The High Court has made orders allowing clinicians to follow a palliative care plan for an 11-year-old boy with severe brain injuries, including withholding specified invasive intensive care treatments if his condition deteriorates. The court found the plan was in the boy’s best interests and reflected what he would choose if able to decide for himself.
The boy, referred to as John in the judgment to protect his identity, suffered severe neurological injuries in an accident in 2020. His treating clinicians said he would not recover significantly and that invasive intensive care could cause further physical trauma, worsen his dystonia and expose him to substantial pain without improving his underlying condition.
The hospital sought permission to provide medication to control severe dystonic pain, even if it carried a secondary risk of suppressing breathing, and to withhold specified life-prolonging treatments, including resuscitation and invasive ventilation. The proposed plan also allowed care such as antibiotics, physiotherapy and other measures directed at comfort.
John’s parents opposed the application. They wanted treatment that could prolong his life and disputed aspects of the clinicians’ assessment of his pain and likely future. The court heard evidence from treating clinicians, independent medical experts, the guardian ad litem and both parents.
After the initial hearing in September 2020, the court received further evidence when John’s dystonia improved from 29 September. The judge said the improvement meant he was likely pain-free at that time, but did not materially alter his long-term outlook or the potential effects of intensive care. The clinicians remained concerned that dystonia could return and agreed that invasive ICU measures would not be in his best interests.
The judgment considered the parents’ constitutional rights and concluded that the evidence established compelling reasons for State intervention to protect the child’s rights. It also rejected the argument that the proposed pain relief amounted to euthanasia: the medication was intended to relieve pain in response to a crisis, while any effect on breathing would be secondary.
The court granted the hospital’s application. The order permits care under the terms sought in the motion, including withholding the specified invasive measures unless clinicians consider one or more of them to be in John’s best interests. The judgment therefore does not impose an absolute prohibition on those interventions; it leaves that decision to clinicians’ judgment in the circumstances.