Birmingham Women's and Children's NHS Foundation Trust v JB & Anor

In determining a child’s best interests, the court must assess welfare in the widest sense, including medical, emotional, social and psychological considerations. Parental views, including religious and cultural beliefs, are relevant but cannot determine the outcome. Medical best interests must form part of the overall welfare assessment.

There is a strong but rebuttable presumption in favour of preserving life. The court must balance the benefits and burdens of treatment, its prospects of success, the child’s likely experience, and the effect on dignity and quality of life. Artificially sustaining vital organs is not necessarily beneficial treatment. Where treatment provides no benefit and merely prolongs dying, withdrawal may be authorised.

The NHS Trust applied for a declaration authorising the withdrawal of intensive care from J, a 12-year-old child who had suffered a profound hypoxic-ischaemic brain injury after a period of cardiac arrest. J remained in a deep coma, required mechanical ventilation and had no realistic prospect of recovery.

The medical evidence was unanimous that continued ventilation provided no benefit and imposed substantial burdens. J’s family accepted the medical evidence but wished for further time for prayer and a possible miracle, relying on their Pentecostal faith. The central issue was whether continued treatment was in J’s best interests.

1. Declaration granted. The court authorised the withdrawal of intensive care and the associated treatment plan.
2. The governing question was J’s best interests. Applying Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67, the assessment had to address welfare in the widest sense, the nature and prospects of treatment, its likely outcome, J’s probable attitude, and the views of those concerned with his welfare.
3. The court adopted the intellectual milestones identified in Wyatt v Portsmouth NHS Trust [2006] 1 FLR 554. Welfare was paramount; the assessment had to proceed from the patient’s assumed viewpoint; the presumption favouring life-prolonging treatment was strong but rebuttable; welfare included medical, emotional and other interests; and all relevant factors had to be balanced.
4. The reasoning in Re J (a minor) (Wardship: Medical Treatment) [1991] Fam 33 remained applicable. Treatment should not be continued where it caused increased suffering and produced no commensurate benefit, giving full weight to the desire to survive.
5. The court explained that parental faith and wishes were important considerations but never determinative. Medical best interests could not be separated artificially from the child’s overall interests. The court did not infer J’s wishes from either his suicide attempt or his faith.
6. The evidence established that J had no prospect of recovery, that ventilation achieved no benefit, and that its burdens risked compromising his dignity. Effective medical intervention was not necessarily beneficial intervention. Continued ventilation would prolong his death rather than save his life.

Not stated in the judgment.