Law Report: 11 DECEMBER 1997: Parents cannot force doctors to resuscitate child

Where it was clear from the medical evidence that it was in the best interests of a child suffering from a fatal disease not to offer treatment other than palliative care, the court should authorise such treatment by the child's doctors, despite the fact that the parents did not consent to such a course.

Re C (A Minor: Withdrawal of Lifesaving Treatment); Family Division (Sir Stephen Brown, President) 18 November 1997

The court granted a declaration giving leave to doctors treating a 16-month-old child suffering from spinal muscular atrophy, type 1, to withdraw artificial ventilation; not to resuscitate in the event of respiratory arrest; and to give palliative care to ease her suffering and permit her life to end peacefully and with dignity, such treatment being within her best interests.

Angus Moon (Hempsons) for the hospital trust; Lindsey Kushner QC (Alexander Harris) for the parents; Michael Nicholls (solicitor of the Official Solicitor's Department) as amicus curiae .

Sir Stephen Brown, P, said that the child, who was born in July 1996 with a fatal disease called spinal muscular atrophy, type 1 (SMA 1), had been in hospital since October on intermittent positive pressure ventilation, which was designed to support her own breathing. She was seriously disabled, and was in what her doctor described as a "no chance" situation.

A "no chance" situation was defined as one "where the child has such severe disease that life-sustaining treatment simply delays death without significant alleviation of suffering. Medical treatment in this situation may thus be deemed inappropriate."

The consultant paediatric neurologist who was responsible for the child's care considered that her case was so grave that it was not in her best interests that she should be further ventilated. He considered that, when ventilation was withdrawn, it should not be reinstituted in the event of a further respiratory arrest. It was his view that such treatment would subject her to further suffering without conferring any benefit.

The parents were highly responsible religious orthodox Jews. They loved their child and could not bring themselves to face what seemed to be her inevitable future. They did not believe that it was within their religious tenets to contemplate the possibility of indirectly shortening life, even if that was not the purpose of the course which the doctors believed to be appropriate in order to spare her further suffering.

The parents had, accordingly, been unable to consent to the course of treatment recommended by the doctors. They wanted to be assured that should the child suffer further respiratory relapse or arrest she would be put back onto ventilation. The doctors had sought advice from another consultant paediatric neurologist, whose opinion entirely supported that of the doctor treating the child. The parents had also sought independent medical advice from two doctors, both of whom had said that further ventitlation was not in the child's best interests.

Since the doctors and the hospital trust had been unable to obtain the parents' consent to the course they wished to follow they had applied to the court for an order. The medical evidence was not in dispute. The views of the parents had been set out in an affidavit sworn by the mother. It was a very moving document, and his Lordship had the very greatest sympathy for the unfortunate parents.

It was quite clear from the authorities that the court could not require a doctor to undertake a course of treatment which he was unwilling to undertake, as was the desire of the parents in the present case. There was no doubt on the evidence that it was in the child's best interests that she be taken off ventilation, and that it should not be restored if she suffered a further respiratory arrest. Whilst the sanctity of life was vitally important, the paramount consideration was the best interests of the child. His Lordship was very conscious of the grave responsibility which rested not only upon the doctors but also on the court, but believed that he should assent to the course proposed by the hospital trust.