Kings College Hospital NHS Foundation Trust v Haastrup (Withdrawal of Medical Treatment)

In disputes about life-sustaining treatment for a child who lacks capacity, the court must make its own independent and objective assessment of the child’s best interests. Best interests include medical, emotional, sensory and instinctive considerations. There is a strong but rebuttable presumption in favour of preserving life. The court must balance the benefits of treatment, its burdens, its prospects of success and the likely quality of the child’s life. Parental views require careful and respectful consideration, particularly where parents know the child well, but their wishes are relevant only insofar as they illuminate the child’s welfare. Where treatment can only prolong life without meaningful benefit, while imposing substantial burdens, withdrawal may be authorised. The court may refuse further expert evidence or an adjournment where the existing evidence is sufficient to determine the issue justly.

King’s College Hospital NHS Foundation Trust applied for declarations authorising the withdrawal of invasive and non-invasive ventilation from Isaiah Haastrup, an 11-month-old child with catastrophic hypoxic-ischaemic brain injury. The application was supported by the Children’s Guardian and opposed by Isaiah’s parents, who sought continued treatment, a tracheostomy and possible home ventilation.

The court heard evidence from treating clinicians, independent experts, the parents and the Guardian. The parents also sought a further adjournment to obtain additional expert evidence, including evidence from foreign doctors. The central questions were whether further evidence was necessary, and whether continued life-sustaining treatment was in Isaiah’s best interests.

1. Further evidence and adjournment. The application for a further adjournment was refused. The court already had extensive evidence from specialists at five hospitals, including two independent experts. Further evidence was not necessary within the meaning of Children and Families Act 2014 s 13(6). Foreign medical expertise might assist where it addressed diagnosis or treatment, but evidence merely expressing a different moral, ethical or cultural approach was of no assistance and was to be deprecated. Any examination of a child involved in proceedings for the purpose of obtaining expert evidence had to comply with the applicable law and procedural rules.
2. Legal approach. The child’s best interests were paramount. The court had to exercise its own independent judgment, considering the matter from the child’s assumed point of view. The assessment included the nature and burdens of treatment, its prospects of success, the likely outcome, and medical, emotional, sensory and instinctive considerations. The strong presumption in favour of preserving life was rebuttable where the burdens and suffering outweighed the benefits.
3. Application to Isaiah. Isaiah’s catastrophic brain injury left him permanently ventilator-dependent, without effective airway-protective reflexes, with profound neurological disability and no prospect of meaningful recovery. Continued ventilation would require lifelong intensive-care treatment, expose him to infection and other physical burdens, and provide no overall benefit or meaningful interaction with the world. The court preferred the consistent clinical and independent expert evidence on responsiveness, consciousness and the effects of medication, while giving respectful consideration to the parents’ evidence and beliefs.
4. Result. It was not in Isaiah’s best interests to continue life-sustaining treatment. The court granted the Trust’s declarations authorising extubation and palliative care.