FD25P00518 - [2025] EWHC 2247 (Fam)

On 9 August 2025 Baby J’s mother suffered a cardiac arrest after a choking incident and cocaine use. She suffered hypoxic brain damage. She spent forty minutes without a heartbeat. Baby J was born at 8.46 am on 9 August 2025 by emergency C section at hospital at 32 weeks and 5 days of gestational age. His birth weight was 2.150 kg which is on the 75th centile. Baby J’s cord blood gases show severe acidosis, indicating that the oxygen supply to him via the placenta has been significantly diminished for a period of time, and as a result he has severe Hypoxic-Ischaemic Encephalopathy (HIE grade 3). The clinical position is that it would be unethical, being futile and contrary to his best interests, to continue intensive care and ventilatory support. With extubation it is very likely that he will not be able to breath independently (with or without non-invasive ventilatory support), and that he would require palliative care. In the unlikely event that he was able to breathe without invasive ventilatory support, and stabilised, he would be provided with non-invasive ventilatory support, and all other support to stabilise, and ceilings of care would not be imposed without further consideration or order.

A factor in this case is that as a result of hypoxic brain damage sustained during the cardiac arrest, the mother has had reduced awareness with little meaningful interaction and does not currently have capacity for any kind of medical decision-making or ability to partake in court proceedings.

At the first hearing of this matter before me on 22 August 2025 the parties initially agreed the matter should be adjourned to a final hearing on or around 8 September 2025. This was to permit the Guardian time to consider the proceedings and to obtain Baby J’s records. More importantly, the parties considered two weeks or so were required to permit the mother’s presentation to improve to permit her to meaningfully engage in the proceedings. Notwithstanding the agreed position of the parties at the outset, the clinical evidence was clear (to which I will return below) that mechanical ventilation was not in Baby J’s best interest on 22 August 2025. Furthermore the evidence stated that it was inappropriate to await improvements in the mother’s functioning. It was noted that Baby J had recently been prescribed morphine for pain relief. I refused to adjourn the case for fourteen days, as I considered there was no certainty about the mother’s condition improving sufficiently and more fundamentally I did not consider it appropriate to subject Baby J to a further two weeks of treatment his treating clinicians had already concluded was no longer in his best interests. I gave an ex tempore ruling explaining my case management decision.

Further directions were made to the final hearing, principally:

Happily, these directions have been complied with.