Oxford University NHS Trust v AB (A Minor) & Ors

Irreversible cessation of brain-stem function constitutes death for legal purposes. The loss of consciousness alone is insufficient, because patients in a vegetative state may remain capable of unaided respiration. Once the clinical criteria for brain-stem death are established in accordance with the applicable Code of Practice, residual neurological activity or reflex movement does not prevent a declaration of death. Continued ventilation is futile and may lawfully be withdrawn. The court may therefore declare that death has occurred and that withdrawal of all care and treatment is lawful.

The NHS Trust applied for declarations concerning AB, a 14-year-old who had sustained catastrophic hypoxic brain injury after being found hanging. She had been ventilated following cardio-respiratory arrest. Two sets of brain-stem tests were conducted, and the medical evidence established irreversible cessation of brain-stem function. AB’s parents opposed withdrawal of ventilation, partly on religious grounds and partly because of their understanding that people can recover from comas.

The central issues were whether the legal criteria for death had been satisfied and whether withdrawal of continuing supportive treatment was lawful and in AB’s best interests.

1. Declaration of death. The court declared that the criteria for death had been established. The legal time of death was accepted as 10:26 on 22 October 2019.
2. Applicable clinical and legal criteria. The court relied on the Code of Practice governing the diagnosis of death following irreversible cessation of brain-stem function. The distinction between coma, vegetative state and brain-stem death was material. Loss of consciousness alone does not establish death, but irreversible cessation of brain-stem function, including the inability to breathe unaided, does.
3. Application of the evidence. Two sets of brain-stem tests confirmed the absence of respiratory effort despite the required rise in carbon dioxide, and no reversible medical cause was identified. A second opinion confirmed the results. The court accepted the evidence of the consultant paediatric intensivist that AB could not revive.
4. Residual activity and withdrawal. Any residual neurological activity or reflex limb movement would not indicate consciousness, sensation or the capacity to sustain respiration. Such activity therefore had no legal relevance to the declaration of death. Continued ventilation was futile because it could not restore AB and would lead to progressive deterioration of the body.
5. The court accordingly declared that it was lawful and in AB’s best interests for all care and treatment to be withdrawn. The decision concerned removal of artificial ventilatory support from a body already legally dead, rather than an act intended to cause death.

not stated in the judgment.