In cases of serious injury or disability, judges may be called upon to make difficult decisions about whether it is in the patient's best interests to continue life-sustaining treatment. A tragic High Court case concerning a severely disabled four-year-old boy illustrated the factors they have to take into account.

The boy was born with significant brain malformation and life-limiting health conditions, resulting in many medical complications. He was unable to walk or talk. For a time, with considerable support, he had been able to live at home with his parents. He derived pleasure from activities and from contact with his parents, had been taken to the park in a pushchair and had been able to attend a special-needs nursery.

However, he had spent the last year in hospital and his condition continued to deteriorate: he had had episodes of sepsis, suffered two cardiac arrests and sustained multiple organ damage. He had required invasive ventilation for the last six months. The NHS trust responsible for the hospital where he was being treated sought a declaration that it would be lawful to withdraw his invasive ventilation and discontinue life-sustaining treatment. His parents opposed the application.

The Court noted that, although parental wishes are relevant in such cases, the child's best interests are the paramount consideration. If life-sustaining treatment were withdrawn, the boy was expected to live for a few hours, or at most a few days. However, his condition was likely to deteriorate further, with no prospect of an improvement, and he was expected to live at most another six months even if treatment were continued. His awareness was extremely limited but he nevertheless suffered significant pain, discomfort and distress. The medical professionals involved were unanimous in their view that the burdens of his condition and treatments outweighed the benefits of continuing treatment.

With great sadness, the Court concluded that the trust's application should be granted and declared that it would be lawful and in the boy's best interests for life-sustaining treatment to be discontinued. His parents had expressed the wish that he should return home if treatment were withdrawn: noting that the opportunity for that to happen could be lost at any time, the Court considered that it would be appropriate for urgent arrangements to be made to transfer him home, if his parents still wished.