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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.
This was an application by a father for a declaration that it should be lawful for him to use an embryo created using his sperm and his late wife’s eggs in treatment with a surrogate. The Human Fertilisation and Embryology Authority opposed the application, on the basis that there was insufficient consent from his wife (AB).
The embryo was created in 2017 during the course of treatment being undertaken by EF and AB at a clinic licensed by the HFEA and remains stored by them. EF’s wife died unexpectedly along with the couple’s youngest daughter. It was against that background that this application was made.
EF argued that the HFEA’s decision preventing him from using the remaining embryo amounted to an interference (i) with his Article 8 rights, alone and as interpreted in light of Article 9, and (ii) with those rights when considered in the context of Article 14, which prohibits discrimination in the treatment of men and women. Such interference with those rights, in the circumstances of this case, was disproportionate. Therefore, argued the applicant, the Court was required by s 3 HRA 1998 to read and give effect to primary and subordinate legislation in a way which is compatible with Convention Rights.
Both EF and his late wife were adherents of what the court called the “J religion”, whose central doctrine is the sanctity of life and the divine purpose of all life forms. They believed that the divine soul enters the embryo at point of conception.
They both came from large families and wished to replicate that pattern for themselves. AB suffered a miscarriage in 2008. They went on to have a daughter (X) and they wanted a sibling for her. After IVF treatment AB gave birth to Y. Y subsequently died of neonatal complications. AB and EF wished to use their remaining embryo retrieved in that IVF treatment to have another child.
The decision of the Court of Protection in Rotherham and Doncaster and South Humber NHS Foundation Trust and NR [2024] EWCOP 17 is the latest in a line of cases where the Court has been asked to determine whether a termination of pregnancy is in a woman’s best interests. Any case about a termination engages the pregnant woman’s Article 8 rights. But where the woman also lacks capacity to decide for herself whether to have a termination, there must be a particularly careful analysis to ensure that her rights are respected. While previous decisions have frequently accorded weight to the wishes and feelings of the pregnant woman at the heart of the case, Mr Justice Hayden’s decision goes further in handing the decision over to the pregnant woman herself.
This was one of those deeply troubling cases where there was disagreement amongst the family members over whether their incapacitated brother/father should continue with clinically assisted nutrition and hydration. One brother had applied for ANH to be discontinued, but because of the objections of the patient’s son, it was said that he would “continue to be cared for by nursing staff”.
As Hayden J observed, this was a “troubling non sequitur”:
Family dissent to a medical consensus should never stand in the way of an incapacitated patient’s best interests being properly identified. A difference of view between the doctors and a family member should not be permitted to subjugate this best interest investigation.
This particular hearing was ex post facto: in 11th June 2021, Hayden J delivered an extempore judgment in which he indicated why the continued provision of nutrition and hydration to GU, in the manner outlined above, was contrary to GU’s interests. However, having concluded that it was not in GU’s best interests to continue to receive CANH at the hearing on 11th June 2021, he considered it was necessary to afford RHND the opportunity of explaining what had happened. Amelia Walker of 1 Crown Office Row represented the hospital in these proceedings.
The appeal was allowed on the basis that care workers making arrangements to secure the services of a sex worker for C would place the care workers in peril of committing an offence contrary to section 39 of the Sexual Offences Act 2003 (“SOA”).
Background
The issue was whether care workers would commit a criminal offence under section 39 of the SOA if they made practical arrangements for C to visit a sex worker. C had the capacity to consent to sexual relations but not to make the arrangements.
Section 39(1) SOA states that:
A person (A) commits an offence if—
(a) he intentionally causes or incites another person (B) to engage in an activity,
(b) the activity is sexual,
(c) B has a mental disorder,
(d) A knows or could reasonably be expected to know that B has a mental disorder, and
(e) A is involved in B’s care in a way that falls within section 42.
[Emphasis Added]
The central question was whether the care workers would “cause” C to engage in sexual activity by making the arrangements. Hayden J concluded that they would not cause C to engage in sexual activity.
