This judgement is in line with various recent decisions on the withdrawal of clinically assisted nutrition and hydration.
Background:
This case relates to Z, a 70-year-old man in a permanent vegetative state following a brain injury in 2021, and the application by the NHS North West London Integrated Care Board (ICB) for an order permitting the withdrawal of clinically assisted nutrition and hydration (CANH). Z suffered his brain injury following a severe haemorrhage after a surgery. Z had been placed in a specialist nursing home in December 2021.
Z lacked capacity and so the question was whether it was in Z’s best interests for CANH to be withdrawn. That application is supported by the Royal Hospital for Neurodisability (RHN), by Z's sister, X, and one of his close friends, Y, and opposed by his wife, W, and another of his close friends, V.
He was regularly assessed with the conclusion that he was always in the same vegetative state with minimal reactions to sounds or being touched.
Decision:
Despite the presumption favouring life, the Court found that Z's exceptional circumstances, including his poor medical condition, the numerous medical interventions required, and the risks associated with his condition, outweighed the benefits of continuing CANH. The presumption was, therefore, displaced. The Judge accepted the unanimous medical evidence that Z was in a persistent vegetative state with no prospect of recovery and that the passing of time would not ameliorate his condition.
Z would become increasingly at risk of an acute event which could be wholly unpredictable as to its timing. The consequences for Z and for his clinical team to manage such a disruption and the risk of further medical intervention for Z were unknown.
The Court also acknowledged Z's wishes and values, including his desire for a dignified death, and determined that discontinuing CANH would enable him to die with dignity and minimal discomfort. There were some differing views about what his wishes would be if he could not die swiftly. The palliative care plan proposed provided a well-thought-out and flexible plan to manage Z's condition.
Justice Theis, while recognising that there could be no guarantee about the time scale and the potential changes involved by discontinuing CANH, also noted that the disconnection was in Z’s best interest.
Implications:
A similar case was decided a few days later with a similar outcome in Whittington Health NHS Trust and XY (by his litigation friend, the Official Solicitor) and others. The facts are slightly divergent, but the care the Court took in making its decision was comparable.
Courts are understandably cautious in displacing the presumption favouring life and require convincing evidence to make such decisions. They also take the person’s best interest into consideration rather than putting most of the weight on the family’s wishes. It is always hard to let someone go but sometimes it is best for that person to allow them to die in dignity as demonstrated in this case and NHS North Central London Integrated Care Board v PC & Ors [2024]