The High Court has approved the withdrawal of artificial nutrition and hydration from an anonymised adult ward, finding that it was in her best interests. The ruling followed a hearing on her mother’s application and distinguishes the case from a recent Supreme Court decision on when doctors may withhold treatment without court consent.
The woman, called “Katie” in the judgment, sustained severe, irreversible brain injuries after a cardiac arrest in 2011. The court found that she was in a persistent vegetative state, would not recover meaningfully and could not experience pain, hunger or thirst. She had been artificially fed and hydrated for about nine years.
Her mother applied for permission to discontinue that treatment and sought pain relief or sedation if clinicians considered it necessary. Family members told the court that Katie had previously said she would not want to be kept alive in circumstances like her current condition. They also described her as private about her body and said her care conflicted with her preferences. These were accounts given in evidence; the court considered them alongside medical evidence and the other circumstances of the case.
The judge held that the court’s substituted consent was required. In a separate Supreme Court case, *In re J.J.*, doctors had sought confirmation that withholding certain life-sustaining measures would be lawful because they considered providing them unethical. Here, no treating clinician had decided that continuing Katie’s treatment was unethical. Expert witnesses said withdrawal could be ethically permissible, but that was not the same as clinicians relying on a right not to provide treatment they considered unethical. The judge said a declaration of lawfulness alone was therefore insufficient in this case.
Applying the best-interests test, the judge weighed the absence of curative benefit, Katie’s prognosis and previously expressed wishes, her family’s evidence, and the effects of ongoing treatment on her privacy, dignity, autonomy and bodily integrity. She concluded that withdrawal was in Katie’s best interests.
The court granted the relief sought by Katie’s mother, with changes to the proposed order: it removed the provision declaring that clinicians would not act unlawfully by withdrawing treatment, and amended the remaining provision. The judgment’s draft order provided for consent to withdraw or withhold life-prolonging treatment or supports not considered by treating doctors to be in the ward’s best medical or welfare interests, and for appropriate care including palliative treatment. The court also prohibited publication of material likely to identify the ward as a person with a medical condition, including her place of care or family.