University Hospitals Bristol and Weston NHS Foundation Trust v The Mother of G

Where properly conducted brain-stem testing establishes irreversible cessation of brain-stem function, the court may declare that the person has died and authorise withdrawal of mechanical support. A dispute is determined under the High Court’s inherent jurisdiction, with the ordinary civil standard of proof. The issue is whether death has occurred; best-interests analysis is unnecessary if death is established. Applications will ordinarily proceed under Part 8 of the Civil Procedure Rules 1998. Although the claimant should normally file clinical evidence with the claim, the court may shorten or dispense with other procedural requirements and list the matter urgently where the testing and conclusions are unchallenged or incontrovertible.

The Hospital Trust applied under the inherent jurisdiction for declarations that G, an adult patient maintained by mechanical ventilation after ingesting ethylene glycol, had died by neurological criteria and that withdrawal of medical support was lawful. Formal brain-stem testing was conducted by two consultants in accordance with the Code of Practice for the Diagnosis and Confirmation of Death and fulfilled all criteria for death by neurological criteria. G’s mother disputed the diagnosis, sought a lengthy adjournment and maintained that G might recover. The Trust opposed further delay. The central issues were whether the testing and diagnosis established death and whether further adjournment or best-interests consideration was required.

1. Adjournment and procedure. A lengthy adjournment was refused. The evidence disclosed no realistic challenge to the testing procedure or its conclusions and no relevant evidential gap. The application was appropriately brought under Part 8 of the Civil Procedure Rules 1998, although strict application of the timetable was unnecessary. The Trust should ordinarily file clinical evidence with the claim form, but the court may expedite the hearing, shorten the timetable or dispense with formal evidence from the defendant where the clinical evidence appears incontrovertible and urgency warrants it.
2. Legal framework. There is no statutory definition of death. The authorities, including Airedale NHS v Bland, established the validity in law of a medical diagnosis of death based on irreversible absence of brain-stem function. Once brain-stem testing has been administered and indicates death under the Code of Practice, any dispute is determined in the Family Division under the inherent jurisdiction. The question is narrowly whether the person has died. The ordinary civil standard of proof applies.
3. Consequences of death. If the court concludes that the person is not brain-stem dead, a best-interests decision may follow in the appropriate jurisdiction. If death is declared, best interests are irrelevant and the court may declare death and authorise withdrawal of medical intervention.
4. Application. The two sets of tests were conducted rigorously and produced identical results. There was irreversible brain-stem damage, no reversible cause or confounder, no available neurosurgical treatment and unanimous clinical evidence that G was dead by neurological criteria. The declaration was therefore made that G died at 13.30 on 15 May 2024. Withdrawal of mechanical ventilation and medical support was authorised, but postponed until 4pm on 27 May 2024 to allow the family additional time.