Requests from paediatric and neonatal intensive care units in England and Northern Ireland for judicial decisions on withholding or withdrawing life-sustaining care: a 20-year retrospective review
Afreen Banu, Christine Pierce, Andy PetrosObjectives
To determine the frequency and temporal trends of applications by National Health Service (NHS) hospital trusts to the High Court for judicial review in cases of disagreement with families regarding the withholding or withdrawal of life-sustaining treatment in paediatric and neonatal intensive care and to examine the outcomes of these applications.
Setting
Retrospective study using publicly available legal records across England and Northern Ireland, reflecting cases arising from tertiary (level 3) paediatric and neonatal intensive care settings across multiple NHS trusts.
Participants
All identified legal cases involving children aged 0–17 years, admitted to paediatric and neonatal intensive care unit who were referred to the High Court for a decision on the withholding or withdrawal of life-sustaining support in the last 20 years. A total of 50 cases were included. Cases were identified through systematic search of the British and Irish Legal Information Institute (BAILII) database. Exclusion criteria included adult cases and those not involving disputes over life-sustaining therapies.
Main outcome measures
The primary outcome was assessing trends in frequency of judicial review applications. Secondary outcomes included to study the outcomes of those applications.
Results
Fifty eligible cases were identified. The frequency of applications increased over the study period. In 96% of cases, the court ruled in favour of the applicant NHS trust, determining that limitation or withdrawal of treatment was in the child’s best interests.
Conclusions
Applications to the High Court in cases of disagreement over life-sustaining treatment in paediatric intensive care are increasing in England and Northern Ireland. Judicial decisions consistently support clinicians, aligning with the child’s best interests following detailed legal scrutiny.