Q (A Child) (Withdrawal of Treatment), Re

In disputes about life-sustaining treatment for a child, the court must independently determine the child’s best interests. It must consider welfare in the widest sense, including the treatment’s burdens, prospects, likely outcome, the child’s assumed perspective, and the views of parents and clinicians.

There is a strong but rebuttable presumption in favour of preserving life. Religious beliefs and the parents’ wishes are important factors, but have no automatic priority. Treatment may lawfully be withheld or withdrawn where, after balancing all relevant considerations, it is futile, causes suffering, and provides no commensurate benefit.

An NHS Foundation Trust applied for declarations concerning Child Q, a twelve-week-old infant with profound brain injury, ventilator dependence, intractable seizures and an exceptionally poor prognosis. The medical evidence was unanimous that continued ventilation was futile, burdensome and contrary to his best interests.

The parents accepted the medical evidence and the court’s jurisdiction, but opposed withdrawal because of their Protestant Christian faith and hope for a miracle. The Guardian supported the Trust’s application. The central issue was whether continued mechanical ventilation was in Child Q’s best interests.

1. Declaration granted. Mechanical ventilation and intensive care were not in Child Q’s best interests.
2. The court’s task was to exercise its own independent and objective judgment. The paramount consideration was Child Q’s welfare, assessed in the widest sense. The court had to balance the advantages and disadvantages of treatment, including its nature, burdens, prospects of success and likely outcome. The assessment was necessarily fact-specific and was not a mathematical exercise.
3. There was a strong presumption in favour of preserving life, but it was rebuttable. It could be outweighed where the quality and benefits of life were sufficiently limited and the pain, suffering and other burdens of treatment were sufficiently great. There was no absolute obligation under Article 2 of the ECHR to provide futile treatment.
4. Child Q’s parents’ religious beliefs were genuine, loving and highly relevant. They formed part of his background and identity, but carried no pre-eminent weight. The parents’ own wishes were relevant only so far as they illuminated Child Q’s welfare and the value of the parent-child relationship.
5. The court accepted that ventilation was futile. It did not reverse or improve Child Q’s profound neurological and physical limitations. It prolonged painful or distressing seizures, suctioning, blood tests and other intensive-care interventions. The temporary reduction in seizures following additional medication did not alter the analysis.
6. Given the absence of any realistic prospect of improvement, the likely continuation of suffering and the lack of commensurate benefit, withdrawal of ventilation was more consistent with Child Q’s best interests than continued treatment. The parents were not required to consent to withdrawal, and remained free to pray for a miracle and draw comfort from their faith.