The mother of a 2-year old child who suffered grave injuries in a road traffic accident appealed against the court order obtained by the grandmother to withdraw all respiration and to treat the child only with pain relief, sedation and nursing as appropriate.

The evidence was that the child could not feel anything below his neck, had lost his sight and hearing and was minimally conscious showing no awareness of his surroundings, with uncertain but limited life expectancy.

The court said that whilst the application of this law requires sensitivity and care of the highest order, the UK law regarding applications to withdraw life-sustaining treatment is now clear and well-established: Is it in the patient’s best interests to give or withdraw the treatment?

The decision-makers must look at the welfare of the patient in the widest sense, not just the medical but also the social and psychological welfare and the prospects of successful treatment. The appeal court found that there was no misdirection by the lower court in ordering withdrawal of the respiration and confirmed the order.

A South African court is likely to have reached the same decision. The law governing minors and consent to medical treatment is contained in various legislation including the Children’s Act 2005, the National Health Act 2003 and the Constitution. The child’s best interests always come first.

A South African court is likely to have reached the same decision.

Consent of the parent or legal guardian is required for medical intervention if a child is under the age of 12 years. If there is a reason to believe that a parent or guardian’s refusal to consent to a child’s medical intervention, including a withdrawal of life support in appropriate circumstances, is placing the child at risk or is not in the child’s best interests, the court as legal guardian of all minor children can be asked for an order to withdraw life support or an application made to the Minister of Health for consent.

The position is the same for unresponsive adults requiring withdrawal of life support. A court order will be required.

(A (A Child) [2016] EWCA Civ 759)