Great Ormond Street Hospital for Children NHS Foundation Trust v ZG & Ors [2025] EWHC 1042 (Fam)

[2025] EWHC 1042 (Fam)Case No FD24P00611
IN THE HIGH COURT OF JUSTICE
FAMILY DIVISION
Venue Royal Courts of Justice, Strand, London, WC2A 2LLDate 24 April 2025
Before
THE HONOURABLE MR JUSTICE TROWELL
Between
GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUSTApplicant
Peter Mant KC (instructed by Hempsons) for ApplicantMichael Mylonas KC and Naomi Madderson KC (instructed by Pepperells) for First and Second RespondentsChristopher Osborne (from Cafcass Legal) for Third RespondentHearing Hearing dates: 14 th and 15 th April 2025
JUDGMENTThis judgment was handed down remotely on 24 rd April 2025This judgment was delivered in private. The judge has given leave for this version of the judgment to be published. Nobody may be identified by name or location. The anonymity of everyone other than the lawyers must be strictly preserved. All persons, including representatives of the media and legal bloggers, must ensure that this condition is strictly complied with. Failure to do so may be a contempt of court.
[1]I am dealing with an application by the Great Ormond Street Hospital for Children NHS Foundation Trust (the Trust) made on the 9 December 2024 for a declaration that it is no longer in MG’s best interests to receive life sustaining treatment; that the treatment is futile and burdensome; and that it would be lawful for the treatment to be withdrawn. The Trust is represented by Peter Mant KC.[2]That application is opposed by MG’s parents, ZG (father) and KG (mother). They have been represented by Michael Mylonas KC and Naomi Madderson KC.[3]The application is supported by MG’s court appointed Guardian, Lauren Doyle of Cafcass, who has been represented by Christopher Osborne.[4]As I shall set out below MG has experienced significant injury to his brain from a stroke in May 2024. He requires intensive care to support his life, which includes continuous mechanical ventilation and an external ventricular drain (EVD) which has been inset (at one end) in his brain.[5]I have heard oral evidence from three doctors:a. For the Trust: Dr A (a consultant paediatric neurologist) and Dr B (a consultant in paediatric intensive care). Both these doctors work in the Trust and treat MG.b. For the parents: Professor Stephen Playfor (a paediatric intensive care consultant).[6]I have read statements from Ms C (sister in paediatric intensive care), Ms D (physiotherapist) and second opinions from Dr E (a consultant paediatric neurologist) and Dr F (a paediatric intensive care consultant).[7]Further I have heard oral evidence from the parents. I have read the report of the Guardian, Ms Doyle. No party wanted to question her.[8]I record at the outset that this has been a very respectful hearing. The doctors acknowledge that the parents love MG enormously. The parents recognise that the hospital has done an excellent job caring for MG.[9]Sadly, the medical evidence all reaches the same conclusion, namely that I should make the declarations sought and that treatment should not be continued.[10]When I asked Mr Mylonas as to his case at the beginning of the hearing, he was clear to me that the parents want treatment to continue because they are hopeful of a miracle. In his written submissions, which I received at the beginning of the case, he urged on me the following question (the wording here is mine): If the doctors are right that MG is totally unaware of his surroundings then it cannot be said that he is suffering, and so how can the burdens of treatment be sufficient to justify the withdrawal of treatment when the treatment is life sustaining?[11]In his closing it is fair to say that the question had a slightly different emphasis, such that it became clearer that the importance of sustaining MG’s life was because the parents thought that while MG was alive there was a chance that his condition might change. In this judgment it will be necessary to consider these arguments.

