By: Rosalind English
27 August 2025 by Rosalind English
This judgment was handed down to parties via email at 3pm on 31st July 2025. A transparency order is in force. The judge has given leave for this version of the judgment to be published on condition that (irrespective of what is contained in the judgment) in any published version of the judgment the anonymity of Patricia must be strictly preserved.
Patricia’s Father & Ors v Patricia & Ors [2025] EWCOP 30 (T3)
This application was brought by the parents and aunt of a woman who has previously been anonymised to “Patricia”. Patricia, aged 25, had lived with anorexia nervosa since childhood, and was extremely malnourished with a BMI as low as 7, unable to walk unaided, and suffering severe complications like bed sores and osteoporosis. Diagnosed also with autism and pathological demand avoidance (PDA), Patricia’s condition was refractory despite years of efforts; she persistently refused to eat enough to sustain herself, though she voiced a desire to live and to travel. In 2023, the Court (Moor J) had ordered—after hearing her strongly expressed wishes—that Patricia should not be force-fed or receive medical treatment against her will, emphasising her autonomy in treatment decisions.
Throughout these proceedings Patricia was an in-patient at Norfolk and Norwich University Hospitals NHS Foundation Trust. She had said she wanted to go to a Specialist Eating Disorder Unit (SEDU) but when this case started she was not medically fit enough to go to one because of her low BMI and her lack of medical stability.
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13 August 2025 by Rosalind English
The Hillingdon Hospitals NHS Foundation Trust v YD & Others (Refusal of Withdrawal of Treatment)
The Court of Protection has refused to let a hospital trust in north-west London withdraw life support from a 60-year-old man described as being in a permanent vegetative state after his two partners spoke about his strong belief in the power of spiritual healing.
Background facts and law
The patient, referred to as YD, suffered a bleed to the brain last October resulting in what’s now called a prolonged disorder of consciousness and leaving him in what his clinicians describe as a permanent vegetative state. YD was being provided with clinically assisted nutrition and hydration (CANH) at a specialist neuro-rehabilitation centre in north-west London.
The Hillingdon Hospitals NHS Foundation Trust, responsible for his care, applied to the Court of Protection seeking permission to withdraw CANH, which would lead to YD’s death. The Trust argued that continuing such treatment was not in YD’s best interests, given the medical prognosis and burdens of ongoing care. The application was opposed by YD’s two partners, JG and MB, who were both closely involved in his daily care and attuned to his needs, and by the Official Solicitor, who represented YD’s interests. Notably, YD’s partners spoke of his strong faith in spiritual healing, his value for life, and his belief in perseverance through adversity.
Best Interests Test:
Central to the Court of Protection’s task was the determination of YD’s best interests under the Mental Capacity Act 2005. The statute requires the court to take into account a range of views, including medical evidence, the patient’s own beliefs and values (as far as they can be discerned), the perspectives of family, and the overall balance between burdens and benefits of ongoing treatment.
There is a strong legal presumption in favour of preserving life, which may only be displaced by countervailing factors such as “the very profound brain damage,” absence of pleasure or awareness, and the absence of any prospect for improvement.
Role of Advance Decisions and Family Views
The Court examined whether YD had made any valid advance decision to refuse treatment (which would be binding under sections 24–26 MCA 2005). No such advance directive existed in YD’s case. The views of his partners were consequently given considerable weight—they described YD as someone who valued life strongly, believed in spiritual recovery, and would have wanted to persevere even in adverse circumstances.
Medical Evidence
Treating clinicians and an independent expert testified that YD’s prognosis was bleak: there was no realistic prospect of meaningful recovery or awareness, and he would not regain consciousness. The medical consensus was that continuing CANH would only prolong biological life, with no benefit or possibility of improvement in consciousness or quality of life.
The Official Solicitor’s Submission
Representing YD’s interests, the Official Solicitor argued that the dignity and meaning of YD’s current existence derived from the love and care provided by his partners, and that YD would wish to continue living in this way until a natural death occurred through another medical event (e.g., infection or heart attack).
