Background to the case
Daniel Taylor of Coram Chambers, with Aswini Weereratne KC and instructed by GN Law, acted for the third respondent in this serious medical treatment trial in the High Court before Justice McKendrick.
The High Court was asked to decide whether continued clinically assisted nutrition and hydration (CANH) should be provided to FHR, a 28-year-old man.
FHR suffered a severe hypoxic brain injury in January 2020 and has lacked capacity since that time. He remained in a prolonged disorder of consciousness for over six years, with significant physical disabilities and complex medical needs.
The court heard evidence from medical professionals, experts, and FHR’s family. There were differing views on whether FHR was in a persistent vegetative state or a minimally conscious state.
Justice McKendrick made clear that the label was not decisive. The main question was whether FHR could recover a quality of life that he would personally value.
The best-interests assessment
The judge applied the Mental Capacity Act 2005. The law requires a holistic approach, taking account of FHR’s wishes and values, welfare, dignity, and the burdens and benefits of treatment. The court also considered the prognosis and the views of those concerned with FHR’s welfare.
Key findings of the judgment
Justice McKendrick decided that continued CANH was not in FHR’s best interests. The treatment was found to be futile. It only maintained an existence marked by distress, very limited consciousness, and a lack of meaningful comfort or pleasure. There was little hope of improvement. The court therefore authorised a transition to palliative care.
The judgment set out that CANH is a form of medical treatment. Its withdrawal must be guided by the same best-interests principles as other treatments. The strong presumption in favour of preserving life is not absolute. Family members’ views are relevant but do not determine the outcome.
The judgment also dealt with the role of diagnostic labels in trials concerning prolonged disorders of consciousness and deals in detail with the competing evidence given by the clinicians in the case in respect of the utility and relevance of different tests to measure a protected party’s consciousness, such as CRS-R, WHIMS and SMART assessments.
Implications for the court of protection and practice
This decision provides further guidance on best-interests assessments for those lacking capacity. It clarifies the role of diagnostic labels in trials concerning prolonged disorders of consciousness, confirms the legal status of CANH, and reaffirms the proper weight to be given to family views.
Read the full judgment below
