Pump Court Chambers

The hardest decision of all? Re C (Baby: Withdrawal of Medical Treatment) [2015] EWHC 2920 (Fam)

Blog 8th December 2015

The case of C does not change the law, it offers little by way of legal analysis or significant upheaval.

However, it should not be overlooked; the judgment of Peter Jackson J provides a concise, clear, and moving appraisal of the law concerning the withdrawal of life sustaining medical treatment in children.

C was born on 28th January 2015, in a car, as her parents made their way to hospital. En route C’s parents were caught in a hailstorm. When C reached hospital, she was in a critical condition with no spontaneous breathing or cardiac activity. The deprivation of oxygen at birth caused serious injury to C’s brain. As a result, C has remained in intensive care all her life and received continuous medical treatment at the highest level.

Proceedings were issued by the Trust treating C on 18th August 2015. The doctors involved in her care had, for some time, been concerned that such intensive treatment was not in C’s best interest.

In two particularly moving paragraphs, Peter Jackson J highlights C’s tragic daily plight:

At [13] –

“Apart from signs of distress, such as facial grimaces or extensor posturing during procedures, C shows little sign of interacting with her environment. She does not open her eyes and makes little or no spontaneous movement. She is not responsive to visual stimulation and did not react to the insertion of the speculum during examination of her eyes. She has optic atrophy, suggesting that she may not have any sight. She does not respond to loud noises, suggesting that she may not have any hearing.”

At [14] –

“Dr S said that C does not appear to be able to gain any pleasure from her environment. She only seems to respond to painful and distressing stimuli. This is in keeping with the nature of her brain injury, since experiencing pleasure requires a higher level of function than experiencing pain.”

In addition to C’s medical circumstances, her parents did not participate in proceedings and did not engage in a meaningful way with the Trust or with C’s guardian.

In the course of proceedings C’s guardian said that in his opinion the point had been reached where the burdens of treatment for C far outweighed the benefits.

Addressing this concern in his judgment Peter Jackson J, at [28] – [33], outlines the key principles and the rationale for his decision to allow the Trust’s application.

Peter Jackson J stresses that in making such a decision, the starting point is that it is in a person’s best interest to stay alive. However, he makes clear that this proposition is not an absolute, and that there are situations where it is not in the patient’s interest to receive life sustaining treatment. In approaching these principles, Peter Jackson J, at [28] states:

“…This has been stated in a series of decisions, starting with In Re J (A Minor) (Wardship: Medical Treatment) [1991] Fam 33 and culminating in Aintree University Hospitals NHS Foundation Trust v James [2014] AC 591. These decisions are in harmony with Articles 2 and 3 of the European Convention on Human Rights, which provide that everyone’s right to life shall be protected by law and that no one shall be subject to inhuman or degrading treatment…”

In allowing the Trust’s application, Peter Jackson J harrowingly concludes that given C’s considerable burdens, she will “experience none of the joys of life, but at best a continuous series of medical interventions.”

Regardless of the assurances of case law and the ECHR, the decision to withdraw life, is no doubt, one of the hardest decisions for any judge to make.

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