The Court of Protection refused an application by a North-West London hospital trust to withdraw life-sustaining treatment from a 60-year-old man said to be in a permanent vegetative state. The decision followed powerful evidence from his two partners about his deeply held belief in spiritual healing and his commitment to preserving life.
Background of the Case
YD suffered a catastrophic brain haemorrhage in October 2024, leaving him with what is now described as a prolonged disorder of consciousness. His treating clinicians consider him to be in a permanent vegetative state. He has since been cared for at a specialist neuro-rehabilitation unit, where he receives clinically assisted nutrition and hydration (CANH).
The Hillingdon Hospitals NHS Foundation Trust, responsible for his treatment, applied to the Court of Protection for permission to withdraw CANH. If granted, this would inevitably have led to the termination of his life. The Trust argued that continuing treatment was not in YD’s best interests, given the medical prognosis and the burdens associated with ongoing care.
Opposition to the Application
The application was opposed by YD’s two partners, JG and MB, both of whom are closely involved in his daily care, as well as by the Official Solicitor acting on YD’s behalf. His partners described him as someone with a profound belief in spiritual healing, a deep respect for life, and a determination to endure hardship.
The Legal Framework: Best Interests
In Hillingdon Hospitals NHS Foundation Trust vs YD and others. the court’s task was to determine YD’s best interests under the Mental Capacity Act 2005. This involves weighing medical evidence alongside the patient’s own beliefs and values (so far as they can be ascertained), the views of those close to him, and the overall balance of benefit and burden in continuing treatment.
There remains a strong legal presumption in favour of preserving life. That presumption can only be displaced where the evidence demonstrates that ongoing treatment would not be in the patient’s best interests, for example, where there is profound brain damage, no awareness, and no prospect of recovery.
Advance Decisions and the Weight of Family Evidence
The court considered whether YD had made a valid advance decision refusing life-sustaining treatment under sections 24-26 of the Mental Capacity Act 2005, in which he had not.
In the absence of such a directive, the court gave considerable weight to the evidence of his partners. They spoke of his strong spiritual convictions, his optimism about recovery, and his likely wish to persevere even in severe circumstances.
Medical Evidence
Both the treating clinicians and an independent expert agreed that YD’s prognosis was extremely poor. There was no realistic prospect of meaningful recovery or regained awareness. In medical terms, continuing CANH would merely prolong biological life without any improvement in consciousness or quality of life.
The Official Solicitor’s Position
The Official Solicitor submitted that YD’s dignity and the meaning of his life were reflected by his partners. It was argued that YD would wish to continue living in this way until death occurred naturally from another medical cause.
The Decision
In a detailed judgment delivered on 12 August 2025, Mrs Justice Theis, Vice-President of the Court of Protection, refused the Trust’s application.
The court emphasised:
- The presumption in favour of life had not been displaced. Despite the bleak medical evidence, the testimony regarding YD’s beliefs and values was compelling.
- Best interests had not been shown to require withdrawal. The court was persuaded that YD’s dignity and sense of meaning could not simply be assumed to be absent.
- No binding advance decision existed. In its absence, continuation of life-sustaining treatment was favoured.
Accordingly, CANH will continue.
Significance and Context
This case reaffirms the centrality of the best interests test and the strength of the presumption in favour of life, even in cases involving a permanent vegetative state. It also demonstrates the considerable weight the court may attach to the sincerely expressed beliefs of those closest to the patient.
Unless a court is satisfied on all the evidence that continued treatment is not in the patient’s best interests, life-sustaining care will remain in place.
This is, in many respects, a striking decision.
Since Airedale NHS Trust v Bland, where the House of Lords confirmed that life-sustaining treatment may lawfully be withdrawn when it confers no therapeutic benefit, the general direction of travel has been towards accepting medical evidence that life without consciousness offers no benefit to the patient.
Here, however, the Court of Protection upheld continued artificial nutrition and hydration largely based on the patient’s spiritual outlook and the belief that he would have wished to continue treatment to ‘heal himself’. The evidence included assertions of spiritual communication, and the court concluded that withdrawal would not reflect his perceived wishes or beliefs.
Ultimately, this decision by the Court of Protection powerfully reaffirms the strength of the presumption in favour of life under the Mental Capacity Act 2005, demonstrating that even in cases of permanent vegetative state and unanimous medical evidence of no prospect of recovery, the patient’s own beliefs, values and perceived wishes can be decisive and that life sustaining treatment will continue unless the court is firmly satisfied that withdrawal truly accords with the patient’s best interests.
Contact a Specialist Court of Protection Solicitor
If you need any expert advice on any Court of Protection matters like deputyship applications or best‑interests proceedings, please contact one of our specialist Court of Protection Solicitors or call us on 020 8492 2290.
