RS, Re

Factual and Procedural Background

The judgment concerns RS, a patient whose medical treatment and care have been the subject of court declarations and multiple applications. On 15th December, the court declared it was not in RS's best interests to receive life-sustaining medical treatment, including artificial nutrition and hydration, and authorized lawful discontinuation of such treatment. The court further declared that palliative care should be provided to maintain dignity and minimize discomfort until RS's death.

Following this, RS's birth family sought permission to appeal the decision to the Court of Appeal, which was refused. A further application by the birth family to reverse the decision was heard and rejected, with the court finding RS's condition had deteriorated rather than improved. The Court of Appeal again refused permission to appeal. The birth family and the Government of the Republic of Poland also applied for interim relief from the European Court of Human Rights (ECtHR), which was denied, and a substantive application was deemed inadmissible.

The repeated applications resulted in RS's nutrition and hydration being removed and reinstated on three occasions, causing distress to RS's wife and children. The court referenced the Court of Appeal's remarks on the distress and indignity caused by these repeated interventions.

Currently, the Trust has made an application prompted by the birth family’s requests. The birth family seeks a visit from the Polish Consul General and a remote assessment by Dr S from Poland, with a stay on the previous order and reinstatement of nutrition and hydration to ensure RS is alive for such actions. RS is reported to be very ill, with limited time expected to live, and his wife opposes the visit and further examination. The Trust opposes the birth family's requests, seeking an order that such visits and assessments should not occur in RS's best interests.

Legal Issues Presented

1. Whether it is in RS’s best interests to allow a visit by the Polish Consul General and a remote medical assessment by Dr S.
2. Whether the court should grant a stay of the existing order and reinstate nutrition and hydration to facilitate the visit and assessment.
3. The legal effect and applicability of Article 36 of the Vienna Convention on Consular Relations 1963 in the context of hospital patients.

Arguments of the Parties

Trust's Arguments

• The court should apply the best interests test, which supports maintaining the previous decision to discontinue life-sustaining treatment.
• Article 36 of the Vienna Convention has no bearing on the case and does not override domestic law or the best interests assessment.
• It is not in RS’s best interests to permit the visit or remote assessment given his deteriorated condition and the opposition of his wife.
• There is no reason to believe RS is not receiving optimal care.

Birth Family's Arguments

• It is not unlawful and is in RS’s best interests to allow the Polish Consul General to visit and for Dr S to conduct a remote assessment.
• The Trust should reinstate nutrition and hydration, which would not be contrary to RS’s best interests.
• If the hospital refuses, the court should grant a stay of the order to enable these actions.
• Article 36 of the Vienna Convention requires the court to facilitate consular functions, including communication and access to nationals, which should apply here.

Official Solicitor's Position

• The Official Solicitor opposes the declarations and orders sought by the birth family and has no reason to doubt the Trust’s care of RS.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The court reaffirmed that it had twice determined RS’s best interests, consistently concluding that life-sustaining treatment should be discontinued, and these decisions were upheld by the Court of Appeal and the ECtHR. The court noted that Article 36 of the Vienna Convention is not incorporated into UK law and that its rights must be exercised in conformity with domestic law. The Convention’s provisions concerning consular access apply to persons in custody or detention, not hospital patients, and do not impose a duty to allow consular officials to inspect every citizen’s medical treatment in a hospital.

The court assessed RS’s best interests as paramount and found that a visit by the Polish Consul General and a remote assessment by Dr S would not be in RS’s best interests. The proposed remote assessment was criticized as inherently limited and less reliable due to lack of direct contact with treating staff and access to full medical records. The court also considered the distress that such a visit and stay would cause RS’s wife and the hospital environment, concluding that forcing the visit would be contrary to RS’s dignity and welfare.

Accordingly, the court declined to make the declarations sought by the birth family and granted the application made by the Trust, emphasizing that this did not impede the Republic of Poland or the Consul General in fulfilling their consular rights under the Vienna Convention.

Holding and Implications

The court’s final decision was to REFUSE the birth family’s requests for declarations permitting a consular visit and remote medical assessment, and to GRANT the Trust’s application opposing those requests.

The direct effect is that RS will not be visited by the Polish Consul General nor assessed remotely by Dr S, and the existing medical care arrangements will continue without reinstatement of nutrition and hydration for the purpose of these consular activities. No new legal precedent was established; the decision reinforces the primacy of the best interests test in medical treatment decisions and clarifies that consular rights under the Vienna Convention do not extend to imposing visits or examinations on hospital patients against their best interests or domestic law.