Court Refuses Application to Withdraw Life-Sustaining Treatment

When deciding what is in the best interests of a patient who lacks capacity to make decisions about their care, the courts will take into account any wishes and feelings the patient has previously expressed, as well as the medical evidence. Recently, the Court of Protection refused an application by an NHS trust for permission to withdraw clinically assisted nutrition and hydration (CANH) from a patient in a prolonged disorder of consciousness.

The 60-year-old man had been admitted to hospital in October 2024 after suffering a bleed to the brain. Since January 2025 he had been in a rehabilitation ward. He was able to breath independently but received all his nutrition and medication through a gastronomy tube. Assessments suggested that he was in a vegetative state. The NHS trust responsible for his care applied for an order permitting them to withdraw CANH. This was opposed by his partners.

The consultant responsible for his care gave evidence that he was unlikely to make any significant neurological recovery and regain a quality of life that reflected the values he held. He would be permanently disabled and would have significant lifelong care needs, and it was likely that he would only suffer negative experiences, such as pain and infections. In the consultant's opinion, the most compassionate approach would be to withdraw CANH and focus on palliative care.

One of the man's partners stated that she believed his condition was improving and that he would wish to continue living. His other partner, who also claimed that he was improving, stated that he would take any chance of recovery, big or small, and that he did not believe in giving up. His partners both visited him daily and claimed that he was able to communicate. They also pointed to his long-held spiritual beliefs.

Under Section 1(5) of the Mental Capacity Act 2005, where a person is unable to make a decision for themselves there is an obligation to act in their best interests. In the Court's view, his longstanding interest in the healing power of the mind, spirit or soul were likely to be values that would have informed his decision if he had had capacity. He would be likely to value the devotion shown by his partners. From the evidence the Court had about him, he would have approached the decision-making in this case in a very different way from the medical staff.

The Court concluded that it was in his best interests for CANH to continue. In its judgment, the burdens did not outweigh the benefits. Looking at the wider evidential picture, the view taken by the medical staff did not pay sufficient regard to his beliefs and his wishes and feelings. While any awareness he had was extremely limited and there might be little or no further improvement, it was far from clear that in his circumstances he would regard his continued existence as a burden. There was a strong presumption in favour of preserving life, which the NHS trust had not displaced.