Sheffield Teaching Hospitals NHS Foundation Trust v AB & Anor

In an application concerning withdrawal of life-sustaining treatment from an infant, the governing principle is the child’s best interests. The court must assess welfare in the widest sense, including medical, social and psychological considerations, the nature and prospects of the treatment, its likely outcome, and the patient’s attitude where ascertainable. The fact that parents, including for sincere religious reasons, favour continued treatment does not determine the issue. Where treatment is futile, imposes an unsupportable burden and exposes the child to a painful death without realistic prospect of benefit, withdrawal of intensive care and commencement of palliative care may be authorised.

The Trust applied under the inherent jurisdiction for a declaration that it was in the best interests of Z, an eight-week-old infant, to discontinue intensive care and commence palliative care. Z had severe necrotising enterocolitis, extensive bowel infarction, multi-organ failure, profound oedema and continuing need for intensive ventilation and complex pain relief. His parents accepted limits on further treatment but opposed withdrawal of ventilation, principally because of their religious beliefs and their hope that further intervention might permit survival.

The court considered whether continued intensive care remained in Z’s best interests, having regard to the clinical evidence, the risk of a painful and undignified death, the parents’ views and the absence of any realistic treatment option.

1. Application granted. It was in Z’s best interests to stop intensive care and commence palliative care. Intensive care was futile, no further treatment or procedure was available, and continued treatment placed an unsupportable burden on him.
2. The court applied the approach stated by Baroness Hale in Aintree University Hospital NHS Trust v James [2013] UKSC 67. The question is whether treatment is in the patient’s best interests, rather than whether withholding or withdrawing it is in the patient’s best interests. If treatment is not in the patient’s best interests, it is lawful to withhold or withdraw it, and a clinical team acting reasonably and without negligence will not thereby breach its duty.
3. Best interests require welfare to be assessed in the widest sense. Relevant matters include the medical, social and psychological consequences; the nature, burdens and prospects of success of the treatment; the likely outcome; the patient’s attitude; and the views of those involved in the patient’s welfare.
4. The court also applied the principle identified in Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017] EWCA Civ 410: the child’s best interests prevail even where parents, acting for the best of motives, hold an alternative view.
5. Z was an independent and autonomous being despite his age. The evidence established a real likelihood of a painful and agonising death if the parents’ proposed course were followed. The professional consensus that his life had become medically futile was compelling and could not be reconciled with continued intensive treatment as being in his best interests.

First-instance determination under the inherent jurisdiction. No appellate history was stated.