The appellants’ daughter had been born with very severe disabilities. Her doctors obtained an order allowing them a discretion not to ventilate her to keep her alive if necessary. She had improved, but the family now sought leave to appeal an order continuing the discretion.
Held: ‘we came to the clear conclusion that the judge had approached the best interests question correctly, and that permission to appeal against his decision in principle to make the declarations should be refused. We have taken some considerable time over this part of the case because we think it important that in cases of this sensitivity and difficulty, the guidelines which the experienced judges of the Family Division have to follow should be both as clear and as simple as is consistent with the serious issues which they engage.
It is nearly always a matter of regret when the debate relating to the treatment of a seriously disabled or sick child, which frequently involves issues of life and death, needs to be conducted in a courtroom, rather than a hospital or a consulting room. Where that happens, however, the forensic debate should, in our judgment, be unfettered by any potentially contentious glosses on the best interests test which are likely either inappropriately to shift the focus of the debate, or to restrict the broad exercise of the judicial discretion involved in balancing the multifarious factors in the case.
In our judgment, the intellectual milestones for the judge in a case such as the present are, therefore, simple, although the ultimate decision will frequently be extremely difficult. The judge must decide what is in the child’s best interests. In making that decision, the welfare of the child is paramount, and the judge must look at the question from the assumed point of view of the patient (Re J). There is a strong presumption in favour of a course of action which will prolong life, but that presumption is not irrebuttable (Re J). The term ‘best interests’ encompasses medical, emotional, and all other welfare issues (Re A). The court must conduct a balancing exercise in which all the relevant factors are weighed (Re J) and a helpful way of undertaking this exercise is to draw up a balance sheet (Re A). ‘
Judges:
Lord Justice Laws Lord Justice Lloyd Lord Justice Wall
Citations:
[2005] EWCA Civ 1181, [2005] 1 WLR 3995
Links:
Jurisdiction:
England and Wales
Citing:
Appeal from – Wyatt v Portsmouth NHS Trust and Another FD 21-Apr-2005
Charlotte Wyatt had been born very premature and so severely disabled that her doctors sought and obtained an order that she should not be revived if she died. She had survived several months longer than expected and her parents had noticed . .
Cited – Regina v Portsmouth Hospitals NHS Trust ex parte Glass Admn 22-Apr-1999
Application with regard to continuation or otherwise of life saving treatment for a child. . .
Cited – Burke, Regina (on the Application of) v General Medical Council and others (Official Solicitor and others intervening) CA 28-Jul-2005
The claimant suffered a congenital degenerative brain condition inevitably resulting in a future need to receive nutrition and hydration by artificial means. He was concerned that a decision might be taken by medical practitioners responsible for . .
Cited – Re L (a child) (Medical Treatment: Benefit) FD 1-Nov-2004
(Date) . .
Cited – Glass v The United Kingdom ECHR 9-Mar-2004
The applicant’s adult son was disabled. There was a disagreement with the hospital about his care. The hospital considered that to alleviate his distress, he should not be resuscitated. The family wanted to take him home, fearing euthanasia. The . .
Cited – Portsmouth NHS Trust v Wyatt and others FD 7-Oct-2004
Charlotte Wyatt was born prematurely, and depended for day to day her life on medical support. Her doctors asked to be permitted not to resuscitate her again if she needed it. Her parents asked that she be given whatever chance was available for her . .
Cited – Regina (Burke) v General Medical Council Admn 30-Jul-2004
The applicant, suffering a life threatening disease, wanted to ensure his continued treatment and revival in the circumstance of losing his own capacity. He said the respondent’s guidelines for doctors were discriminatory and failed to protect his . .
Cited – In Re B (A Minor) (Wardship: Medical Treatment) CA 1981
The child was born with Down’s Syndrome and an intestinal blockage. She needed the obstruction to be relieved if she was to survive. If the operation were performed, the child might die within a few months but it was probable that her life . .
Cited – Airedale NHS Trust v Bland HL 4-Feb-1993
Procedures on Withdrawal of Life Support Treatment
The patient had been severely injured in the Hillsborough disaster, and had come to be in a persistent vegetative state (PVS). The doctors sought permission to withdraw medical treatment. The Official Solicitor appealed against an order of the Court . .
Cited – Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security HL 17-Oct-1985
Lawfulness of Contraceptive advice for Girls
The claimant had young daughters. She challenged advice given to doctors by the second respondent allowing them to give contraceptive advice to girls under 16, and the right of the first defendant to act upon that advice. She objected that the . .
Cited – W Healthcare NHS Trust v KH and Others CA 17-Sep-2004
The patient was very severely disabled. She was a lady of 59 suffering from multiple sclerosis. She was not competent to make decisions about her own treatment. She was in a pitiful state, and had to be fed through a percutaneous gastronomy tube but . .
Cited by:
See Also – D and D W v Portsmouth Hospital NHS; in re W (A Child) CA 3-May-2006
The claimants had sought court orders against the hospital to secure continuing life-supporting treatment for their daughter who had been born very severely disabled. The Trust now sought their costs from the various actions.
Held: The parents . .
See Also – In re Wyatt FD 23-Feb-2006
. .
Cited – Re OT (A Child) CA 14-May-2009
Parents sought leave to challenge a decision made on the request of their child’s doctors to discontinue treatment to avoid a more painful but inevitable death. The parents alleged a defect in the procedure applied by the hospital.
Held: . .
Cited – Aintree University Hospitals NHS Foundation Trust v James and Others CA 1-Mar-2013
The patient had been found to lack capacity to litigate and make decisions as to his medical treatment. The Hospital appealed against rejection of its request for a declaration that it would be lawful to withhold treatment in the case of clinical . .
Cited – Great Ormond Street Hospital v Yates and Others FD 11-Apr-2017
Baby Gard suffered an overwhelming and life threating condition. The Hospital considered that his welfare wa sbest served by withdrawal of life support. His parents could not agree. The Hospital now sought a declaration from the court as to the . .
Lists of cited by and citing cases may be incomplete.
Health
Updated: 04 July 2022; Ref: scu.231063