A Local Authority v The Mother & Ors

In determining a child’s best interests, the court must exercise its own independent and objective judgment. It must consider welfare in the widest sense, including medical, emotional and social factors, the burdens and prospects of treatment, the likely outcome, the child’s likely attitude and the views of those concerned with the child’s welfare.

There is a strong presumption in favour of preserving life, but that presumption may be outweighed where life-sustaining treatment imposes substantial burdens, offers no realistic prospect of beneficial recovery and diminishes the child’s dignity. A court may declare withdrawal lawful where treatment is not in the child’s best interests. Contact with a dying child remains governed by welfare, risk and practicability, and may be subject to safeguards.

A local authority was involved in proceedings concerning a 15-month-old child who had suffered catastrophic and irreversible brain injury following cardiac arrest. The child was comatose, dependent on mechanical ventilation and unable to recover meaningful awareness or independent life.

An NHS Trust applied for declarations that withdrawal of ventilation and implementation of longer-term and symptom-management plans would be lawful and in the child’s best interests. All parties agreed. The mother, who lacked capacity to conduct litigation and was detained in hospital, separately sought direct contact before treatment was withdrawn. The central issues were the child’s best interests in relation to continued ventilation and the conditions, if any, for maternal contact.

1. Withdrawal of treatment. The court made the declarations sought. It exercised independent and objective judgment, notwithstanding the parties’ agreement, and treated the child’s best interests as paramount.
2. The court applied the established approach that welfare must be assessed in the widest sense. Relevant considerations included the nature and burdens of mechanical ventilation, the treatment’s risks, its prospects of success, the likely outcome for the child, his likely attitude if capable of awareness, and the views of those concerned with his welfare. The child’s injury was irreversible, his prognosis was hopeless, and continued treatment involved pain, infection, pressure sores, fluctuating vital signs, risk of stroke and sudden death, with no corresponding prospect of meaningful benefit.
3. The strong presumption in favour of preserving life was outweighed by the burdens of treatment, the absence of a realistic prospect of recovery and the loss of dignity associated with continued intensive care. The proposed Longer-Term Care Plan and Symptom Management Plan were in the child’s best interests.
4. Maternal contact. Although the child had no awareness of visitors, the court concluded, just, that direct contact would be in his wider best interests because it might allow the mother to say goodbye and might support her mental health. Contact was conditional on appropriate escorting staff and specialist mental-health nurses being available, with funding not imposed on the hospital. The Trust retained responsibility for deciding whether contact could safely occur.
5. The declaration and treatment plan were not to be delayed pending maternal contact. The father could visit if he wished, subject to the Trust’s arrangements.