Mr Justice Hedley recently heard the matter of NHS Trust v Baby X and others and handed down judgment on 30 July 2012.
The question in the case was whether a baby known as X should be removed from a ventilator and made the subject only of palliative care. This was the wish of his treating team. It was the view of the majority of the clinicians involved in the case, including the independent experts instructed, that it was highly improbable that X would improve.
X was born in 2011 but on 10 May 2012 he suffered a catastrophic accident at home which resulted in chronic, profound and irreversible brain damage. It was described by the judge as "a wholly unforeseeable disaster".
His parents opposed the treating teams’ proposals and felt that he should be given every chance to improve, however unlikely it looked at that present time; they thought there were discernible signs of improvement; and that the tenets of their faith prevented them giving their consent in those present circumstances to a course which would almost inevitably lead to death.
The judge reiterated the judicial process set out in the case of Wyatt (in which members of the Mills & Reeve health team acted). It is worth reiterating these, as the judge did, for readers’ information:
- The Judge must decide what is in the best interests of the child
- In doing so, the child's welfare is a paramount consideration
- The judge must look at it from the assumed point of view of the patient
- There is a strong presumption in favour of the course of action that would prolong life but that presumption is not rebuttable
- The term "best interests" encompasses medical, emotional and all other welfare issues
- The court must conduct a balancing exercise in which all relevant factors are weighed
The judge emphasised that a decision must be informed by a clear understanding of the medical evidence. This underpins the need to ensure that comprehensive and clear evidence is compiled for the court.
The judge also referred to the Royal College of Paediatrics and Child Health's Withholding or Withdrawing of Life Sustaining treatment in Children: a Framework for Practice and outlined that while not binding, it had value in allowing the court to understand the framework of thought for professional witnesses.
The judge held that he agreed with the majority consensus of the clinicians in relation to X's prognosis.
In relation to X's welfare and best interests, the judge concluded that on balance, the evidence pointed to offering X palliative care only. He was willing to make a declaration that to so treat was lawful as being in X's best interests. The judge pointed out that this may result in a very speedy death and would require planning and management. His expectation was that this would be discussed between the treating team and the family. He also emphasised that the treating team must satisfy themselves that it remained in X's best interests to withdraw ventilation and/or decline any other aggressive, invasive treatment, at the time they sought to withdraw it.
While the case does not provide any new law in relation to end of life decisions for children, it does highlight the difficult balance involved for clinicians. It also highlights the need for a “good death” to be achieved and that the views of family members should be given appropriate weight, but that ultimately it is what is in the best interests of the child that is the paramount consideration.