The Court’s Decision
Mrs Justice Theis, Vice-President of the Court of Protection, refused the Trust’s application to withdraw life-sustaining treatment. In a detailed judgment delivered on 12 August 2025, the court emphasized the following:
• Presumption in Favour of Life: The court found that, despite the medical evidence of permanent vegetative state and the bleak prognosis, the presumption in favour of life had not been displaced by the Trust. The evidence from family and the Official Solicitor about YD’s values and perceptions of his dignity was compelling.
• Best Interests Not Demonstrated: The court concluded that withdrawal of CANH was not proven to be in YD’s best interests. The strong and heartfelt testimony of YD’s partners, coupled with their daily engagement with him, supported the continuation of care. The court was persuaded that YD’s sense of dignity and the meaning of his life could not be presumed to be absent or negative.
• No Valid Advance Decision: In the absence of a legally binding advance decision to refuse treatment, continued life-sustaining treatment was favored
Conclusion
The Court of Protection’s refusal to permit withdrawal of treatment in this case signals the ongoing primacy of the best interests test, fortifies the presumption in favor of life even against a grim prognosis, and puts significant weight on the genuine beliefs and wishes of those closest to the patient. Unless and until a court is satisfied, based on all the evidence, that ongoing treatment is not in the patient’s best interests, life-sustaining treatment will continue.
Comment
This is a surprising and unusual decision. Following the case of Airedale NHS Trust v Bland, where the House of Lords ruled that it was lawful to discontinue life support when it serves no useful therapeutic purpose and does not benefit the patient, the tendency has been to go along with the medical evidence that mere life without consciousness is of no benefit to the patient.
Here the Court of Protection upheld the continuation of artificial nutrition and hydration because of the evidence advanced by the patient’s partners, who cited his spiritual beliefs and the view that he would want to continue receiving treatment to try to “heal himself”. The evidence included declarations of spiritual communication, which led to the Court deciding that withdrawal of ANH would not be in line with the patient’s perceived best wishes and spiritual beliefs.
This is all very well, but as we know, the NHS is running out of money.
The average annual NHS cost to care for a patient in a persistent vegetative state (PVS) in a specialist nursing home is about £85,000–£91,000, which covers nursing care, medication, feeding (such as percutaneous endoscopic gastrostomy), and, for some, tracheotomy. Occasionally, additional costs from emergency hospital admissions (“blue light events”) for infections or other complications add roughly £5,000 per year, bringing the typical annual cost close to £91,600.
Not now, or even in the near future, but one day it will occur to cancer patients being denied treatment or sufferers from severe cardiac conditions on never ending waiting lists for surgery that perhaps public money should be spent on them, rather than keeping PVS patients alive for years if not decades.
This will require a root and branch review of the “best interests” test and promote the absence of an Advance Decision to the same level as an Advance Decision not to prolong life. Simply saying that these decisions “should never be driven by resource allocation or staff burdens, but solely by robust best interests assessments” is no answer to the profound and continuing financial burden on the public purse for prolonging unconscious life at all costs.
For a nuanced discussion of the cost consequences of this case, read Alex Ruck-Keene KC’s post on the Mental Capacity Law and Policy blog.
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11 August 2025 by Rosalind English
David Wolfson KC, Lord Wolfson of Tredegar, Shadow Attorney General, and Michael Ellis KC, Attorney General from 2021 – 2022, have written to Labour’s Attorney General Richard Hermer KC regarding the government’s decision to recognise Palestine at the UN General Assembly meeting in September. We highlight this here because Lord Wolfson has recently given an interview on Law Pod UK setting out some of the differences between him and Richard Hermer on what they deem to be the proper boundaries of international law.
They commence their letter with the following statement:
“The recognition of a foreign state is a prerogative act, exercised by the Government. The long-standing position of the UK Government has been that the UK will recognise a state if four criteria are met, often referred to as the Montevideo criteria: ” it should have, and seem likely to continue to have, a clearly defined territory with a population, a government who are able of themselves to exercise effective control of that territory, and independence in their external relations”.
In their view, the position taken by successive UK governments until 2025 was that the Palestinian Authority has been both factually and legally unable to exercise a range of governmental functions in the West Bank,
The PA, they point out, has also, “of course, lost control of Gaza to Hamas”.
They therefore pose a number of questions, as to whether the government is applying a different basis of statehood and recognition, and on what basis.
“If the new policy is that protracted frustration of self-determination justifies recognition of statehood regardless of facts on the ground, why is the UK refusing, for example, to recognise Western Sahara as a state?”
