N v. Secretary of State for the Home Department

Factual and Procedural Background

The Appellant, a 30-year-old national of The Country, arrived in The State in March 1998 and was immediately refused leave to enter. Within hours she was admitted to The Hospital where she was diagnosed with advanced HIV/AIDS. Modern antiretroviral medication raised her CD4 count from 10 to 414 and stabilised her health, but her prognosis without continuing treatment is an early death after serious suffering.

On 28 March 2001 the Defendant refused her asylum application. An adjudicator allowed her appeal under Article 3 of the European Convention on Human Rights (ECHR), labelling the humanitarian case “overwhelming.” The Immigration Appeal Tribunal reversed that decision on 20 February 2003. The Court of Appeal held the Tribunal’s reasoning inadequate but, by majority, dismissed the appeal because the facts were not “extreme” enough for Article 3 protection. The present judgment is the Appellant’s further appeal to the House of Lords.

Legal Issues Presented

1. Does deporting an HIV/AIDS sufferer who would lose life-saving treatment in the receiving state constitute “inhuman or degrading treatment” contrary to Article 3 ECHR?
2. What threshold of “exceptional circumstances” must be met, in light of Strasbourg jurisprudence, before Article 3 bars expulsion on medical grounds?

Arguments of the Parties

Appellant's Arguments

• Expulsion would rapidly lead to pain, suffering and death, rendering the act itself inhuman under Article 3.
• The case falls within the principle in D v United Kingdom, where removal of a terminally ill AIDS patient was found to breach Article 3.
• Humanitarian considerations outweigh the Defendant’s interest in immigration control because she received treatment for years in The State and is now dependent on it.

Defendant's Arguments

• Article 3 only prevents removal in “very exceptional” cases; it imposes no duty to provide indefinite medical care to aliens.
• Post-D Strasbourg cases show a restrictive approach; the Appellant is currently stable, fit to travel, and some treatment exists in The Country.
• Granting relief would create an unmanageable precedent inviting countless similar claims and imposing heavy resource burdens on The State.

Table of Precedents Cited

Court's Reasoning and Analysis

All five Law Lords agreed that Strasbourg jurisprudence fixes a “very high” and “exceptional” threshold. Drawing extensively on D v United Kingdom and the series of later inadmissibility decisions, the House concluded that Article 3 does not impose a duty on Contracting States to provide indefinite, resource-intensive medical care to aliens whose conditions are stabilised.

Key steps in the analysis included:

• Article 3 is absolute, but its application to deportation for medical reasons has been limited by Strasbourg to cases where the applicant is already in the final, critical stage of illness.
• The Appellant’s current health is stable; she is fit to travel and has a prospect—though uncertain and costly—of accessing treatment in The Country. This aligns her with applicants refused relief in SCC, Henao, Ndangoya and Amegnigan.
• Extending Article 3 to cover her circumstances would effectively create an unlimited right for seriously ill foreigners to remain in The State, a result the European Court has “been at pains to avoid.”
• Humanitarian sympathy cannot override the clear line of authority; domestic courts must “mirror” Strasbourg unless and until that court changes course.
• The obligation sought would be a positive one—continuing lifelong treatment—not a mere negative duty to refrain from harmful conduct. Strasbourg has not recognised such a positive duty in comparable contexts.

Holding and Implications

Appeal dismissed.

Deporting the Appellant to The Country is not incompatible with Article 3 ECHR because her case does not meet the “very exceptional” threshold established in D v United Kingdom. The decision re-affirms that:

• Article 3 will bar expulsion on medical grounds only where the person is at a critical, terminal stage with no real prospect of adequate care or support abroad.
• Contracting States are under no Convention duty to provide aliens with lifelong medical treatment unavailable in their home countries.
• While the Defendant retains a discretionary power to grant leave to remain on compassionate grounds, denial of such discretion does not breach Article 3.