![FD24P00611 - [2025] EWHC 1042 (Fam)](https://backend.juristeca.com/files/emisores/logo_0FrGysm.png){kind=logo}
The Evidence
The Evidence
I will here first describe the parents’ evidence even though Dr A and Dr B gave their evidence ahead of them.
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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:
Mechanical ventilation by a tube.
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).
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.
Mouth care, eye care and nappy changes.
Physiotherapy and movement to avoid sores.
Monitoring of the EVD.
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.
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:
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.
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.
There is no prospect of MG regaining cognitive awareness of the world around him or the ability to experience pleasure or pain.
I shall repeat here what I consider the substantial conclusion of his report
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.
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.
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.
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.
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.