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The Court of Protection has refused an application by an NHS trust seeking permission to withdraw clinically assisted nutrition and hydration (CANH) from a patient in a prolonged disorder of consciousness, reaffirming the strong legal presumption in favour of preserving life and the importance of a patient’s wishes, values and beliefs when assessing best interests.
The decision provides important guidance for healthcare providers and families involved in serious medical treatment cases where a patient lacks capacity.
Background to the Case
The patient, a 60-year-old man, was admitted to hospital in October 2024 after suffering a bleed to the brain. By January 2025, he had been transferred to a rehabilitation ward. He was able to breathe independently but received all nutrition and medication via a gastrostomy tube.
Clinical assessments indicated that he was in a vegetative state. The NHS trust responsible for his care applied to the Court of Protection for authorisation to withdraw CANH, arguing that continuing treatment was no longer in his best interests. The application was opposed by his two partners.
Medical Evidence
The consultant responsible for the man’s care gave evidence that:
- he was unlikely to make any meaningful neurological recovery;
- he would remain permanently disabled with significant lifelong care needs; and
- his future experiences were likely to be negative, including pain and recurrent infections.
In the consultant’s view, withdrawing CANH and providing palliative care would be the most compassionate course.
Family’s Position and the Patient’s Beliefs
The man’s partners both stated that they believed his condition was improving and that he was capable of limited communication. They gave evidence that he would wish to continue living and would take any chance of recovery, however small.
They also highlighted his long-standing spiritual beliefs, including an interest in the healing power of the mind, spirit and soul. Both partners visited him daily and described the importance he placed on relationships and emotional connection.
The Court’s Decision on Best Interests
Under Section 1(5) of the Mental Capacity Act 2005, where a person lacks capacity, any decision made on their behalf must be in their best interests.
The Court emphasised that determining best interests is not limited to medical prognosis alone. It must also include consideration of:
- the patient’s wishes and feelings;
- their beliefs and values; and
- how they would have approached the decision if they had capacity.
The Court concluded that the man’s spiritual beliefs and the devotion shown by his partners were likely to have been highly significant to him. From the evidence available, he would have approached the decision very differently from the medical professionals.
Presumption in Favour of Life
The Court found that continuing CANH was in the patient’s best interests. While his awareness was extremely limited and further improvement uncertain, it was not clear that he would regard his continued existence as a burden.
The Court held that the burdens of CANH did not outweigh the benefits and that the NHS trust had failed to displace the strong presumption in favour of preserving life.
The application was therefore refused.
Q&A: Withdrawal of Life-Sustaining Treatment
What is the Court of Protection?
The Court of Protection makes decisions about the welfare, property and finances of people who lack mental capacity.
What is CANH?
Clinically assisted nutrition and hydration refers to the provision of food and fluids through medical means, such as a feeding tube.
How does the Court decide what is in a patient’s best interests?
The Court considers medical evidence alongside the patient’s wishes, feelings, beliefs and values, and the views of those close to them.
Is there a presumption in favour of preserving life?
Yes. There is a strong presumption in favour of life, which can only be overridden where it is clearly not in the patient’s best interests.
Does a poor prognosis automatically justify withdrawal of treatment?
No. A poor prognosis alone is not determinative. The wider context of the patient’s values and perspective is crucial.