Liverpool City Council v VT & Ors

In applications concerning life-sustaining treatment, the court must decide whether providing the treatment is in the patient’s best interests. The assessment considers welfare in its widest sense, including medical, social and psychological factors, the nature and prospects of treatment, its likely outcome, the patient’s wishes or likely attitude, and the views of those involved in the patient’s care. Where treatment no longer benefits the patient and instead prolongs dying and suffering, withdrawal may be authorised. The same best-interests test applies to consequential contact decisions under Children Act 1989 s34(3).

The local authority applied under the inherent jurisdiction for declarations concerning end-of-life care for N, an eight-year-old child with severe, progressive neurological and respiratory conditions. The proceedings were later restored at the hospital trust’s request after N’s condition deteriorated substantially. The medical evidence became unanimous that long-term ventilation no longer provided benefit, prolonged dying and caused suffering.

N’s mother did not challenge the medical evidence but sought one final face-to-face visit before ventilation was withdrawn. The issues were whether to authorise withdrawal of ventilation and whether such contact was in N’s best interests.

1. Withdrawal of treatment. The court applied the established best-interests approach summarised in Re A (A Child) and derived from Aintree University Hospital NHS Foundation Trust v James. The focus was whether continuing ventilation was in N’s best interests, rather than whether withdrawal was separately justified. The court considered N’s welfare in the widest sense, including his medical condition, suffering, consciousness, capacity for pleasure and interaction, treatment burden, and the views of his carers and clinicians.
2. The evidence was unanimous and clear that N had become minimally conscious, no longer experienced pleasure or benefit from life, suffered repeated severe pain and distress, and had no available curative treatment. Ventilation, suctioning and tracheostomy care prolonged dying and caused significant suffering. It was therefore not in N’s interests to prolong his life by artificial means. The declarations authorising withdrawal of long-term ventilation and associated life-sustaining treatment were granted.
3. Contact. The mother’s request for direct contact was treated as a deemed application under Children Act 1989 s34(3), applying the same best-interests test. Direct face-to-face contact was refused. N had not seen his mother since he was two, the earlier video call had produced no apparent benefit, the visit would intrude upon the foster placement and delay withdrawal, and N was experiencing continuing pain. The delay would prolong his suffering.
4. One final remote video call, monitored by a social worker, was permitted. The parents and other family members could attend a bereavement suite after N’s death.