The Secretary of State for Justice appealed on three grounds:
The Judge misinterpreted section 39 SOA;
To sanction the use of sex is contrary to public policy (this ground of appeal was raised by way of an opposed amendment);
The Judge erred in concluding that Articles 8 and 14 of the European Convention on Human Rights (“ECHR”) required his favoured interpretation.
In a recent report entitled “It Still Happens Here”, the Centre for Social Justice (CSJ) and the anti-slavery charity Justice and Care have found a rise in incidents of domestic slavery, and warned that the problem is likely to intensify in the aftermath of the coronavirus crisis.
How to determine “best interests” in the case of an adult lacking capacity, where a proposed medical donation for the benefit of a close relative may cause lasting harm to the donor?
COVID-19 has changed many things about society, and one of the most significant is the erosion of the taboo surrounding death. After all, we have daily bulletins on death figures. As Dignity in Dying Sarah Wootton says, in her forthcoming book “Last Rights”,
The coronavirus pandemic has thrust death and dying into the mainstream.
This sensitive and compassionate judgment by Hayden J following a remote hearing of the Court of Protection is therefore worth our attention, as we all become more aware of how acutely things slip out of our control, not least of all our health.
The application from the Trust concerned a 34-year-old man (MSP) who has had significant gastrointestinal problems for approximately 10 years, requiring repeated invasive surgery. At the time of the hearing he was unconscious and on life support in ICU. The issue framed in the application was whether the Trust should continue to provide ITU support or withdraw treatment other than palliative care.
Between 2013 and 2020 MST underwent significant abdominal surgery and had a stoma inserted in 2018. The court noted that he “utterly loathed” life with a stoma. He did express his consent to the stoma being inserted at the time, but this consent seemed entirely contrary to his unambiguous rejection of this procedure, expressed bluntly to three consultants with whom he had discussed it. It also appeared entirely inconsistent with everything he had said to his mother, father and step-sister on the point.
Significantly, on 4th February 2020 MSP had written a carefully crafted Advance Directive which he had copied to his parents and to his step-sister. Outside the hospital setting these were the only three people who knew MSP had a stoma. He did not even wish his grandmother to be told. In this Advance Directive he stipulated, among other things, that he would refuse the “formation of a stoma, through an ileostomy, colostomy, urostomy or similar, that is expected to be permanent or with likelihood of reversal of 50% or under”.
In the matter of proceedings brought by Kings College NHS Foundation Trust concerning C (who died on 28 November 2015) v The Applicant and Associated Newspapers Ltd and others [2016] EWCOP21 – read judgment
The Court of Protection has just ruled that where a court has restricted the publication of information during proceedings that were in existence during a person’s lifetime, it has not only the right but the duty to consider, when requested to do so, whether that information should continue to be protected following the person’s death.
I posted last year on the case of a woman who had suffered kidney failure as a result of a suicide attempt has been allowed to refuse continuing dialysis. The Court of Protection rejected the hospital’s argument that such refusal disclosed a state of mind that rendered her incapable under the Mental Capacity Act. An adult patient who suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment (King’s College Hospital NHS Foundation Trust v C and another [2015] EWCOP 80). Continue reading →
King’s College Hospital NHS Foundation Trust v C and another [2015] EWCOP 80 read judgment
A woman who suffered kidney failure as a result of a suicide attempt has been allowed to refuse continuing dialysis. The Court of Protection rejected the hospital’s argument that such refusal disclosed a state of mind that rendered her incapable under the Mental Capacity Act. An adult patient who suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment. Continuation of such treatment is unlawful, even if the refusal seems irrational to others. As the judge said, this rule
reflects the value that society places on personal autonomy in matters of medical treatment and the very long established right of the patient to choose to accept or refuse medical treatment from his or her doctor (voluntas aegroti suprema lex). Over his or her own body and mind, the individual is sovereign (John Stuart Mill, On Liberty, 1859).
The Trust’s further application to be allowed to restrain C “physically or chemically” from leaving the hospital where she was receiving the dialysis was therefore rejected.
