Manchester University Hospital NHS Foundation Trust v M & Anor

In determining whether life-sustaining treatment should be provided to a child, the court must decide whether the proposed treatment is in the child’s best interests. The assessment is individual and fact-sensitive. It must address welfare in the widest sense, the nature and burdens of treatment, its prospects of success, the likely outcome, the child’s perspective where ascertainable, and the views of those concerned with the child’s welfare. The child’s best interests prevail over parental views, even where those views are sincerely held. A decision may require reconsideration promptly if the clinical balance changes, particularly where treatment causes unacceptable suffering or becomes unsuccessful.

The NHS Trust sought authority to provide haemodialysis to M, a 13-month-old child with end-stage renal failure. Peritoneal dialysis had become ineffective because of severe abdominal adhesions and the position of the catheter. The alternative was conservative palliative care, under which M would be expected to die within weeks. The parents opposed haemodialysis, principally on religious grounds. The central issue was whether haemodialysis, despite its substantial risks and burdens, was in M’s best interests and what directions should govern any material change in her condition.

1. Best interests. The court applied the approach identified in Aintree University Hospital NHS Trust v James [2013] UKSC 67. The question was whether providing haemodialysis was in M’s best interests, rather than whether withholding it was preferable. The assessment required consideration of M’s welfare in the widest sense, the treatment’s nature, burdens and prospects, its likely outcome, her likely attitude, and the views of those involved in her welfare.
2. The sole governing principle was that M’s best interests prevailed. The court was required to apply that principle even though her parents’ opposition was sincerely held and grounded in faith. The medical evidence showed a finely balanced decision, but haemodialysis offered M a real, albeit difficult, prospect of survival and eventual transplantation. The court therefore concluded that it was premature to restrict treatment to palliative care.
3. The court authorised haemodialysis as M’s current best-interests treatment. The decision was expressly capable of revision because the balance could change quickly.
4. If the dialysis catheter ceased to function, a further application was not required before another attempt was made, provided the clinicians continued to act cautiously, collaboratively and in M’s needs. The court did not exclude a further application if considered necessary.
5. If M became clearly symptomatic or suffered on dialysis, including through collapse, repeated seizures or cardiovascular instability, the matter was to return promptly to court. A return was also required if haemodialysis proved unsuccessful, in which event an expedited palliative-care plan and DNAR certificate would need consideration.

Not stated in the judgment. This was a first-instance decision of the High Court (Family Division).