They urge the Attorney General to explain how, as a matter of international law, steps taken by Israel can themselves lead to the non-recognition of Palestine. In this case it would seem to be that by declaring a ceasefire, Israel could avoid the “punishment” of Palestine being recognised as a state. This, in the authors’ view, is an incoherent interpretation of international law – “the Government, so vocal when it comes to public pronouncements of general legal principle, appears to lose its voice.”
They conclude their letter with the following paragraph:
“The position of the UK government in recognising Palestine while hostages remain in dungeons in Gaza is shameful. That is a matter for your private conscience. But we believe that the Government’s policy on this issue is also a significant change from the UK’s policy as long stated and understood. That is something which you ought to explain, in public, to Parliament.”
Whatever your position on the conflict, it is worth reading the letter in full, to understand the UK’s policy on statehood recognition as set out by a written answer in the House of Commons in 1986, and in several subsequent communications.
The response to the points raised in this communication will no doubt add to the warp and weft of international law and its varying interpretations in Westminster. There can be no doubt that policy on this issue is governed not by law, but by politics.
A debate in the House of Lords on this issue would be of considerable utility to all lawyers interested in this area.
The UK Human Rights Blog is now available on Substack – see our profile and subscribe here.
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4 July 2025 by Rosalind English
The King on the Application of Al-Haq (Claimant) v Secretary of State for Business and Trade (Defendant) [2025] EWHC 1615 (Admin)
The Secretary of State for Business and Trade decided in September 2024 to suspend licences authorising the export of items that might be used in carrying out or facilitating military operations in the conflict in Gaza. He did so explicitly because the Government had formed the view that Israel was not committed to compliance with international humanitarian law (‘IHL’) in the conflict in Gaza and that there was therefore a clear risk that such items might be used in that conflict to commit or facilitate a serious violation of IHL. However, the Secretary of State excluded from that suspension licences for the export of components for F-35 combat aircraft which could not be identified as destined for Israel. In this claim for judicial review the Claimant, supported by the Interveners, challenged the lawfulness of this exclusion, which has been referred to as the ‘F-35 Carve Out’.
In reaching these decisions, together referred to as ‘the September Decision’, the Secretary of State received advice from the Defence Secretary and the Foreign Secretary. In short, the advice of the Defence Secretary, set out in a letter dated 18th July 2024, was that:
(1) the multinational F-35 joint strike fighter programme (‘the F-35 Programme’1) is significantly dependent on the United Kingdom as the largest national provider of component parts outside the United States;
(2) it was not currently possible to suspend licensing for export of F-35 components for use by Israel without having an impact on the entire F-35 Programme;
(3) a suspension of licensing for all F-35 nations would have a profound and immediate impact on international peace and security, would undermine US confidence in the UK and NATO at a critical juncture, would seriously undermine the credibility of the UK as a trusted partner on the international stage, and would undermine a key capability allowing the UK and its closest allies and partners to address current security challenges.
The Claimant “Al-Haq”, an independent Palestinian non-governmental human rights organisation based in Ramallah, contended that the F-35 Carve Out was unlawful. Al-Haq was supported by Oxfam, Amnesty International and Human Rights Watch. This was a “rolled up” hearing, in which permission to bring judicial review proceedings is considered at the same time as the merits of the claim.
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24 June 2025 by Rosalind English
In Episode 222 of Law Pod UK, Marina Wheeler KC and Rosalind English of 1 Crown Office Row are joined by Shadow Attorney General Lord Wolfson of Tredegar to discuss the legal challenges facing David Wolfson KC in his new appointment to the commission tasked with reforming the European Court of Human Rights.
During our conversation Lord Wolfson addresses the political sensitivities involved in reforming the ECtHR, particularly where it comes to the balance between national sovereignty and international human rights obligations, a topic on which he has been in public disagreement with the current government’s Attorney General Lord Hermer KC. We explore the legal questions that predate and would arise from those reforms, including the implications for the rule of law and the long term relationship between the UK and Strasbourg.
