An NHS Trust v NM & Ors

In applications concerning life-sustaining treatment, the court must determine the child’s best interests from the child’s assumed point of view. Welfare is paramount and includes medical, emotional, social, psychological and other relevant considerations. There is a strong but rebuttable presumption in favour of preserving life. The court must independently balance the treatment’s prospects and burdens, the child’s likely experience and the views of parents and clinicians. Parental wishes do not take precedence. Treatment may lawfully be withdrawn where it provides no overall benefit and its burdens outweigh its benefits.

An NHS Trust applied under the inherent jurisdiction for declarations concerning the continued ventilation and medical treatment of NM, an infant with catastrophic antenatal spinal-cord and brain injuries. The treating clinicians and independent expert considered continued life-sustaining treatment futile and contrary to NM’s best interests. NM’s parents sought a further three-month period of treatment to assess her progress, although the medical evidence indicated no prospect of improvement and increasing risks from continued ventilation. The central issues were whether treatment should continue and where and how withdrawal should occur.

1. Best interests. The court’s task was to decide whether continued life-sustaining treatment was in NM’s best interests. Her welfare was paramount, viewed from her assumed perspective. The court had to exercise its own independent judgment and was not bound by the clinicians’ opinions, although their evidence required careful consideration. The best-interests assessment included medical, emotional, social, psychological, sensory and instinctive considerations.
2. Balancing exercise. The strong presumption in favour of preserving life was rebuttable. The court had to weigh the nature of the treatment, its prospects of success, its likely outcome, its burdens and benefits, NM’s likely attitude, and the views of her parents and those caring for her. The parents’ views were important but did not take precedence over NM’s best interests.
3. Application. The medical evidence was unanimous that NM had suffered irreversible catastrophic spinal-cord and brain injury, had made no meaningful progress and had no prospect of future improvement. She could not breathe, swallow or clear secretions independently. Continued ventilation involved daily pain and discomfort, dangerous procedures and an increasing risk of sudden, uncontrolled death. A three-month delay would confer no benefit and would increase those burdens and risks.
4. The court concluded that the burden of continued treatment greatly outweighed its benefit. It was not in NM’s best interests for life-sustaining treatment to continue. The Trust was therefore permitted to withdraw all life-sustaining treatment and provide palliative care directed to preventing pain and discomfort, allowing NM a peaceful and dignified death.
5. Extubation at the parents’ home or a hospice was impractical or unsafe. Extubation was to occur in hospital after the family had been given time to prepare. The reporting restrictions were continued for two months after NM’s death, applying Abbasi and Ors v Newcastle upon Tyne Hospitals NHS Foundation Trust [2025] UKSC 15.

First-instance decision under the High Court’s inherent jurisdiction. No earlier decision in the same proceedings is stated.