General Background

[12]I will take this shortly as it is not in issue between the parties.[13]MG is now 3 years and 4 months old. He is a much loved child of his parents and a much loved member of his entire family. He has an elder and a younger sister. I have seen a video of him which was taken while he was in intensive care. From that I can see that he is a handsome child, who even when in a hospital bed, is well presented.[14]MG was diagnosed with B cell precursor acute lymphoblastic leukaemia on 19 April 2024 and started receiving chemotherapy. His parents were told that this treatment had a 90% success rate. On the 24 May 2024, after 5 weeks of induction chemotherapy, he had a sudden neurological collapse (the stroke). Scans of his brain showed that he had a large clot in one of the main blood vessels supplying blood to the brain.[15]On the 3 June 2024 his pupils stopped reacting and an MRI scan showed a haemorrhage with hydrocephalus. He had an operation and an EVD was inserted to relieve the pressure on his brain. The EVD has remained in place. Since this episode MG has remained ventilator dependant and in an intensive care unit at Great Ormond Street Hospital. He has had to have chest physiotherapy and suctioning of secretions. He is fed through a nasogastric tube.[16]The medical opinion is that MG has suffered a catastrophic brain injury from which he cannot recover. His brain stem is irrecoverably damaged, I am told. The medical opinion is that since this incident occurred MG does not react purposefully to his environment. He does have some reflex movements and he does have other movements, but they are not, according to the medical opinion, any sign of consciousness. The parents consider that some of MG’s movements do relate to his environment. As I have already said, I have been shown a video of him with his mother and his younger sister when it is clear that he does move. The medical opinion is unequivocal that such movement is not in response to the environment; it is just occasional movement.[17]It is not necessary for me to chart the progress of the differences between the parents and the Trust in relation to the care which MG should receive. I mention only that the Trust held an Ethics Case Review in July 2024 in which it was concluded that it would be in MG’s best interest for life sustaining treatment to stop. Second opinions were obtained in August 2024. In October 2024 mediation was attempted with the parents.[18]I will repeat that the case is remarkable as to the respect which each party affords the other. Nonetheless the differences between the Trust and the parents were not resolved and proceedings were issued in December 2024 and statements were prepared on behalf of the Trust. Mrs Justice Judd gave directions in that month, and made a declaration that MG lacked competence to consent to or refuse medical treatment. That is not controversial.[19]On the 13 January 2025, following statements from the parents, a further MRI scan and EEG were carried out. I was told they showed no meaningful improvement in MG’s health. That was followed on the 31 January 2025 by second statements from Dr B and Dr A.[20]The matter was transferred to me by Judd J and I gave directions (by consent) that the parents could instruct Professor Playfor. A provisional earlier hearing of this matter then had to be adjourned because of the ill health of a witness.

The Law

[21]I turn now to the legal framework for my decision. This has not been an area of dispute between the parties. Mr Mylonas is content to accept the account of the law set out by Mr Mant in his position statement. Mr Mant has referred me to a number of authorities but I will set out here the five point ‘milestones’ listed in paragraph 78 of Re Fixler [2021] EWCA Civ 1018 (to which Mr Osborne took me). These milestones, as that judgment makes clear, derive from another decision of that court, Wyatt v Portsmouth Hospital NHS Trust [2025] EWCA Civ 1181 (which was cited by Mr Mant). “The approach to be followed by a judge determining an application for an order authorising the withdrawal of life-sustaining treatment of a child is well established in the case law. The “intellectual milestones”, as characterised by this Court in Wyatt v Portsmouth Hospital NHS Trust are as stated above: 1) The judge must decide what is in the child’s best interests. 2) In making that decision, the child’s welfare is the paramount consideration. The term “best interests” encompasses all welfare issues. 3) The judge must look at the question from the child’s assumed point of view. 4) There is a strong presumption in favour of the course of action which prolongs life, but that presumption is not irrebuttable. 5) The judge must conduct a balancing exercise in which all the relevant welfare factors are weighed.” 1) The judge must decide what is in the child’s best interests. 2) In making that decision, the child’s welfare is the paramount consideration. The term “best interests” encompasses all welfare issues. 3) The judge must look at the question from the child’s assumed point of view. 4) There is a strong presumption in favour of the course of action which prolongs life, but that presumption is not irrebuttable. 5) The judge must conduct a balancing exercise in which all the relevant welfare factors are weighed.”[22]Further, given the arguments in this case it is appropriate for me to highlight two other decisions Mr Mant drew to my attention, one a case decided by the House of Lords and one decided by the Supreme Court. The House of Lords case is Airedale NHS Trust v Bland [1993] UKHL 17, [1993] A.C. 789, and I have been referred to the speech of Lord Goff at 869:
“medical treatment or care may be provided for a number of different purposes. It may be provided, for example, as an aid to diagnosis; for the treatment of physical or mental injury or illness; to alleviate pain or distress, or to make the patient's condition more tolerable. Such purposes may include prolonging the patient's life, for example to enable him to survive during diagnosis and treatment. But for my part I cannot see that medical treatment is appropriate or requisite simply to prolong a patient's life, when such treatment has no therapeutic purpose of any kind, as where it is futile because the patient is unconscious and there is no prospect of any improvement in his condition. It is reasonable also that account should be taken of the invasiveness of the treatment and of the indignity to which, as the present case shows, a person has to be subjected if his life is prolonged by artificial means, which must cause considerable distress to his family — a distress which reflects not only their own feelings but their perception of the situation of their relative who is being kept alive. But in the end, in a case such as the present, it is the futility of the treatment which justifies its termination.”
