C (An Infant), Re (Rev 1)

When deciding whether life-sustaining treatment should be withheld from an infant, the court must determine the child’s objective best interests. Welfare is assessed in the widest sense, including medical, emotional and sensory interests, pain and suffering, family relationships and the child’s interest in continued life.

There is a strong presumption in favour of prolonging life, but it is not absolute. Treatment may properly be withheld where it offers no real or commensurate benefit, is futile, or imposes burdens of pain, distress and suffering which outweigh its benefits. The court cannot require doctors to provide treatment contrary to their professional judgment.

An NHS Trust applied for declarations concerning the treatment of C, a two-month-old infant with profound brain malformation, severe refractory seizures and a life expectancy of less than one year. The Trust sought authority not to intubate or mechanically ventilate C, not to provide resuscitative measures including cardiac massage and bag-valve-mask ventilation, and to limit treatment to palliative care.

C’s parents wished to continue resuscitation and sought further anti-epileptic drug trials. C’s guardian supported the Trust’s application. The central issue was whether continued ventilation, CPR and further medication trials were in C’s best interests.

1. Best interests. The court applied the objective best-interests test. The assessment included C’s medical, emotional and sensory welfare, his awareness, pain and suffering, family care, and the strong but non-absolute presumption in favour of prolonging life. The parents’ love, religious beliefs and wishes were important background matters but were not determinative.
2. Benefits and burdens. C received comfort and affection from his family. Against that, he suffered frequent seizures, bradycardia, apnoea and oxygen desaturation, together with repeated painful or distressing interventions. Bag-valve-mask ventilation, jaw thrust, tube replacement and CPR imposed significant burdens. CPR was an aggressive procedure likely to cause trauma and pain.
3. Futility and treatment options. C’s underlying condition was irreversible and untreatable. Continued ventilation and CPR would only delay inevitable death, without controlling the seizures or providing an overall benefit. The evidence did not justify further trials of zonisamide, cannabidiol or a second trial of topiramate.
4. Professional judgment. The court recognised that it could intervene where parents refused treatment considered to be in their child’s best interests. It could not require doctors to carry out treatment contrary to their professional judgment.
5. Disposition. It was in C’s best interests to receive only treatment directed to comfort and relief of pain and distress. The declarations sought by the NHS Trust were made, and it was lawful to withhold intubation, mechanical ventilation and resuscitative treatment.