An NHS Trust & Ors v Y & Anor

Factual and Procedural Background

“Patient,” an active individual in his fifties, sustained severe brain damage after a cardiac arrest in June 2017 and never regained consciousness. He required clinically-assisted nutrition and hydration (“CANH”) to remain alive. After transfer to a specialist unit operated by “Entity A,” two independent specialists concluded that Patient had a prolonged disorder of consciousness (“PDOC”) with no prospect of meaningful recovery. Patient’s spouse and children (“Patient’s Family”) agreed with the treating team that continued CANH was not in Patient’s best interests.

On 1 November 2017 Entity A applied to the High Court for declarations that (1) court approval was not mandatory before withdrawing CANH when clinicians and family agreed it was against a PDOC patient’s best interests, and (2) no civil or criminal liability would arise from withdrawal. The Official Solicitor was invited to act for Patient. On 10 November 2017 Judge O’Farrell granted the declaration sought. Permission for a “leap-frog” appeal to the Supreme Court was given.

Before the appeal was heard, Patient died of sepsis on 22 December 2017. Owing to the general public importance of the issue, the Supreme Court (constituted by Judge Black, Judge Hale, Judge Mance, Judge Wilson and Judge Hodge) nonetheless proceeded to determine the question.

Legal Issues Presented

1. Does domestic common law require a court order before CANH can be withdrawn from a patient in PDOC when clinicians and the patient’s family agree that continuation is not in the patient’s best interests?
2. Do the Mental Capacity Act 2005 (“MCA 2005”) and its Code of Practice impose such a requirement?
3. Do Articles 2, 6, 8 or 14 of the European Convention on Human Rights (“ECHR”) necessitate mandatory judicial scrutiny in every case?

Arguments of the Parties

Official Solicitor’s Arguments

• Court approval is essential in every PDOC withdrawal case to safeguard the patient’s right to life and dignity.
• Mandatory applications derive from common-law principles developed in earlier leading cases and are reinforced by Articles 2 and 6 ECHR.
• The MCA 2005 Code of Practice, properly interpreted, requires court involvement notwithstanding the absence of an express statutory clause.
• Without litigation, vulnerable patients risk misdiagnosis, undue pressure on families, and doctors acting as “judge in their own cause.”

Entity A and Entity B’s Arguments

• Neither common law nor the ECHR imposes a universal duty to seek court approval.
• The MCA 2005 establishes a comprehensive statutory framework permitting clinicians to act lawfully in a patient’s best interests without court reference, provided its safeguards and professional guidance are followed.
• Compulsory litigation would create delay, distress for families, and unnecessary cost, without adding meaningful protection.

Table of Precedents Cited

Court's Reasoning and Analysis

Judge Black, delivering the judgment for a unanimous court, traced the historical evolution from In re F and Bland to the statutory regime under the MCA 2005. The court held that:

• No common-law rule has ever required court approval in every case; earlier authorities recommended judicial involvement only as a matter of prudent practice during a period of medical and ethical uncertainty.
• The MCA 2005 creates a complete framework enabling clinicians to act in a patient’s best interests without court intervention, provided the Act’s decision-making process, section 5 protections and section 4 “best-interests” checklist are followed.
• The Code of Practice, though influential, cannot impose legal duties beyond the statute; its apparently mandatory language is reconciled by reading it in conjunction with sections emphasising recourse to court only where there is “doubt or dispute.”
• Article 2 ECHR is satisfied by the combined effect of the MCA 2005, the Code, and professional guidance issued by entities such as Company D. The Strasbourg jurisprudence (Lambert and subsequent cases) recognises that decisions may lawfully rest with clinicians within a regulated, consultative process.
• Article 6 concerns arise only where a concrete dispute exists; assuming a dispute in every case would render the procedural protections in the MCA 2005 meaningless and impose disproportionate burdens on families, clinicians and courts.
• Article 14 comparisons with assisted-dying legislation are inapposite because withdrawing treatment after a best-interests analysis is categorically different from intentionally hastening death.

The court emphasised the importance of existing professional safeguards: multi-disciplinary assessments, independent second opinions, consultation with those close to the patient, thorough record-keeping, and ready access to the Court of Protection whenever disagreement or genuine uncertainty arises.

Holding and Implications

APPEAL DISMISSED.

The Supreme Court ruled that a court application is not legally mandatory before withdrawing CANH from a patient with PDOC where clinicians and the patient’s family agree that continuation is not in the patient’s best interests, provided the MCA 2005 and relevant professional guidance are complied with.

Immediate Effect: Entity A and all healthcare professionals may lawfully withdraw CANH in similar circumstances without first seeking judicial approval, shielding them from civil or criminal liability under section 5 MCA 2005.

Broader Implications: The decision clarifies that litigation is reserved for cases involving dispute or uncertainty, potentially reducing delays, costs and emotional strain for families while preserving judicial oversight when required. No new cause of action or statutory amendment was created; the ruling harmonises pre-existing practice under the MCA 2005 with ECHR standards.