[23]I acknowledge that in considering the context of these words it should be held in mind that Anthony Bland’s family supported the application for declarations.[24]The Supreme Court case is Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67, and I have been referred to it through Re A (A Child) [2016] EWCA Civ 759 by the words of King LJ at paragraph 31: “Whilst its application requires sensitivity and care of the highest order, the law relating to applications to withdraw life sustaining treatment is now clear and well established. It can be summed up with economy by reference to two paragraphs from the speech of Baroness Hale in what is generally regarded as the leading case on the topic, notwithstanding that it related to an adult, against the backdrop of the Mental Capacity Act 2005. In Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67; [2014] AC 591 Baroness Hale said at paragraph 22:- ‘Hence the focus is on whether it is in the patient’s best interests to give the treatment rather than whether it is in his best interests to withhold or withdraw it. If the treatment is not in his best interests, the court will not be able to give its consent on his behalf and it will follow that it will be lawful to withhold or withdraw it. Indeed, it will follow that it will not be lawful to give it. It also follows that (provided of course they have acted reasonably and without negligence) the clinical team will not be in breach of any duty toward the patient if they withhold or withdraw it.’ And from paragraph 39:- ‘The most that can be said, therefore, is that in considering the best interests of this particular patient at this particular time, decision-makers must look at his welfare in the widest sense, not just medical but social and psychological; they must consider the nature of the medical treatment in question, what it involves and its prospects of success; they must consider what the outcome of that treatment for the patient is likely to be; they must try and put themselves in the place of the individual patient and ask what his attitude towards the treatment is or would be likely to be; and they must consult others who are looking after him or are interested in his welfare, in particular for their view of what his attitude would be.’ ‘Hence the focus is on whether it is in the patient’s best interests to give the treatment rather than whether it is in his best interests to withhold or withdraw it. If the treatment is not in his best interests, the court will not be able to give its consent on his behalf and it will follow that it will be lawful to withhold or withdraw it. Indeed, it will follow that it will not be lawful to give it. It also follows that (provided of course they have acted reasonably and without negligence) the clinical team will not be in breach of any duty toward the patient if they withhold or withdraw it.’ ‘The most that can be said, therefore, is that in considering the best interests of this particular patient at this particular time, decision-makers must look at his welfare in the widest sense, not just medical but social and psychological; they must consider the nature of the medical treatment in question, what it involves and its prospects of success; they must consider what the outcome of that treatment for the patient is likely to be; they must try and put themselves in the place of the individual patient and ask what his attitude towards the treatment is or would be likely to be; and they must consult others who are looking after him or are interested in his welfare, in particular for their view of what his attitude would be.’[25]In his closing Mr Mant returned to the law and in response to questions from me as to whether the observations of Lord Goff set out above fitted into balancing exercise or whether futility of treatment and lack of consciousness were sufficient of themselves to warrant withdrawal of treatment, he made clear that a balancing exercise was required. A balancing exercise is clearly consistent with the requirement of a ‘best interest’ test and as all counsel adopted this approach I shall not consider the law further, and shall adopt ‘balanced best interest’ as the test I must apply.

