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NHS Trust and Ms D (By Litigation Friend, The Official Solicitor) and Mr And Mrs D [2005] EWHC 2439 (Fam)

This case confirms the principle of ‘best interests’ when deciding whether to grant a declaration that life preserving treatment be withheld from a patient who was critically ill and in a vegetative state.

NHS Trust and Ms D (By Litigation Friend, The Official Solicitor) and Mr And Mrs D [2005] EWHC 2439 (Fam)

High Court (Family Division): Coleridge LJ (10 November 2005)

Summary
This case confirms the principle of 'best interests' when deciding whether to grant a declaration that life preserving treatment be withheld from a patient who was critically ill and in a vegetative state.

Background
Ms D, a woman of thirty-two, was critically ill and suffered from mitochondrial cytopathy. The NHS trust sought a declaration from the court that it was not in Ms D's best interests to try and prolong her life if, for example, either her breathing fails, she suffers cardiac arrest or contracts a potentially life threatening infection which would normally be treated by antibiotics. Ms D's family disagreed. The Official Solicitor appeared for Ms D, it being accepted that she lacked capacity to make a decision for herself. The Official Solicitor was supportive of the declaration being made.

The medical evidence was unanimous from the consultant neurologists instructed to report on Ms D's health. They all concluded that Ms D displayed no response that indicated any reaction to the outside world, that she exhibited a near vegetative state and that there was no prospect for any improvement in her brain condition. The relatives opposed the medical evidence on the grounds of their own observed responses from Ms D that they say demonstrated an understanding on her part. The expert evidence was that the family had misinterpreted basal reflex responses and myoclonic activity.

In relation to the court's assessment of Ms D's 'best interests' Coleridge J cited Portsmouth NHS Trust v Wyatt [2004] EWHC 2247 (Fam) and Hedley J's judgment (paras 20-26) as outlining the relevant principles of law. This states that the sanctity of life and the respect for the dignity of the individual human being are not always compatible with each other. In these circumstances, when the court has to make a decision, the choice must be made on the basis of what is in the individual's best interests. Previous authorities have established that an evaluation of 'best interests' is akin to a welfare appraisal, encompassing more than medical interests. The court's task is to weigh up the 'benefits and disbenefits' of giving or not giving potential treatments.

Ms D's case concerned the withholding of life preserving treatment and not the discontinuance of existing treatment.

Judgment
Ms D's death within a relatively short time span was inevitable. A few extra months would not be of benefit to her. The court's focus should be on the patient's best interests and not on the best interests of the family.

Ms D's best interests demanded that she should not be subjected to more than the minimum necessary to allow her to die peacefully and with dignity. On that basis the declarations were granted.

Read the full text of the judgment here