Children and end-of-life care

Liverpool City Council v VT & Ors (End of Life Care) [2025] EWHC 3215 (Fam) (5 December 2025) 

In the Family Court before Mr Justice Peel

Background

This case concerned N, an eight-year-old child with complex life-limiting disabilities. The court was required to determine whether it was in his best interests for life-sustaining ventilation to be withdrawn. The application was brought under the court’s inherent jurisdiction and arose in circumstances of unanimous medical agreement that N was at the end of his natural life.

N was of Romanian heritage with both of his parents being Romanian nationals living in Romania. N was born with complex medical needs and had been the subject of care orders since birth. His parents did not feel able to care for him, and following the making of a full care order in February 2018, N was placed with long-term foster carers. He had five siblings, all of whom were also placed in foster care, though not with N. N’s last direct contact with his mother occurred when he was two years old.

At nine weeks old, N presented with stridor, accompanied by abnormal muscle tone and irritability. Despite surgical intervention to address airway obstruction, his breathing difficulties persisted, leading to the insertion of a tracheostomy. Over the following years, N experienced repeated hospital admissions and was ultimately discharged into the community in December 2019 on long-term ventilation, supported by a comprehensive care package.

Notwithstanding his significant disabilities, N attended school, was able to go out into the community, and enjoyed sensory and social experiences. Mr Justice Peel paid particular tribute to the exceptional devotion and compassion shown by N’s foster carers and long-term carers, noting that they enabled him to enjoy life to the fullest extent possible within its limitations.

Over time, however, N’s condition deteriorated. A best interests meeting in July 2025 concluded that he should receive community-based palliative care, that CPR should not be attempted, and that there should be no further hospital admissions. In August 2025, the local authority applied to invoke the court’s inherent jurisdiction to authorise best interests decisions in respect of end-of-life care in the absence of parental consent. At that stage, clinicians did not consider it to be in N’s best interests for long-term ventilation to be withdrawn.

Extensive medical evidence was placed before the court, including reports from specialists in paediatric palliative care, neurology and respiratory medicine. Genetic testing confirmed that N suffered from a rare and severe autosomal recessive disorder associated with progressive neurological decline, severe developmental delay, epilepsy and respiratory insufficiency. The prognosis was uniformly described as poor, with no available curative treatment and respiratory failure being a common cause of death.

By autumn 2025, N’s condition worsened significantly. He became increasingly unresponsive, experienced escalating seizures, required rising doses of analgesia, and showed signs of autonomic instability. His ability to tolerate basic care diminished, and he could no longer engage with his environment in any meaningful way. Clinicians unanimously concluded that ventilation was now serving only to prolong dying and suffering rather than providing any therapeutic benefit.

Following a best interests meeting on 12 November 2025, the consensus view of all professionals involved was that continued ventilation was no longer in N’s best interests and that its withdrawal would allow a natural death. The hospital trust applied to restore proceedings and sought declarations authorising withdrawal of life-sustaining treatment.

N’s mother attended the proceedings. She did not dispute the medical evidence and accepted that N was dying. Her sole request was to be able to see him in person one final time before ventilation was withdrawn.

Legal framework

The court emphasised that the legal principles governing withdrawal of life-sustaining treatment are clear and well established. The task for the court was to conduct a best interests analysis, focusing on whether it was in N’s interests to continue treatment, rather than whether it was justified to withdraw it.

Mr Justice Peel relied on the authoritative guidance of the Supreme Court in Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67 in which Baroness Hale stressed that decision-makers must consider the patient’s welfare in the widest sense, including medical, emotional and psychological factors, and must attempt to view matters from the patient’s perspective. Treatment which confers no benefit, and instead causes suffering, cannot be in a patient’s best interests and cannot lawfully be continued.

The court also referred to Re A (A Child) [2016] EWCA Civ 759, which confirms that these principles apply with equal force in cases involving children. Although the Mental Capacity Act 2005 does not apply directly to children, the welfare analysis developed in adult cases provides essential guidance in paediatric end-of-life decisions.

In relation to the mother’s request for contact, the court treated this as a deemed application under section 34(3) of the Children Act 1989. The legal test remained the same: whether the proposed contact was in N’s best interests at this particular stage of his life.

Judgment

At the outset of the hearing, all parties agreed that the declarations sought by the Trust should be granted. The court accepted the unanimous medical evidence that N had reached the end of his natural life, and that continued ventilation was causing significant suffering without any corresponding benefit. Mr Justice Peel described the evidence as overwhelming and clear.

The court found that N was almost entirely reliant on ventilation, was largely unresponsive, experienced no pleasure or engagement with his surroundings, and was suffering repeated episodes of pain and distress despite optimal symptom management. The very treatments keeping him alive, including suctioning and tracheostomy care, were themselves sources of suffering. There was no curative treatment available, and no prospect of improvement. In those circumstances, it was not in N’s best interests for his life, and the attendant suffering, to be prolonged by artificial means.

The court therefore granted the declarations authorising withdrawal of long-term ventilation and associated life-sustaining treatments.

The more difficult issue concerned N’s mother’s wish to see him in person before life support was withdrawn. Mr Justice Peel acknowledged the depth of her distress and the tragedy of the situation. However, he concluded that a face-to-face visit was not in N’s best interests and refused the application.

In reaching that decision, the court considered that N had not seen his mother since early childhood and would not recognise her. A previous video call had caused distress and provided no discernible benefit to N. Any delay in withdrawing ventilation in order to facilitate an in-person visit would unnecessarily prolong N’s suffering. The court also took into account the impact such a visit would have on the foster carers, who wished to preserve the confidentiality of the placement and to focus on providing N with comfort and peace in his final moments.

The court permitted one final monitored video call between N and his mother, which subsequently took place. It was also directed that following N’s death, he would be moved to a bereavement suite where family members could attend to say their goodbyes.

In closing, Mr Justice Peel described the case as deeply sad and paid tribute to the courage of N, the love and dedication of his foster carers, and the compassion shown by the clinical teams. While expressing sympathy for N’s mother, the court reiterated that its paramount concern must remain the welfare of the child. Allowing N’s final moments to take place in as calm, stable and pain-free a manner as possible was the course most consistent with his best interests.

Full Judgment: https://www.bailii.org/ew/cases/EWHC/Fam/2025/3215.html

Lamis Fahad and Caitlin Smithey are September 2025 pupil barristers at Spire Barristers.