The Evidence

[26]I will here first describe the parents’ evidence even though Dr A and Dr B gave their evidence ahead of them.[27]The father was an impressive witness. He struck me as a man who had thought hard about what had happened to MG. He took care at the conclusion of his evidence to pause and praise the Trust for the care with which they had looked after MG and praise them for how welcome they had made his family on the Paediatric Intensive Care Unit.[28]He was religious and he made clear to me that should MG’s condition worsen he would be resigned to his death. He would see that as a sign from God. What he would not accept is withdrawing the treatment which MG currently receives. He prayed to God, and he took me through his prayer. It was his view that God had looked after MG by stopping any recurrence of his leukaemia, stopping his condition deteriorating as had been expected, and stopping the predicted blocking of the EVD.[29]He stressed to me the lightness of the load of MG’s treatment. And, he told me that much of it was done by his family.[30]The mother followed the father’s evidence and agreed with it. While the father struck me as a hard thinker, she struck me as more practically engaged. From the videos I can see her trying to interact with MG. She is a strong source of love and care for him. She had done all that she could to make his bed in intensive care a part of their family home. There can be no doubt that anything that could be done for him she would do.[31]Dr A gave his evidence first. I record that he and Dr B both paid tribute to the parents. Dr A was cross examined for some time. He did not depart from the written evidence that he had given. I will draw attention to the following points that he made:a. The improvement which the parents point to in MG’s condition in their written statements, is in fact no change in his underlying condition. It is a settling down as would be expected from the catastrophe of the stroke and the pressure on the brain caused by the haemorrhage.b. The movements of MG that the parents point to are no signs of consciousness or reaction to the world. They are either reflex movements or just occasional movements.c. He did not think MG was engaging with his environment at all. There was a risk that he had primal sensations, which could be pain or pleasure. It was a worry to him that there might be such primal sensation because MG would be feeling pain. The possibility that the parents might be right that MG had a form of consciousness was a terrifying possibility – because MG would be trapped, in pain, and isolated – but he did not think this was at all likely.d. He remained entirely confident in his view that there is no realistic prospect of neurological recovery for MG – beyond reasonable doubt was his phrase. MG, he related, is not able to benefit from continued treatment. He will remain unconscious until he dies. Ongoing treatment is futile.[32]Dr B too paid tribute to the parents. He too was cross examined for some time. He again did not move from his written evidence. He similarly considered the changes referred to by the parents in their statements, and described by them as improvements, were in fact MG’s body ‘settling down’ after the moments of crisis. He too was clear that MG’s brain injury was severe and irreversible. He too said that MG could not benefit from treatment. (I note he recoiled from the word ‘futile’ which I put to him but not from its meaning.) In support of a point made by him that there was no benefit to MG of continued treatment he told me MG could not grow and develop and he could not interact with others.[33]He said that MG’s treatment was invasive and caused a loss of dignity to him. He was challenged on this and said that the continual experience of treating MG had normalised it for the parents. He singled out the process of ventilation and being in a busy ICU as being particularly invasive and undignified, but he did acknowledge that the parents had attempted to make their corner of the ICU as calm as possible. He drew attention to the fact MG was fed by a nasogastric tube. In re-examination he was taken to the statement of Ms C, a sister in the paediatric intensive care unit. She set out in her statement of December 2024 the care which MG requires. I summarise that below:a. Mechanical ventilation by a tube.b. Chest physiotherapy twice a day, to keep his chest clear. (In a later statement, dated 31 January 2025, the physiotherapist said that MG was receiving physiotherapy once a day, although the frequency varied according to clinical need).c. Endotracheal suction to clear secretions – this, it was subsequently clarified, was performed every 4 hours by a nurse to remove secretions from MG’s lungs, but suction of his mouth and nose was performed by his parents.d. Mouth care, eye care and nappy changes.e. Physiotherapy and movement to avoid sores.f. Monitoring of the EVD.[34]Dr B confirmed this. He repeated that by long exposure he and the family had become normalised to it and he related that the parents had taken on a lot of these tasks.[35]Professor Playfor, the expert instructed by the parents, was (as might be expected) more detached than Dr A and Dr B. I will summarise his evidence largely using words from his report:a. MG has permanently lost the ability to breathe because of the destruction of vital parts of his brain which control his breathing following his stroke.b. MG does not have any cognitive awareness of the world around him, and on the balance of probability, does not experience pleasure or pain. In oral evidence Professor Playfor was less concerned than Dr A about the possibility that MG might feel pain at a primal level.c. There is no prospect of MG regaining cognitive awareness of the world around him or the ability to experience pleasure or pain.