Lord Wolfson emphasises the importance of careful legal analysis and the need for clear, principled leadership in this sensitive area, since he is now tasked with reviewing how to prevent the ECtHR from blocking government policies, especially on contentious issues like immigration and climate change mitigation. Above all, he stresses that the rule of law must be observed by asserting parliamentary sovereignty over Strasbourg and other decisions by international institutions.
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18 June 2025 by Rosalind English
In ALR and others v Chancellor of the Exchequer [2025] EWHC 1467 (Admin), the High Court has dismissed a challenge against the government’s manifesto policy of adding VAT to private school fees. The claimants were a group of students, parents, and schools. Some of the students required specific schooling because of (inter alia) special educational needs and religious convictions; all claimants sought a declaration that the VAT addition was incompatible with the European Convention of Human Rights. Specifically, they argued that imposing VAT was incompatible with Article 2 Protocol 1 (right to education) and 14 (protection from discrimination).
This dismissal of the judicial review challenge represents a significant ruling on the interplay between fiscal policy, human rights law and the allocation of resources for education.
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6 June 2025 by Rosalind English
R (on the application of Animal Equality UK v North East Lincolnshire Borough Council and ASL New Lee Ltd [2025] EWHC 1331 (Admin)
This was an application for judicial review brought by an animal welfare charity challenging North East Lincolnshire Council’s decision to grant planning permission for the UK’s first full commercial scale onshore salmon farm proposed by AquaCultured Seafood Ltd. The farm, to be built in Cleethorpes, is designed to produce 5,000 tonnes of salmon per year.
The High Court had dismissed the application on paper in March 2025. However it was subsequently decided that Animal Equality’s challenge could proceed on the grounds that there was an arguable case that North East Lincolnshire Council’s planning officers had misdirected the Planning Committee by advising that animal welfare concerns could not be considered as material planning considerations under planning law. This potential misdirection raised a legal question about whether the approval of the salmon farm was lawful, warranting a full judicial review of the decision.
Arguments before the court
Animal Equality highlighted risks of welfare issues, such as the pain and suffering felt by animals kept in highly packed units, being eaten alive by sea lice; mass fish deaths including cannibalism and other problems such as high effluent levels in recirculating aquaculture systems. They referred to the deaths of 1.5 million fish at another onshore facility due to electricity supply interruptions. The Claimant did not seek to persuade the Court that the committee were required to take animal welfare concerns into account, rather that they should properly have been advised that it was open for them to do so if they wished to. They maintained that the Council’s planning committee members had been materially misled in relation to animal welfare concerns when the committee was advised that it could not take animal welfare concerns into account.
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24 March 2025 by Rosalind English
Non-human animals lack agency. They’re not legal entities. They’re mere possessions, like furniture. Of course, there are laws around to stop us trashing them like furniture. How well those laws are enforced is a big question. Another challenge is the purpose for which these animals are kept. Companion animals enjoy much better protection under the law than animals kept for commercial purposes such as food. When this country left the EU the recognition of animal sentience under Article 13 of the EU Treaty was not kept as part of retained EU law. The government at the time made it clear that the reason that they didn’t want to retain it is because they wanted to do something different. And that is the recognition of animal consciousness in the Animal Welfare (Sentience Act) 2022 with a committee that is dedicated to looking at policy and deciding whether ministers have had due regard to the welfare of animals as sentient beings in formulating that policy.
Has this legislation made any difference to the animals hidden from sight in the farming industry? In Episode 217 of Law Pod UK Rosalind English talks to Edie Bowles of the Animal Law Foundation and Dr Rachel Dunn from Leeds Beckett University, both experts in this area, about the difficulties of compliance and enforcement of animal welfare legislation and the general hoodwinking of the purchasing public by misleading labelling and misinformation about farmed animals in the media.
Here is a short animation from the German studio Kurzgesagt which is rich in information on the subject of food animals: This is not an anti-meat video
Law Pod UK is published by 1 Crown Office Row. Supporting articles are published on the UK Human Rights Blog. Follow and interact with the podcast team on Twitter.
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25 February 2025 by Rosalind English
In Episode 215 Jonathan Sumption, formerly of the Supreme Court and author of five volumes of the Hundred Years War, says, after some reflection that “the ECHR is manifestly not a sensible and democratic way of deciding what the law should be in a democracy.
