediate changes to treatment.

An NHS hospital trust applied under the inherent jurisdiction for interim declarations concerning the treatment of H, a seriously injured infant who was receiving intensive medical treatment. The application followed a significant deterioration in his condition, including continuing intracranial bleeding, falling haemoglobin levels, repeated blood transfusions and increasing episodes of dystonia indicative of pain.

On the previous Friday, the court had authorised no further neurosurgical intervention and no cardiac resuscitation, but had deferred the question of ongoing treatment because the evidence was insufficiently detailed. At the resumed hearing, the court considered the proposed treatment plan and the parents’ submissions concerning preservation of life and their personal interests. The central issue was whether the proposed interim programme of non-invasive and palliative care was in H’s best interests.

1. The court granted the hospital trust’s application for an interim declaration authorising the treatment plan proposed by the consultant paediatric intensivist. The plan comprised continued nutrition, hydration, antibiotics and symptom relief, while excluding specified invasive interventions, including high-frequency ventilation, new central-line insertion, inotropes, vasopressors and haemofiltration where the relevant conditions arose.

2. In applying the best-interests principles identified in the earlier judgment, the court considered H’s right to life and the importance of preserving it, together with the interests and perspectives of his parents. A best-interests assessment requires consideration of the child as a whole and is not confined to a medical assessment.

3. The medical evidence established that H was suffering pain associated with increasing dystonia and that his condition had no realistic prospects of reversal or recovery. Continued supportive blood transfusions had enabled him to survive but did not treat the underlying cause of the bleeding. In those circumstances, the judge found that the proposed course was the only course that could properly be endorsed for the short period before the extubation hearing.

4. The declarations made on the previous Friday, prohibiting further neurosurgical intervention and cardiac resuscitation, were continued. The additional declaration concerning ongoing treatment was also continued until the hearing on Thursday. Blood transfusions were to continue until that hearing, consistently with the overall non-invasive treatment programme.

Not stated in the judgment.