Barts Health NHS Trust v MC & Anor

Brain stem death, established by the applicable neurological criteria, constitutes legal death in the United Kingdom. Once the court is satisfied that brain stem death has occurred, a best-interests analysis does not arise because the patient is already dead. The court may refuse further invasive investigations undertaken solely to reassure relatives where they are unnecessary for diagnosis, would compromise the deceased person’s dignity, or would require clinicians to undertake an unethical process.

LS, aged twelve, suffered a catastrophic hypoxic-ischaemic brain injury after asphyxiation and remained mechanically ventilated. Brain stem testing on 4 November 2025, conducted under the Academy of Medical Royal Colleges’ Code of Practice for the Diagnosis and Confirmation of Death 2025 Update, confirmed death by neurological criteria.

The parents disputed the legal significance of the testing on religious grounds and sought a second opinion and further brain imaging. The matter came before the court for rehearing after the Court of Appeal set aside an earlier declaration because the parents had not been given a procedurally fair opportunity to engage with the evidence. The central issues were whether LS had died and whether further testing or imaging should be undertaken.

1. Declaration of death. The court found, on compelling and unanimous medical evidence, that LS’s brain stem function had permanently ceased and that she died on 4 November 2025 at 4.45pm.
2. Legal test. The court applied the established legal position that brain stem death constitutes death. Airedale NHS Trust v Bland [1993] 1 AC 789 accepted brain stem death as legal death, and Re M (Declaration of Death of Child) [2020] EWCA Civ 164 confirmed that brain stem death is the legal criterion in the United Kingdom.
3. Application of the 2025 Code. The Trust complied with the Code’s requirements concerning the clinicians, preconditions, testing of brain stem reflexes and confirmation of death. The expert evidence confirmed that the testing was valid. Observed limb movements were reflexive and did not demonstrate brain stem function.
4. No best-interests jurisdiction. Once brain stem death is established, the court is declaring that the patient is already dead. It is not deciding whether death is in the patient’s best interests. The court therefore had no best-interests jurisdiction to exercise.
5. Further investigations. Additional CT angiography or functional MRI was unnecessary for diagnosis and was sought only to reassure the parents. The court declined to encourage further imaging because it would compromise LS’s dignity in death, would not realistically reassure the parents, and would require clinicians to undertake a process they regarded as unethical.

Declarations were made that LS died at the stated time and date.

• Court of Appeal: On 23 November 2025, the appeal from the earlier hearing was allowed because the parents had not been afforded a procedurally fair opportunity to engage meaningfully with the proceedings. The earlier declaration was set aside and the matter was remitted for rehearing.
• High Court (Family Division): On rehearing, the court declared that LS died on 4 November 2025 at 4.45pm.