[36]I shall repeat here what I consider the substantial conclusion of his report 5.7 I have assessed the benefits and burdens associated with ongoing mechanical ventilatory support. I do not believe there are any benefits associated with ongoing life. Sadly, MG’s brain injury is so severe that he gains no apparent enjoyment from any aspect of ongoing life. Because of the severity of MG’s brain injury, there appear to [be] minimal burdens associated with his underlying illness or associated with the treatment he receives. In the future, if ventilatory support is continued, MG will undoubtedly eventually develop burdens associated with his underlying illness. These are primarily due to his relative immobility and lack of spontaneous breathing and include, likely episodes of pneumonia and worsening respiratory failure, bone disease due to osteopaenia (secondary to lack of load-bearing and associated with pathological fractures and the development of renal stones) and scoliosis with associated cardio-respiratory impairment. 5.8 If mechanical ventilatory support were to be continued, MG’s prognosis is difficult to predict: As a result of his neurological injury alone, and the complications that will inevitably develop due to his relative immobility and lack of spontaneous breathing (as described above), MG would suffer an early death but could survive for a period of several years. However, MG’s clinical status is more complex given the background of partly treated leukaemia and the presence of an external ventricular drain that has been in-situ for 9 months. Given the risk of leukaemia relapse and the risk of EVD infection, it is my opinion that MG could survive for a period from several months up to a few years if mechanical ventilatory support were to be continued.[37]He tells me in his report that if mechanical ventilation were to be withdrawn MG would not breathe and that he would die within the hour.[38]He tells me in his report that it is his opinion that ongoing mechanical ventilation is not in MG’s best interest and that palliative extubation should be undertaken.[39]I also record that Professor Playfor like Dr A and Dr B was keen to tell me that the clinical situation of MG meets the criteria laid down by the Royal College of Paediatrics and Child Health as to where treatment limitation can be considered because it is no longer in the child’s best interests for it to continue.

The disputed facts

[40]Given the way in which the case has advanced there is little dispute of fact.[41]There are three areas which I should cover:a. I prefer the doctors’ evidence to the parents’ that MG has no consciousness. I find that the parents are interpreting movements as responses when they are not, they are just movements. I do not like the term but I cannot argue with a description of MG being in a persistent vegetive state, as Mr Mant says. On the balance of probabilities I reject the view that MG has primal pain and can experience primal pleasure. I do not consider that even Dr A puts his fear that there might be such experiences as high as the balance of probabilities.b. I accept the very firm evidence of all three doctors that there will be no meaningful recovery of MG. I record that Dr A and Dr B were both asked to consider the uncertainty of medical prediction and both did and were confident even in the light of that consideration that given the damage to his brain, in particular the brainstem that there could be no recovery.c. It will come as a surprise to no one that I am not prepared to make a finding that there will be a miracle. It is the essence of a miracle that it is outside the laws of nature and I am not going to make a decision predicated on something occurring which is beyond the laws of nature. I acknowledge that there is a gap between a miracle occurring and something unexpected occurring. So far as is critical to the decision I am making is concerned, this possibility is subsumed by my finding at (b) above, but in respect to the argument skilfully advanced to me by Mr Mylonas I will deal with the three ‘miracles’ or unexpected events that he says have already occurred: i. MG has not succumbed to leukaemia already, as the doctors had expected. I had no oncological expert evidence on this point but the likely explanation, I am told, is that it is extremely rare for a young child to have had their treatment interrupted as MG’s was, so the likely recurrence and timing of the recurrence of leukaemia was not something of which the hospital has experience. MG’s stroke though unusual is nowhere near as rare and so the prognosis arising from his neurological condition is reliable. ii. MG, I was told for the parents, had defied all expectation in relation to deterioration and has got better. The apparent improvement I find is no more than stabilisation. The avoidance of deterioration through infections is a consequence of the very high level of care which the collaboration of the hospital and the parents have been able to provide for MG. iii. The EVD has not become blocked, or become infected. This is agreed to be remarkable and it is again a testament to MG’s care. Taken together and put to the doctors these points did not cause them to change their views as to the outcome for MG and I accept their collective evidence.