“The Strasbourg Court is a wholly irresponsible body…in the sense that it is not responsible to anyone”
Listen to Rosalind English in conversation with Lord Sumption about the reasons why this country should prepare for withdrawal from the ECHR; the “mission creep” of Articles 6 and 8; the avid adoption of the “living instrument” doctrine whereby that court extends its jurisdiction beyond its original remit; the “contempt” showed by the Strasbourg Court at the Swiss government’s democratic handling of climate change emissions, and the possible reputational consequences of the UK removing itself from the Council of Europe.
Law Pod UK aims to inform and enlighten our audience on important developments in civil and public law with a range of guests from 1 Crown Office Row and other legal experts. Law Pod UK is available on Spotify, Apple Podcasts, Audioboom, Player FM, ListenNotes, Podbean, iHeart, Radio Public, Deezer or wherever you listen to your podcasts.
Please remember to rate and review us if you like what you hear.
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27 January 2025 by Rosalind English
It may come as a surprise that there still exists a country or countries in the enlightened West which do not regard sexual intercourse without consent within marriage as rape – or at least sexual assault. After a long campaign in this country, the courts of England and Wales finally capitulated in October 1991, recognising marital rape as a crime in the landmark case of R v R [1991] UKHL 12. In his judgement, Lord Lane confirmed: “The idea that a wife consents in advance [i.e. by being married] to her husband having sexual intercourse with her whatever her state of health or however proper her objections, is no longer acceptable.”
This was a long cry from the position that had held before, best expressed by Justice Henry Hawkins in 1888, that
“The intercourse which takes place between husband and wife after marriage is not by virtue of any special consent on her part but is mere submission to an obligation imposed on her by law.”
Now comes a judgement against France that shows that in some pockets of the Council of Europe, the old rule still applies, even if the criminal law has established the possibility of rape within marriage.
H.W. c. FRANCE (Requête no 13805/21)
The judgment is presently only available in French, so I give a fairly detailed summary below.
Background facts
In July 2015, the applicant sued her husband for divorce on the grounds of fault. She claimed that he had prioritised his professional career over their family life and that he had been irascible, violent and hurtful. Her husband counterclaimed that the divorce be granted on the grounds of the applicant’s exclusive fault, arguing, among other things, that she had failed in her marital duties for several years. Alternatively, he requested a divorce on the grounds of permanent breakdown of the marital relationship.
In a judgment of July 2018, the family court judge of the high court considered that none of the spouses’ claims were substantiated and that the divorce could not be granted on the grounds of fault. He granted it on the grounds of permanent breakdown of the marital relationship.
The applicant appealed this judgment. In November 2019, the Court of Appeal granted a divorce for fault, the exclusive fault of the applicant, on the grounds that she had acknowledged having ceased all intimate relations with her husband since 2004, which constituted a serious and repeated violation of the duties and obligations of marriage, making the continuation of their life together intolerable. [my italics]
The applicant’s appeal on points of law was dismissed in September 2020.
Background law
The divorce was granted pursuant to the relevant articles of the French Civil Code, which provide that a divorce may be granted for fault when facts constituting a serious or repeated breach of the duties and obligations of marriage are attributable to one of the spouses and make the continuation of the common life intolerable.
It follows from the long-standing but consistent case law of the Court of Cassation that spouses are bound by a marital duty and that its failure to perform may constitute a fault justifying divorce. Although the high court has not reaffirmed this case law since then, it has never been reversed and continues to be applied by the lower courts.
French case law does not consider every refusal to have sexual relations to be wrongful. It leaves it to the lower courts to determine whether this refusal is sufficient to characterise a serious or repeated breach of the duties and obligations of marriage justifying divorce. It also acknowledges that certain circumstances such as the age, state of health or abusive or violent nature of the spouse are such as to justify the failure to perform the marital duty. Domestic law gives trial judges the power to assess whether or not the breach of a matrimonial obligation is serious enough to justify divorce.
In this case the Strasbourg Court upheld the wife’s application, finding a breach of her right to private life under Article 8 of the Convention.
