Recent case update: High Court ruling on the withdrawal of life-sustaining treatment – A Hospital Trust v MB & Ors [2026] EWCOP 32 (T3)

The judgment considers the complexities of determining serious medical treatment decisions when an individual lacks the capacity to make the decision themselves, the family does not agree with the clinical view, and the decision is to end life-sustaining treatment.

Background

The extremely unfortunate circumstances of this case are such that MB suffered a cardiac arrest on 17 June 2026 while commemorating the 20 year anniversary of his father’s death. Following his admission to hospital, MB was placed on mechanical ventilation. A series of tests were undertaken by the medical staff and it was concluded that MB’s neurological status would not improve with continued ventilation, rather it was an almost certain guarantee he would develop a new complication and that this would lead to an uncontrolled death from a ventilatory-induced illness. The Court of Protection was therefore faced with the incredibly difficult decision of lawfully authorising the removal of mechanical ventilation or continuing MB’s treatment with no real prospect of a preferential outcome.

The Court of Protection’s role

The Court of Protection‘s role is to make decisions in the best interest of P (the person at the centre of the legal proceedings who lacks the capacity to make a specific decision for themselves), where the interested persons involved in P’s care cannot agree on a particular action. Any decisions in respect of serious medical treatment are incredibly sensitive. They require careful consideration of the individual’s wishes and feelings, the views of P’s family and those involved in his care, the concept of dignity and the sanctity of life.

Conflicting views

It is important to note in this case that MB’s family did not consider themselves able to make the decision to withdraw mechanical ventilation. While the family members respected the views of all the medical practitioners involved in MB’s care and treatment, who advised that the removal would be in MB’s best interests, their religious views focused on the importance of the sanctity of life. They felt that they could therefore not agree to withdraw something that was upholding life.

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Take Me There

Legal framework

The Judge considered the following factors in making his decision:

1. Mental capacity: Did MB have the mental capacity as defined by s1(2), s3(1) and s2(4) Mental Capacity Act 2005 (“MCA”) to make this particular decision himself?
2. Best interests: Was this decision in the best interests of MB? The case of Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67 established that you must consider if it is in P’s best interests to give the treatment, rather than whether it is in his best interests to withhold or withdraw it. Section 4 MCA 2005 sets out all the factors to be taken into account when determining best interests. While not an exhaustive list, some of the main factors specific to this case are as follows:

(5) When considering if the decision is in P’s best interests, and it relates to life-sustaining treatment, the decision maker must not be motivated by a desire to bring about P’s death.

(6) P’s past and present wishes must be taken into account.

(7) As much as is practical and appropriate, the views of any interested person or care staff must be taken into account.

3. Presumption in favour of life-sustaining treatment: The starting point is that it is in P’s best interests to stay alive as established by Article 2 (the right to life), Article 3 (protection from inhuman or degrading treatment) and Articles 8 (right to respect for private and family life) of the European Convention on Human Rights. However, if it would be contrary to P’s best interests to continue life-sustaining treatment, the presumption may be rebutted. This was reiterated by Lady Hale in Aintree v James [2013] UKSC 6.

Decision held

Mr Justice Cusworth held that it was in MB’s best interests to withdraw mechanical ventilation. The medical evidence was such that MB’s dignity and sanctity of life would be upheld by a dignified and controlled death, rather than a sudden death that was almost certain would prevail in the coming weeks, of pneumonia and septic shock. He held that, while this decision was not motivated by a desire to bring about death, unfortunately death was a likely consequence.

While the family were of the religious belief that it is not for us but for God to decide when life ends, Mr Justice Cusworth agreed with the priest who spoke to the family stating that a miracle was just as likely to occur after MB’s ventilation came to an end, as it was while ventilation was in place. He said: ‘Man’s hand is withdrawn, and MB is then in the hands of God alone‘ [37].

Legal implications

This Judgment emphasises the moral, religious and ethical complexities concerned when providing life-sustaining treatment, along with all of the relevant circumstances to take into account when deciding best interest decisions. Despite the fact that all decisions must be made in P’s best interests, where continuing life-sustaining treatment is futile with no real prospect of recovery it may be in P’s best interests to withdraw that treatment. While the views of family members are important, as they are usually the people closest to P and can advocate for P’s wishes and feelings, their views are not determinative. In this case, there was no evidence to suggest what MB would have wanted in these particular circumstances.

If you would like to read about this case in more detail, you can access the published Judgment here. If you have any questions, please get in touch with our healthcare lawyers.

Co-written by Victoria Parker and May Turner.