England and Wales Case Law

Lesley Barnor Townsend v Epsom and St Helier University Hospitals NHS Trust

The refusal to grant permission to apply under s.50(2) MCA was unlawful because all decisions about withdrawal of life-sustaining treatment from an incapacitated adult must be subject to best interests analysis and, where there is disagreement, court supervision. The Trust's attempt to pre-empt court proceedings by characterising the decision as purely clinical was contrary to established law and guidance. The proper course was to grant permission for the application and remit the matter to the Court of Protection.

Source excerpt

• Withdrawal of life-sustaining treatment
• Best interests decision-making
• Court of protection procedure
• Article 2 echr obligations
• Judicial review of clinical decisions

Read case analysis

Manchester University NHS Foundation Trust v RNM & Ors

Given the severity and irreversibility of RN’s brain and brain stem injury, his total dependence on invasive ventilation, lack of meaningful awareness or purposeful movement, ongoing pain and suffering from medical interventions, and the unanimous medical evidence that continued life-sustaining treatment confers no benefit and only prolongs suffering, it is not in RN’s best interests for life-sustaining treatment to continue. The presumption in favour of preserving life is rebutted on these facts.

Source excerpt

• Withdrawal of life-sustaining treatment
• Best interests of child
• Parental responsibility
• Medical futility
• Inherent jurisdiction
• Declarations as to lawfulness of treatment withdrawal

Read case analysis

G (Discontinuation of Ventilatory Support), Re

The High Court authorised withdrawal of ventilation for a seven-year-old girl with profound brain injury, finding ongoing treatment was no longer in her best interests.

• Withdrawal of life-sustaining treatment
• Best interests of the child
• Medical ethics
• Parental rights
• Delay in medical cases
• Withdrawal-of-life-sustaining-treatment

Read case analysis

G (Discontinuation of Ventilatory Support), Re

G (Discontinuation of Ventilatory Support), Re [2026] EWHC 812 (Fam) (02 April 2026)

The High Court held that continued mechanical ventilation for G, a severely brain-injured child, was no longer in her best interests and authorised withdrawal.

• Withdrawal of life-sustaining treatment
• Best interests of child
• Medical ethics
• Parental rights
• Delay in medical proceedings
• Withdrawal-of-life-sustaining-treatment

Read case analysis

Royal Free London Hospital NHS Foundation Trust v RH & Anor

The Court of Protection authorised ceilings of care for a critically ill man lacking capacity, including conditional RRT, limited escalation, and no CPR.

• Withdrawal of life-sustaining treatment
• Best interests
• Medical decision-making for incapacitated adults
• Ceilings of care
• Best-interests
• Withdrawal-of-life-sustaining-treatment

Read case analysis

Royal Free London Hospital NHS Foundation Trust v RH & Anor

Royal Free London Hospital NHS Foundation Trust v RH & Anor [2026] EWCOP 17 (T3) (01 April 2026)

The Court of Protection authorised ceilings of care for a critically ill man lacking capacity, allowing limited continued RRT but no CPR and a palliative plan.

• Withdrawal of life-sustaining treatment
• Best interests
• Mental incapacity
• Ceilings of care
• Palliative care
• Best-interests

Read case analysis

Lesley Townsend v Epsom and St Helier University Hospitals NHS Trust

Leave to apply was refused because the medical decision-making process had concluded that dialysis would no longer be offered, and the Court of Protection cannot compel clinicians to provide treatment they are unwilling to offer. The application had no realistic prospect of success as the court cannot confer greater rights on a person lacking capacity than on a person with capacity.

Source excerpt

• Withdrawal of life-sustaining treatment
• Best interests
• Jurisdiction of court of protection
• Article 2 echr
• Transparency orders

Read case analysis

Townsend v Epsom and St Helier University Hospitals NHS Trust (Rev2)

Townsend v Epsom and St Helier University Hospitals NHS Trust (Rev2) [2026] EWCA Civ 195 (03 March 2026)

The Court of Appeal held that disputes over life-sustaining treatment for an incapacitated patient may require Court of Protection scrutiny, and granted permission to appeal and to apply under s.50 MCA.

• Withdrawal of life-sustaining treatment
• Best interests decision-making
• Clinical decision-making
• Article 2 echr
• Court of protection procedure
• Withdrawal-of-life-sustaining-treatment

Read case analysis

Manchester University NHS Foundation Trust v RNM & Ors

Manchester University NHS Foundation Trust v RNM & Ors [2026] EWHC 452 (Fam) (27 February 2026)

The High Court authorised withdrawal of ventilatory support for a severely brain-injured toddler, holding that ongoing treatment was not in his best interests.

• Withdrawal of life-sustaining treatment
• Best interests of child
• Parental responsibility
• Inherent jurisdiction
• Medical ethics
• Withdrawal-of-life-sustaining-treatment

Read case analysis

Cardiff and Vale University Local Health Board v SR & Ors

It is not in TR’s best interests for life-sustaining treatment to continue given the overwhelming medical evidence of irreversible brain damage, absence of cognitive awareness, no prospect of recovery, and the burdens of ongoing invasive treatment, despite the parents’ religious beliefs and wishes.

Source excerpt

• Withdrawal of life-sustaining treatment
• Best interests of child
• Parental rights
• Religious considerations in medical treatment
• Children act 1989
• Human rights (echr)

Read case analysis