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27 January 2025 by Rosalind English
In Episode 213 of Law Pod UK, Alasdair Henderson of 1 Crown Office Row joins Labour MP Henry Tufnell (formerly of 1 Crown Office Row) to discuss some of the salient and problematic proposals in Labour’s most sweeping changes to employment law in decades. They consider the proposed restrictions on zero hours contracts, the radical reduction of the qualifying period for unfair dismissal and that most controversial part of the bill, Clauses 15 and 16, which impose liability on the employer for third party harassment (as defined under the 2010 Equality Act). This goes beyond sexual harassment and could cover situations where for example an entertainment venue books a comedian whose riff, though legal, is maybe offensive to some people. If there are employees who say, we really hate what this comedian’s saying on stage, the Bill may impose a duty on the employer to cancel the comedian; does this not impose a chilling effect on free speech?
Join Ally and Henry for a lively and interesting to and fro on the Bill as it passes through its various Committee and Report stages in the Commons.
Law Pod UK starts 2025 with nearly 950K listens. We aim to inform and enlighten our audience on important developments in civil and public law with a range of guests from 1 Crown Office Row and other legal experts. Law Pod UK is available on Spotify, Apple Podcasts, Audioboom, Player FM, ListenNotes, Podbean, iHeart, Radio Public, Deezer or wherever you listen to your podcasts.
Please remember to rate and review us if you like what you hear.
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20 January 2025 by Rosalind English
In Episode 211 of Law Pod UK I am joined by former President of the Supreme Court, Brenda Hale, first female law lord in the Court of Appeal, one time Professor of Law at Manchester University and participant in many Law Commission projects during her nine year sojourn there. She discusses with me the emergence of the English law of privacy from the network of common law torts such as breach of confidence, misuse of private information and libel, in the constellation of cases that reached the courts before the 1998 Human Rights Act ushered in the right to respect to private life and the right to freedom of expression under the European Convention on Human Rights and Freedoms. The balancing act between Article 8 and 10 is not always straightforward, as Lady Hale points out, where different members of the appellate committee have differing views on transparency and confidentiality.
She talks about her years at the Law Commission and her role in the team collaborating with what was then the Department of Health and Social Security to come up with a systematic drawing together of all the different rules about the care and upbringing of children the Children Act 1989. At this point of the discussion, Rosalind and Lady Hale touch upon the novel by Ian McEwan by that very title, The Children Act (2014), which gets Lady Hale’s full endorsement.
The full citations of the cases we discuss are set out below.
Kaye v Robertson [1991] FSR 62
Campbell v Mirror Group Newspapers Ltd [2004] UKHL 22
The “salt overdose” case
Patel v Mirza [2016] UKSC 42 (general principles of illegality)
Law Pod UK starts 2025 with nearly 950K listens. We aim to inform and enlighten our audience on important developments in civil and public law with a range of guests from 1 Crown Office Row and other legal experts. Law Pod UK is available on Spotify, Apple Podcasts, Audioboom, Player FM, ListenNotes, Podbean, iHeart, Radio Public, Deezer or wherever you listen to your podcasts.
Please remember to rate and review us if you like what you hear.
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1 January 2025 by Rosalind English
O v P and Q [2024] EWCA Civ 1577
(Jeremy Hyam KC and Alasdair Henderson of 1 Crown Office Row represented the mother in this case)
This was an appeal from a decision in the Divisional Court by Judd J in April 2024. The case raises a question at the core of the transgender debate involving young people: consent.
The young person at the centre of this litigation is now 16 years old. He was born female and started to identify as male in 2020 at the age of about 12.
His parents were estranged. In these circumstances his mother appealed against the refusal of her request for an adjournment of proceedings in which she sought a prohibited steps order and a best interests declaration in relation to her child, pending an assessment being undertaken by a private gender dysphoria clinic (Gender Plus), the first private gender dysphoria hormone clinic in the UK.
It was accepted that, now the young person was by now 16, no Gillick competence question arose (see Sir James Munby at [55] in An NHS Trust v. X [2021] EWHC 65 (Fam), [2021] 4 WLR 11, and MacDonald J at [48]-[49] in GK and LK v. EE [2023] EWCOP 49). It was also accepted that the young person was “impressive, hardworking and intelligent” and had no mental health problems.
Puberty Blockers and Cross-Sex Hormones: Policy Background
As Vos MR noted, a number of events coalesced to make this case a particularly sensitive one at the time of this appeal.
