A Local Authority & Anor v MC & Ors (Care proceedings)(Inherent Jurisdiction)

In determining whether invasive, potentially life-prolonging treatment should be withheld from a child lacking capacity, the court must decide whether the treatment itself is in the child’s best interests. A strong presumption favours prolonging life, but it is not absolute. The court must balance the treatment’s prospects and benefits against its burdens, including pain, loss of communication, reduced interaction and effects on medical, psychological, social and emotional welfare. The child’s presumed wishes, parental views and clinical opinions are relevant, but the decision remains objective and fact-specific. If treatment is not in the child’s best interests, the court cannot consent to it and withholding it is lawful. The court cannot require doctors to provide treatment contrary to their professional judgment.

The NHS Trust applied within parallel care proceedings for declarations under the inherent jurisdiction that specified invasive treatments could lawfully be withheld from C, a thirteen-year-old child with profound disabilities, severe respiratory problems, malnutrition and a limited life expectancy. His mother opposed withholding treatment and opposed a care order. The local authority sought continuation of an interim care order under section 38 of the Children Act 1989. The court considered the medical evidence, the child’s welfare and communication, the mother’s views, and the burdens and limited benefits of invasive treatment. The central issues were whether the proposed ceiling of care was in C’s best interests and whether the interim care order should remain in force.

1. Best interests. The court granted interim declarations that the Trust could lawfully withhold the specified invasive treatments. The declarations were to be reviewed and refined after a comprehensive neurological assessment.
2. The decision was governed by C’s objective best interests. The welfare assessment had to include medical, psychological, social, emotional and sensory considerations. The strong presumption in favour of prolonging life was important but not irrebuttable.
3. The court balanced the limited and probably transient possibility that treatment would prolong life against the burdens of central lines, sedation, immobilisation, intubation, ventilation, CPR, renal replacement therapy, pain, infection, further lung injury, reduced consciousness and loss of C’s limited means of communication. The treatments offered no prospect of recovery or reversal of his underlying conditions and were likely to increase suffering without commensurate benefit.
4. C’s presumed instinct to survive, his capacity for pleasure and distress, his relationship with his mother, and the mother’s views were relevant. The mother’s knowledge of C gave her views considerable value, but her wishes were not determinative and had to be assessed objectively.
5. The court confirmed that it could not require doctors to perform treatment contrary to their professional judgment. Where treatment is not in the patient’s best interests, the court cannot consent to it and it is lawful to withhold or withdraw it, provided the clinical team acts reasonably and without negligence.
6. The interim care order under section 38 of the Children Act 1989 remained in force. The court found, on the balance of probabilities, that the statutory circumstances for continuation were met, including findings that C’s mother had deliberately removed feeding tubes and placed him at significant risk.

First-instance decision. No appellate history is stated in the judgment.