Background facts
The coverage of this case reflects a certain level of social disapproval. “Right to die for socialite scared of growing old” – “Socialite allowed to die was terrified of being poor” run the headlines. Behind them lurks an essentially religious consensus that people should not be allowed to opt out of senescence and its associated poverty and suffering, such matters being for God alone. There is also a measure of censoriousness behind the details brought to court regarding C’s attitude to motherhood and men, the news that she had breast cancer, her love of “living the high life” and her dread of growing old “in a council house”. Continue reading →
Judgments in best interests cases involving children often make for heart-wrenching reading. And so it was in Bolton NHS Foundation Trust v C (by her Children’s Guardian)[2015] EWHC 2920 (Fam), a case which considered Royal College of Paediatrics and Child Health guidance, affirming its approach was in conformity with Article 2 and Article 3 ECHR. It also described, in the clearest terms, the terrible challenges facing C’s treating clinicians and her parents. Continue reading →
SF, Re [2015] EWCOP 68 (26 October 2015) – read judgment
This Court of Protection case has, unusually, made the papers, and when you read the details you won’t be surprised. What the judge described as a “callous and calculating” son charged his widowed mother, who suffered from dementia, more than £117 000 for “out of pocket expenses” visiting her in her nursing home. He had been in charge of her expenses since 2004 when Sheila (the mother) had been admitted to hospital under the Mental Health Act 1983. But alarm bells only went off after her unpaid nursing bills reached nearly £30 000. The Public Guardian launched an enquiry that led to this hearing of an application for the court to revoke the son’s (Martin’s) Enduring Power of Attorney (‘EPA’) and to direct him to cancel its registration. The Public Guardian also applied to freeze Sheila’s bank account. Continue reading →
Wye Valley NHS Trust v B (Rev 1) [2015] EWCOP 60 (28 September 2015) – read judgment
The Court of Protection has recently ruled that a mentally incapacitated adult could refuse a life saving amputation. This is an important judgement that respects an individual’s right to autonomy despite overwhelming medical evidence that it might be in his best interests to override his wishes. The judge declined to define the 73 year old man at the centre of this case by reference to his mental illness, but rather recognised his core quality is his “fierce independence” which, he accepted, was what Mr B saw as under attack. Continue reading →
A healthcare NHS Trust v P & Q [2015] EWCOP (13 March 2015) – read judgment
The Court of Protection has clarified the position on revealing the identity of an incapacitated adult where reporting restrictions apply.
This case concerned a man, P, who as a result of a major cardiac arrest in 2014, has been on life support for the past four months. Medical opinion suggests that he is unlikely ever to recover any level of consciousness, but his family disagrees strongly with this position. The Trust therefore applied to the Court for a declaration in P’s best interests firstly, not to escalate his care and secondly to discontinue some care, inevitably leading to his demise. The trust also applied for a reporting restrictions order. When it sought to serve that application on the Press Association through the Injunctions Alert Service, the family (represented by the second Continue reading →
A Local Authority and M (By his litigation friend via the Official Solicitor) v E and A (Respondents) [2014] EWCOP 33 (11 August 2014) – read judgment
It’s been an interesting week for the extreme fringes of maternal care. The papers report a trial where a mother is being prosecuted for administering toxic levels of medication to her daughter for “conditions that never existed” (as the court heard). Let’s see how that pans out.
And now the Court of Protection has published a ruling by Baker J that a a supporter of the discredited doctor Andrew Wakefield embarked on an odyssey of intrusive remedies and responses to her son’s disorder, fabricating claims of damage from immunisation, earning her membership of what science journalist Brian Deer calls the class of “Wakefield mothers.”
On the face of it, the detailed and lengthy judgment concerns the applicant son’s reaction to the MMR vaccination when it was administered in infancy, and whether it was the cause of his autism and a novel bowel disease, the latter being Wakefield’s brainchild. But at the heart of the case lies the phenomenon that we all used to know as Munchausen’s syndrome by proxy.
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Judgments in best interests cases involving children often make for heart-wrenching reading. And so it was in 
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