(i) the Cass Interim Review in 2022 led to the closure of the Tavistock clinic that had been in issue in Bell v. Tavistock;
(ii) on 12 March 2024, NHS England published a clinical policy concluding that there was not enough evidence to support the safety or clinical effectiveness of puberty blockers to make the treatment routinely available (outside a research protocol);
(iii) as the first instance judge recorded at [58], NHS Scotland had announced before the hearing that persons under 18 would not be prescribed cross-sex hormones;
(iv) on 21 March 2023, NHS England published a clinical commissioning policy laying down stringent eligibility and readiness requirements to be met before cross-sex hormones could be administered to those over 16;
(v) on 9 April 2024, NHS England wrote to all NHS gender dysphoria clinics asking them to defer offering first appointments to those under 18 “as an immediate response to Dr Cass’s advice that ‘extreme caution’ should be exercised before making a recommendation for [cross-sex hormones] in [children]”;
(vi) on 10 April 2024, the Cass Review was published*; and
(vii) on 11 December 2024 (the day before the hearing before the Court of Appeal), the government announced that the temporary embargo on the use of puberty blockers would be made indefinite (subject to a review in 2027).
* For the purposes of this case, the mother highlighted that the Cass Review had called into question the quality of the evidence on which hormone treatments for adolescents are based. Dr Cass says at page 13, for example, that “[t]he reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress”. Moreover, Dr Cass highlights new evidence about brain maturation continuing into the mid-20s, whilst it was originally thought to finish in adolescence. Dr Cass recommended that puberty blockers should only be available within a research protocol, and that recommendation has now been implemented.
The judge at first instance had said first that, whilst the findings of the Cass Review might turn out to be very significant, she did not think they justified her departure from Bell v. Tavistock and from Lieven J’s decision in AB v. CD and Tavistock [2021] EWHC 741 (Fam) (AB v. CD), which the Court of Appeal approved in Bell v. Tavistock.
Arguments before the Court
The father sought to terminate the proceedings begun by the mother on the ground that they were causing the young person significant distress.
The mother contended that the proceedings should be adjourned because the legal and regulatory landscape for gender dysphoria treatment was changing rapidly; the Cass review had only been published a week before the hearing before the judge; and Gender Plus was a private provider whose practices and procedures were diverging from the NHS approach. In these circumstances, it behoved the court to keep an eye on a case of this kind in a time of flux. The mother also argued, though not strenuously, that cases concerning treatment for gender dysphoria should be regarded as being in in a special category requiring judicial oversight wherever there was less than complete unanimity. If necessary, the mother submitted that the Court of Appeal should depart from its recent decision in R (Bell) v. Tavistock and Portman NHS Foundation Trust [2021] EWCA Civ 1363, [2022] 1 All ER 416.
The judge below had concluded that, while the Cass review might be significant, it did not justify a departure from the decision in Bell v Tavistock and Portman NHS Foundation Trust [2021] EWCA Civ 1363, [2022] 1 All E.R. 416, [2021] 9 WLUK 157, in which it was held that treatment with puberty blockers should not be distinguished from the consideration of contraception in Gillick, and that questions of Gillick competence were for doctors, not the courts. Judd J held there was no realistic basis upon which to override the young person’s consent to treatment by a regulated provider and that there was no legitimate purpose in adjourning the case.
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31 December 2024 by Rosalind English
Join Rosalind English in Episode 211 as she discusses with Lucy McCann and Jonathan Metzer of 1 Crown Office Row the cases that have been decided at all levels in the courts in 2024 that have had, or will have, important implications for practitioners and litigants in fields ranging from children in care through anonymity in medical negligence to the forfeiture of property under the Suicide Act 1961 in the light of the passage of the Assisted Dying Bill. The cases we talk about include the following:
HXA v Surrey County Council [2023] UKSC 52 (abuse, failure to remove and Article 3)
AB (by the Official Solicitor) v Worcestershire County Council and Anor [2023] EWCA Civ 529 (local authority liability under Article 3)
Sammut v Next Steps Mental Healthcare Ltd [2024] EWHC 2265 (KB) (inquests, Article 2 and private care homes)
PMC v A Local Health Board [2024] EWHC 2969 (KB) (anonymisation in clinical negligence cases)
Abbasi and Haastrup (conjoined cases) [2023] EWCA Civ 331 (reporting restriction orders, anonymisation of professionals in medical treatment cases)
Paul v Wolverhampton NHS Trust [2022] EWCA Civ 12 (psychiatric injury or “nervous shock)
Tindall & Anor v Chief Constable of Thames Valley Police [2024] UKSC 33 (23 October 2024) (police Liability)
N v Poole Borough Council [2019] UKSC 25 (duty of care of public authorities)
Philip Morris v James Morris, Kate Shmuel and Gregory White [2024] EWHC 2554 (Ch) (assisted dying and the Forfeiture Act)
McKleenon, re Application for Judicial Review (Northern Ireland) 2024 UKSC 31 (judicial review and remedies)AB
By the end of 2024, Law Pod UK has gained 940K listens. We aim to inform and enlighten our audience on important developments in civil and public law with a range of guests from 1 Crown Office Row and other legal experts. Law Pod UK is available on Spotify, Apple Podcasts, Audioboom, Player FM, ListenNotes, Podbean, iHeart, Radio Public, Deezer or wherever you listen to your podcasts.
