NHS Trust v A & Anor

NHS Trust v A & Anor

The court, not any individual doctor, must determine the best interests of an incapacitated patient. Where the overwhelming weight of responsible medical evidence is that continued life-sustaining treatment is futile, causes suffering, and offers no prospect of meaningful recovery or quality of life, it is not in the patient's best interests to continue such treatment. The Bolam test does not require the court to defer to any responsible minority medical opinion. The judge was entitled to prefer the evidence of the treating clinicians and independent expert over the contrary view of Dr R, and to conclude to a high degree of probability that withdrawal of treatment was in Mr A's best...

Parties
Claimant/first Respondent: AN NHS Trust; First Defendant/second Respondent: A (An Adult, represented by the Official Solicitor as Litigation Friend); Second Defendant/respondent: SA
Jurisdiction
England and Wales
Judgment Date
01 September 2005
Procedural Posture
Civil Appeal (family/medical) / Appeal From High Court Judgment on Declarations Regarding Withdrawal of Life Sustaining Treatment
Outcome
Appeal dismissed; permission to appeal granted; declarations of the High Court affirmed.
Legal Topics
Withdrawal of Life Sustaining Treatment, Best Interests of Incapacitated Patient, Role of Court in Medical Decisions, Application of Bolam Test, Religious and Family Considerations in Medical Treatment
Medical Law Family Law Human Rights Withdrawal of Life Sustaining Treatment Best Interests of Incapacitated Patient Role of Court in Medical Decisions Application of Bolam Test Religious and Family Considerations in Medical Treatment

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Parties

AN NHS Trust

Claimant/first Respondent

A (An Adult, represented by the Official Solicitor as Litigation Friend)

First Defendant/second Respondent

SA

Second Defendant/respondent

Procedural Posture

Civil Appeal (family/medical) / Appeal From High Court Judgment on Declarations Regarding Withdrawal of Life Sustaining Treatment

Legal Issues

  1. 1 Whether it is in the best interests of an incapacitated adult patient to withdraw life-sustaining medical treatment
  2. 2 Whether the court or a responsible body of medical opinion determines best interests in the presence of conflicting medical evidence
  3. 3 The relevance and scope of the Bolam test in withdrawal of treatment cases

Ratio Decidendi

The court, not any individual doctor, must determine the best interests of an incapacitated patient. Where the overwhelming weight of responsible medical evidence is that continued life-sustaining treatment is futile, causes suffering, and offers no prospect of meaningful recovery or quality of life, it is not in the patient's best interests to continue such treatment. The Bolam test does not require the court to defer to any responsible minority medical opinion. The judge was entitled to prefer the evidence of the treating clinicians and independent expert over the contrary view of Dr R, and to conclude to a high degree of probability that withdrawal of treatment was in Mr A's best...

Court Disposition

Appeal dismissed; permission to appeal granted; declarations of the High Court affirmed.

Orders

  • Declarations that Mr A lacks capacity to consent to continued life-sustaining treatment measures; it is not in his best interests to be given such treatment and such measures may lawfully be discontinued; he is to receive appropriate palliative care to ensure dignity until death.
  • Legal Services Commission to pay Respondents' costs, subject to detailed assessment.