The Arguments

[42]There are two options for me:(i) I grant the declaration; treatment does not continue; MG will die;(ii) I deny the declaration; the current care continues; and according to the medical evidence MG dies, albeit he is likely to be alive for substantially longer.[43]The parents want the latter, in essence, because they hold out hope either for a miracle or that the medical evidence is wrong, and that MG will recover. Through the skill of Mr Mylonas they put their case by an argument on the balancing exercise. It is therefore not enough for me to say I reject their case that there will be a miracle, and that I accept the three doctors’ evidence (one of whom is their own expert) that MG will not recover and will die at most within a few years. I must turn to the balancing exercise and consider each of the factors.[44]I remind myself of the five stage process. My decision must be what is in MG’s best interest; his welfare is my primary consideration; I must assume his point of view; there is a strong presumption in favour of the course which prolongs life, but that presumption is rebuttable; and I must conduct a balancing exercise in which all the relevant factors are weighed.[45]This is necessarily a fact specific exercise.[46]The potential benefits to MG of the treatment continuing which I should consider are:a. He is kept alive for longer. I note that there is a strong presumption in favour of preserving life but that like any presumption this presumption can be rebutted. Here, I am told by Mr Mant, that it is rebutted. Being alive, but with no ability to engage with anybody, no conscious sensations, and facing the inevitability of death with no improvement is, I am told, no life worth living. The only answer that Mr Mylonas can give to that is keeping MG living keeps alive the possibility that the medical evidence is wrong, or that there will be a miracle. I cannot accept that argument: I have said I will not take a course relying on a miracle; and I have three experts all in unequivocal agreement that MG will not recover and will die, and I have accepted their evidence. The presumption is therefore rebutted.b. He continues to be the object of the love of his family. If he were conscious it would be a great thing for him to receive the love of this family. Sadly he is not, and it can be said given he lacks consciousness there is no real benefit to him of this love. Nonetheless looked at from the position of MG, rather than narrowly considering his lack of consciousness, I do think this love should carry weight.[47]The potential burdens to MG that are advanced on me are:a. The treatment that he has to receive is intrusive. I have detailed above the treatment. This point is resisted by Mr Mylonas on the basis that it cannot be a burden for MG if, as I have found, he is not conscious. In that regard he is supported by Professor Playfor who agreed with him, and his reasoning, in his oral evidence as well as his written evidence. Mr Mant disagrees on the basis that the physical intrusion constitutes a burden simply because it is happening, whether or not MG is aware of it. He must be right – at least to a degree. MG has to breathe by a tube – albeit one pushing in air at low pressure. He has to feed by a tube pushed down his nose into his stomach. He has secretions sucked out of his lungs. He has a ‘port’ to enable blood tests to be taken. I agree that on my findings these do not cause MG pain but they are nonetheless burdens. I agree they will carry less weight than they otherwise would because they cause no pain. Mr Mylonas took time in closing to show me that in some other cases there are heavier burdens placed on patients. The Guardian makes a similar point in her report. I can see that Mr Mylonas is right. That can only take me to the conclusion that these burdens are less heavy than those that other people have endured. Nonetheless they are burdens for this boy that I must weigh in his balance. I find that they are significant.b. Further, Mr Osborne points out to me, with acuity, that there is a reference by Professor Playfor in the passage already quoted by me above (paragraph 5.7 of his report) to burdens that are to come as MG deteriorates over time. Professor Playfor said (and I repeat it): In the future, if ventilatory support is continued, MG will undoubtedly eventually develop burdens associated with his underlying illness. These are primarily due to his relative immobility and lack of spontaneous breathing and include, likely episodes of pneumonia