Please remember to rate and review us if you like what you hear.
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13 December 2024 by Rosalind English
Prismall v Google UK Ltd [2024] EWCA Civ 1516
This was not a class action but a representative action, pursuant to what is now Civil Procedure Rule (CPR) 19.8, for the tort of misuse of private information against the respondents Google UK Limited (Google) and DeepMind Technologies Limited (DeepMind). The action was on behalf of Mr Prismall and a class of persons said to number approximately 1.6 million.
The appeal was against the striking out of his representative claim for misuse of private information in the court below. In a representative action like this the task before the judge is to establish whether the “lowest common denominator” claimant in the class would fail to make their claim. The judge found that the lowest common denominator claimant in the group of persons represented did not have a realistic prospect of success.
Details of the Case
The claim was for damages in respect of both the one-off transfer by the Royal Free London NHS Foundation Trust (the Royal Free Trust) of data in October 2015, and the continuing transfer of data thereafter until 29 September 2017 pursuant to a live data feed. The data which was transferred took the form of patient-identifiable medical records held by the Royal Free Trust of patients, including Mr Prismall, who had attended hospitals in the Royal Free Trust or had blood tests processed by laboratories operated by the Royal Free Trust between 29 September 2010 and 29 September 2015. Google and DeepMind used the data for the purposes of developing an app called “Streams” which was intended to be used to identify and treat patients suffering from Acute Kidney Injury. Google and DeepMind also had, however, a contractual entitlement to use the data for purposes wider than direct patient care and to develop and prove capabilities to enhance future commercial prospects.
At first instance the judge found that each member of the class did not have a realistic prospect of establishing a reasonable expectation of privacy in respect of their medical records or of crossing the de minimis threshold in relation to such an expectation such that there was no realistic prospect of establishing misuse of private information of each member of the class, or a realistic prospect of establishing an entitlement to damages for loss of control. The lowest common denominator was a notional claimant in the class whose claim represented the “irreducible minimum scenario” for a claimant in the class of persons. The judge’s lowest common denominator claimant was premised on the basis that there was one attendance at a trust hospital, which was an attendance not concerning “a medical condition involving any particular sensitivity or stigma” and there being “no specific reference to the medical condition that had prompted the attendance”. The judge had identified for the irreducible minimum scenario for the lowest denominator claimant that “no upset or concern was caused by the data transfer”. The judge found that the lowest common denominator claimant’s claim would fail.
Grounds of claim
Mr Prismall’s claim related to the wrongful use of private patient information by Google and DeepMind in: (1) obtaining patient-identifiable medical records with a contractual entitlement under the Information Sharing Agreement which was wider than direct patient care and the Streams project;
(2) storing the medical records prior to Streams becoming operational;
(3) using the medical records in the research and development of Streams; and
(4) developing and providing their general capabilities by the use of the medical records for the purposes of future commercial prospects.
Damages were claimed for loss of control of the private information only.
The judge said that it was “also well-established that not every disclosure of medical information will give rise to a reasonable expectation of privacy and/or involve an unlawful interference.” If anodyne or trivial information about a brief hospital visit was made public by a patient, the judge saw no reason why that information would attract a reasonable expectation of privacy by dint of it being recorded in a medical record.
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