Guys & St Thomas' NHS Foundation Trust v MB & Ors

In determining whether life-sustaining treatment should continue for a child, the court must exercise an independent and objective assessment of the child’s best interests. That assessment includes a strong presumption in favour of preserving life, but the presumption is not conclusive.

The court must consider welfare in its widest sense, including the nature, burdens and prospects of treatment and its likely outcome. Parental wishes and feelings must be taken into account, particularly where the child cannot express wishes, but they cannot replace the objective assessment of the child’s welfare. Where treatment is futile and imposes continuing burdens without benefit, withdrawal of ventilation and palliative care may be lawful and in the child’s best interests.

The Trust sought declarations that it was lawful and in OB’s best interests to withdraw invasive and non-invasive ventilation, discontinue or not escalate intensive care, provide compassionate extubation and provide palliative care only.

OB had suffered an unexplained cardiac arrest when less than one month old. He sustained widespread and severe hypoxic-ischaemic brain injury, remained wholly dependent on ventilation and showed no meaningful neurological recovery. His parents opposed the application and sought further time. The Children’s Guardian supported the Trust’s application. The court heard evidence from treating clinicians, independent doctors, the parents’ expert and the Children’s Guardian.

The central issue was whether continued intensive care, despite the strong presumption to preserve life and the parents’ wishes, remained in OB’s best interests.

1. Declaration granted. The court declared that it was lawful and in OB’s best interests for invasive or non-invasive ventilation and continuation or escalation of intensive care support not to be provided, for ventilation to be compassionately withdrawn and for OB to receive palliative care only.
2. The court applied the established best-interests framework in Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67. The focus is whether treatment is in the patient’s best interests. If it is not, it is lawful to withhold or withdraw it. Welfare must be assessed in the widest sense, including medical, social and psychological considerations, the nature and prospects of treatment, its likely outcome, the patient’s attitude and the views of those concerned with the patient’s welfare.
3. The court was required to exercise its own independent and objective judgment, while giving substantial weight to the strong presumption in favour of preserving life. The unanimous specialist medical evidence established that OB’s brain injury was catastrophic and irreversible, that he would not recover and that continued ventilation was futile.
4. Although OB was unlikely to experience pain, the continuing treatment imposed physical burdens and risks, including dependence on ventilation, airway and nutritional problems, progressive stiffness and the risk of infection. The absence of conscious awareness did not prevent treatment from causing physical harm, consistently with Parfitt v Guy’s and St Thomas’ Children’s NHS Foundation Trust [2021] EWCA Civ 362.
5. The parents’ devotion, wishes and request for further time were carefully considered. They were relevant to the assessment, including under the family-life rights engaged, but did not determine OB’s best interests. There was no evidential basis for delaying the decision, and the Children’s Guardian’s analysis that delay conferred no welfare advantage was accepted.