Mid Yorkshire Hospitals NHS Trust v NB

In deciding whether life-sustaining treatment should continue for a person who lacks capacity, the court must determine the patient’s best interests under the Mental Capacity Act 2005. The assessment must consider welfare in its widest sense, including medical, social and psychological factors, the treatment’s burdens and prospects of success, the likely outcome, the patient’s wishes, feelings, beliefs and values, and the views of those concerned with the patient’s welfare.

The court must not be motivated by a desire to bring about death. It is lawful to withhold or withdraw treatment where responsible medical opinion establishes that treatment would be futile and is not in the patient’s best interests. The court must consider the patient’s individual circumstances rather than treating preservation of biological life as determinative.

The Trust applied for declarations concerning NB, who had suffered a severe hypoxic brain injury after a cardiac arrest and remained in a prolonged disorder of consciousness. The parties agreed that he lacked capacity to make decisions about his medical treatment and to conduct the proceedings.

The contested issue was whether it was lawful and in NB’s best interests to withhold life-sustaining treatment, including clinically assisted nutrition and hydration and ventilation, while providing palliative care. His daughter opposed withdrawal, seeking further time because the family hoped for recovery. The court therefore had to determine NB’s best interests under the Mental Capacity Act 2005.

1. Capacity. On the unchallenged evidence of two independent specialists, NB lacked capacity to make decisions about his care and treatment and would not regain it. A declaration was made under section 15 of the Mental Capacity Act 2005.
2. Applicable approach. Section 4 required consideration of all relevant circumstances. Following Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67, the focus was whether treatment was in NB’s best interests. Welfare had to be considered in the widest sense, including medical, social and psychological welfare, the nature and prospects of treatment, its likely outcome, NB’s likely attitude, and the views of those concerned with him. The approach in PL (By her litigation friend, SL) v Sutton Clinical Commissioning Group and Anor [2017] EWCOP 22 was applied.
3. Assessment. NB was in a chronic vegetative state, with no awareness and no prospect of meaningful recovery. Continued clinically assisted nutrition and hydration would prolong his existing condition for approximately seven years without restoring function. Withdrawal would lead to death within weeks under a detailed palliative care plan. His absent wishes, beliefs, family views, dignity, prognosis and the clinical evidence were all weighed.
4. The court was not motivated by a desire to cause death. It concluded that continued treatment would be futile and not in NB’s best interests. It was therefore lawful and in his best interests to withhold ventilation and clinically assisted nutrition and hydration, not to provide cardiopulmonary resuscitation after cardiac arrest, and to provide palliative care directed to minimising distress, maximising comfort and preserving dignity.