Article by Khadim Al’Hassan – “Life, Dignity and Belief: Court Refuses to Authorise Withdrawal of Feeding in UCLH NHS Trust v AB [2025] EWCOP 16”

Read the full judgment here: [2025] EWCOP 17 (T3) 

This judgment serves as a sobering reminder that decisions about life and death are not purely medical. They are, at their core, human judgments—rooted in respect for the individual’s voice, their beliefs, and their dignity as they define it.

In a deeply sensitive and ethically complex judgment, the Court of Protection in UCLH NHS Trust v AB [2025] EWCOP 16 declined an application by an NHS Trust to permit the withdrawal of clinically assisted nutrition and hydration (CANH) from a 73-year-old man, PK, who had suffered a serious stroke. The Trust argued it was no longer in PK’s best interests to continue life-sustaining treatment due to his minimal consciousness and multiple health complications. However, Mr Justice McKendrick ruled that continuing CANH was indeed in PK’s best interests, having carefully weighed medical evidence, the views of his family, and above all, PK’s own values and religious beliefs.

Factual Background:

PK was a 73-year-old man of devout Islamic faith. He suffered a severe stroke in 2020, leaving him with profound physical disabilities, limited speech, and dependent on a feeding tube. He was later diagnosed with vascular dementia, further affecting his mental capacity.

The NHS Trust sought court permission to withdraw feeding, arguing that PK lacked capacity and that his quality of life had become so diminished that continued treatment served no beneficial purpose. The Trust pointed to medical evidence suggesting that PK was largely unresponsive, doubly incontinent, immobile, and at times distressed. They contended that to continue life in such a condition amounted to a denial of dignity.

AB, PK’s daughter and litigation friend, opposed the application. She stated that PK, a devout practising Muslim, believed strongly in the sanctity of life. She referred to his expressed views in earlier years, including during his time caring for his ill wife, when he had opposed euthanasia and expressed that life should be preserved until its natural end. PK’s family, including his sons, also supported the continuation of feeding.

Legal Framework:

The application fell under the Court of Protection’s jurisdiction to make decisions under the Mental Capacity Act 2005, particularly section 4, which requires the court to determine what is in the person’s “best interests”.

Key factors include:

• The person’s past and present wishes and feelings
• The beliefs and values that would likely influence their decision
• The views of those close to the person
• Medical evidence concerning prognosis, pain, and quality of life

Key Submissions and Arguments:

1. The Trust’s Position:

Continued treatment prolonged suffering without any realistic hope of recovery.

PK was largely unaware of his surroundings.

Maintaining life artificially was burdensome and no longer aligned with dignity or humane treatment.

Medical professionals believed that PK would not wish to continue in such a condition, despite not knowing him personally.

1. AB and Family’s Position:

PK had consistently expressed strong religious beliefs affirming the sanctity of life.

He had never supported any form of assisted dying or intervention to shorten life.

There was still some evidence of awareness and connection—PK reacted to voices and smiled at family members.

Withdrawing feeding would actively shorten his life, contrary to his values and those of his family.

Court’s Reasoning and Judgment:

Mr Justice McKendrick undertook a meticulous analysis of both the medical and personal evidence. His key findings included:

• PK Lacked Capacity: The judge accepted that PK did not have the mental capacity to decide on treatment due to his dementia and cognitive impairment.
• Evidence of Consciousness and Response: Despite his impairments, PK showed some signs of awareness, such as reacting to his name, smiling at familiar voices, and responding during religious recitations.
• Weight to Past Beliefs: The court gave significant weight to PK’s known religious convictions. Justice McKendrick quoted from PK’s daughter, who said, “My father believes only God can decide when life should end.” This religious belief, deeply held and clearly expressed during his life, was seen as central to understanding what PK would have wanted.
• Quality vs. Sanctity of Life: The judge acknowledged the medical view that PK’s quality of life was “very poor”. However, he reiterated the legal principle that poor quality of life does not automatically mean life is no longer worth living. He said:

“The best interests test is not a test of what the court thinks is in the person’s clinical interests, but a holistic appraisal of the person’s welfare in the widest sense, including emotional and spiritual welfare.”

• Presumption in Favour of Life: The court reaffirmed that there remains a strong presumption in favour of preserving life, especially where there is no clear evidence the person would have refused such treatment.

The application was dismissed. The court found that continuing CANH was in PK’s best interests, based not only on his awareness but more importantly on his known values and religious beliefs. In doing so, Mr Justice McKendrick stressed that individual dignity is not always defined by independence or physical capability but often by the person’s own sense of meaning, purpose, and belief.

Why This Case Matters:

This case is significant for its reaffirmation of two core principles:

1. Respect for Autonomy through Values: Even when a person loses capacity, their deeply held values, especially religious and cultural, must guide decision-making.
2. Sanctity of Life vs. Medical Futility: The judgment reiterates that life should not be ended based solely on medical prognosis when personal beliefs point to continued treatment, however minimal the benefits.