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Factual Background:

This case relates to a child, NR, who was born in March 2020 with severe disabilities and life-limiting health conditions including a significant brain malformation. From September 2020 to March 2023, NR was cared for at home with additional professional nursing care and many hospital visits and admissions. On 18 March 2023 NR was admitted to King’s College Hospital (KCH) requiring intubation and ventilation for respiratory symptoms. NR suffered two cardiac arrests on 13 October 2023 and has since remained intubated and on artificial ventilation.

The Applicant Trust, responsible for KCH, applied to the court that it would be lawful to withhold certain medical treatment from NR in certain circumstances. Namely whether, in the event of a cardiac arrest, CPR should be administered. This was supported by the Trust’s clinicians, by clinicians from other NHS Trusts, by an independent expert paediatric intensivist and by the Guardian.

The parents opposed this application.

The background of this application was outlined at paragraphs 3 to 8 with details of NR’s condition and prognosis outlined at paragraphs 14 to 22. To summarise, there was concern that NR cannot communicate pain and can be distressed by interventions he can feel but cannot understand. It was submitted that in NR’s current state, CPR would cause harm and would be contrary to NR’s best interests.

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The Applicable Law:

Where there is agreement between treating clinicians and family about life sustaining treatment of a young child there is no need for court intervention. Where there is no agreement Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67, [2014] AC 591 [22 and [23] sets out the key legal principles in withholding life sustaining treatment:

• First, the focus is on the whether it is in the patient’s best interests to give the treatment, rather than it is best to withhold or withdraw it.
• Second, in considering the best interests of this particular patient at this particular time, decision-makers must look at his welfare in the widest sense, not just medical but social and psychological.

Further key principles from authorities including In Re J (A Minor) (Wardship: Medical Treatment) [1001] Fam 33, Wyatt v Portsmouth NHS Trust [2006] 1 FLR 554, An NHS Trust v MB [2006] EWHC 507, [2006] 2 FLR 319 at [16] , and Yates and Gard v Great Ormond Street Hospital for Children NHS Foundation Trust [2017] EWCA Civ 410 as they apply to a decision whether to declare lawful the withholding or withdrawal of life sustaining treatment, can be summarised briefly as follows:

• The child’s best interests are the court’s paramount consideration and must be viewed from the assumed point of view of the child patient.
• The term “best interests” is used in its widest sense and is not limited to medical considerations.
• There is a strong presumption in favour of taking all steps to preserve life but it may be displaced if other considerations outweigh it.
• The views of parents, clinicians, and others caring for the child should be taken into account, but no one person’s views, including those of a parent, are decisive.

Finally, the court must apply these principles to the particular facts of the case. Application of these principles will afford proper recognition to the child’s and family’s Convention rights. As explained in Guy’s & St Thomas’s NHS Foundation Trust [2022] EWHC 2422 (Fam), the court recognises and respects the child’s dignity by conscientiously applying the established legal principles and should not be drawn into making a decision that accords with the court’s own concept of dignity.

Factual Background:

This case relates to whether a judgment relating to T and his older sister S, published in anonymised form on 17 January 2024, should be published naming the parties in August 2026 when T (currently 15) is aged 18. The court also considered whether, if published in an unanonymised form, there would be protection to T and S if their names were removed from the judgment.

The father contends that it should be published in full, and the mother argues that there should be no anonymised version of the judgment published. T and S have said that they would not wish the judgment to be unanonymised at any time.

The family have been subject to proceedings on and off for ten years whereby the father attempted to maintain contact with his children and the mother opposed this. The mother was found to have made a number of untrue allegations against the father and influenced the children so that they did not wish to have contact with him. A full background of the case and summarised history of proceedings can be found in Re T (A CHILD) (s9(6) Children Act 1989 orders: Exceptional Circumstances: Parental Alienation) [2024] EWHC 59 (Fam) [15] to [78].

Applicable Law:

As set out in the case of Griffiths v Tickle & Ors [2021] EWCA 1882 [34], the starting point in domestic jurisprudence is that of open justice. A balancing exercise must then be conducted having regard to Articles 6 (right to a fair trial), 8 (right to respect for private and family life) and 10 (right to freedom of expression) of the European Convention for the protection of Human Rights and Fundamental Freedoms 1950 and governance in the Children’s Act 1989 Section 97(2) which prohibits publication and says:

“(2) No person shall publish to the public at large or any section of the public any material which is intended, or likely, to identify—

1. 1. any child as being involved in any proceedings before the High Court or the family court in which any power under this Act or the Adoption and Children Act 2002 may be exercised by the court with respect to that or any other child; or
   2. an address or school as being that of a child involved in any such proceedings.”

The President of the Family Division, Sir Andrew McFarlane said that the courts approach to the balancing exercise was most “conveniently summarised” in Re J (A Child) [2013] EWHC 2694 (Fam) [22] and considered in Re S (Identification: Restrictions on publication) [2004] UKHL 47; [2005] 1 AC 593 [17].