and worsening respiratory failure, bone disease due to osteopaenia (secondary to lack of load-bearing and associated with pathological fractures and the development of renal stones) and scoliosis with associated cardio-respiratory impairment. This burden of future harm is a burden that I must also weigh into the balance. It is clear to me that burden is likely to be significantly greater than the current burden as MG’s health deteriorates before death. I consider that this will weigh heavily in the balance.c. It is urged on me by Mr Mant that being kept alive with no potential to engage with others is a burden on MG. I understand that it is immensely sad for his parents and the Trust to witness MG unconscious and immobile. It does not stop there; it is immensely sad for me looking at the case through the perspective of MG. Even though it is a burden that he himself cannot perceive, I find that being kept alive with no potential to engage with others is a burden, but I have already accepted force in the same point as discharging the presumption in favour of life, and I ask myself whether to count it again risks double counting. I remind myself that the balance metaphor is just that, a metaphor. Worrying about the same factor pushing up one arm of the balance and down the opposite one is to take the metaphor too far. I must hold this point in mind.d. It is urged on me by Mr Mant and Mr Osborne that being kept in a Paediatric Intensive Care Unit is a burden. I am reminded not only of alarms and bustle and beeps, but of deaths occurring in the ward. Mr Mylonas, on the other hand, reminds me of the steps taken by the parents to make this bed a piece of the parents’ home. There is force in what both say. This is a burden but it is not dreadful to be in such a ward.[48]How do I balance these benefits and burdens? I consider that it is appropriate before I make this decision to remind myself that the medical evidence is clear that MG is going to die without regaining consciousness. That is the context that I need to look at the balance. Physical harm, and indeed pain, would not turn the scale if there was a strong hope held out for recovery. Here there is no hope. I must weigh the benefits and burdens in that context.[49]I remind myself of what the Guardian said in her report (paragraph 33):
“It is with great regret that having carefully considered MG’s unique health needs and individual circumstances that I have concluded that it is not in his best interest to receive further life sustaining intervention. He has received the very best of care for over 10 months, but neither acute medical care, his parents loving presence, faith, nor time has enabled him to recover from the catastrophic brain injury caused by his stroke. Furthermore, the medical evidence establishes that the damage to the vital parts of his brain which he requires to benefit from life, is incapable of repair. Intensive care can keep MG alive, and it has enabled him to receive the love, care and attention of his family and his sisters [to] spend time with him over a prolonged period. However, he is an individual child, a patient in his own right and a view as to what is in his best interest must be considered separate to what those who love him may wish.”
[50]I note further that the Guardian has formed her view from a social work perspective rather than a medical one and has factored in the weight to be attached to MG’s family’s Muslim faith and culture and his relationship with his family in coming to her conclusion as to his best interests.[51]Looking at the balance, holding all these points in mind, my conclusion is that it is in MG’s best interests that the treatment should not continue. I agree that the treatment is futile. I agree that it is lawful for it to be withdrawn. I will make the declarations sought.[52]I know that this conclusion will cause heartbreak for ZG and KG. I cannot here say anything which will take away from their pain. Nonetheless, I do say that their love for MG, their dignity throughout the time of his treatment and, throughout the court process are profoundly impressive.[53]At the conclusion of the hearing I had a discussion with counsel about the arrangements for handing down of this judgment in perfected form, and consequential matters, which will include a palliative care plan. I am confident in assuming that I need say no more here other than I assume that a co-operative approach will be taken and should there be an issue my clerk should be contacted. Mr Justice Trowell 24 April 2025