An NHS Trust v Mrs H, Re (Rev 1) [2012] EWHC B18 (Fam) (05 October 2012)

An NHS Trust v Mrs H, Re (Rev 1) [2012] EWHC B18 (Fam) (05 October 2012)

Given KH's catastrophic and irreversible brain injury, lack of meaningful awareness, and progressive deterioration, it is lawful and in his best interests to withhold aggressive life-sustaining interventions (including resuscitation, intubation, and invasive procedures) in the event of serious deterioration, focusing instead on comfort and symptom relief. The court's declarations are limited to clear, enduring issues and do not prevent clinicians from acting in KH's best interests as circumstances require.

Citation
[2012] EWHC B18 (Fam)
Parties
Applicant: An NHS Trust; First Respondent: Mrs H; Second Respondent: Mr H; Third Respondent: A Borough Council; Fourth Respondent: CB; Fifth Respondent: KH (a child represented by CAFCASS as his Guardian ad litem)
Jurisdiction
England and Wales
Judgment Date
05 October 2012
Procedural Posture
Inherent Jurisdiction Application (family Division) / Final Judgment and Order on Application for Declarations Regarding Medical Treatment
Outcome
Declarations granted as to lawfulness and best interests of withholding specified life-sustaining treatments for KH.
Legal Topics
Best Interests of Child, Withholding Life Sustaining Treatment, Parental Responsibility, Mental Capacity, Declarations as to Lawfulness of Medical Treatment
Family Law Medical Law Human Rights Best Interests of Child Withholding Life Sustaining Treatment Parental Responsibility Mental Capacity Declarations as to Lawfulness of Medical Treatment

Case Brief

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Parties

An NHS Trust

Applicant

Mrs H

First Respondent

Mr H

Second Respondent

A Borough Council

Third Respondent

CB

Fourth Respondent

KH (a child represented by CAFCASS as his Guardian ad litem)

Fifth Respondent

Procedural Posture

Inherent Jurisdiction Application (family Division) / Final Judgment and Order on Application for Declarations Regarding Medical Treatment

Legal Issues

  1. 1 Whether it is lawful and in the best interests of KH, a severely brain-injured child, to withhold certain life-sustaining treatments in the event of deterioration
  2. 2 Whether the court should approve an Advanced Care Plan involving non-escalation of treatment
  3. 3 How the court should weigh parental wishes, medical evidence, and best interests in such cases

Ratio Decidendi

Given KH's catastrophic and irreversible brain injury, lack of meaningful awareness, and progressive deterioration, it is lawful and in his best interests to withhold aggressive life-sustaining interventions (including resuscitation, intubation, and invasive procedures) in the event of serious deterioration, focusing instead on comfort and symptom relief. The court's declarations are limited to clear, enduring issues and do not prevent clinicians from acting in KH's best interests as circumstances require.

Court Disposition

Declarations granted as to lawfulness and best interests of withholding specified life-sustaining treatments for KH.

Orders

  • It is lawful and in KH's best interests not to receive mouth-to-mouth or bag and mask resuscitation, endotracheal intubation, or invasive/non-invasive ventilation in case of severe respiratory compromise.
  • In the event of cardiac arrest, not to receive cardiac resuscitation, including defibrillation, cardiac massage, or resuscitation drugs including inotropes.