Mid Yorkshire Teaching NHS Trust v QM & Anor

Until her tragic and unexpected collapse in early January 2026 QM, age 33, was a devoted mother to her two young children and life partner to her husband, as well as being a much-loved member of her family and her wider community. The consequences of the devastating brain injury she suffered that day has been felt far and wide. The visceral loss felt by those close to QM was clear and felt by all who have been present during this hearing. QM’s husband, GE, has not left her bedside since her collapse, their two young children have been cared for within the wider family and community. GE said in evidence that he intended to remain at QM’s bedside until she was off the ventilator, or he felt she was no longer in danger in the sense of any risk to her life.

It is against this background that the court is considering this application by the Mid Yorkshire Teaching NHS Trust (‘the Trust’) for a declaration that it is lawful being in QM’s best interests to cease invasive ventilation and Clinically Assisted Nutrition and Hydration (‘CANH’) and for her to receive palliative care in accordance with the palliative care plan. That plan is opposed by GE and the wider family.

There is no issue between the parties that QM lacks capacity to make decisions about her treatment. There is no dispute about the medical evidence which concludes that QM is in a prolonged disorder of consciousness (‘PDOC’) at the lowest end of the spectrum of awareness.

The central issue is what is in QM’s best interests.

During the hearing the court heard oral evidence from Dr A, the treating Intensive Care Consultant, Professor Wade, Consultant and Professor in Neurological Rehabilitation, who the Trust sought a second opinion from, GE, QM’s husband, and QM’s sister, MM. QM’s brother in law also spoke at the conclusion of the hearing and many members of QM’s wider community attended the hearing. Their love for QM and their very deep distress about the situation QM and her family are in was obvious to see.

QM and GE met about 17 years ago and married 8 years ago. They are both from the Irish Travelling Community.

They have two children, age 7 and 4. Both their children are autistic and non-verbal. The evidence established that both their parents, but in particular QM, were very attuned to their care and their particular needs. GE gave powerful evidence about the extent to which QM was able to meet their particular needs through a combination of patience, perseverance and love.

Prior to the 3 January 2026 their life was centred around the family and their community.

On 3 January 2026 QM suffered a cardiac arrest whilst at home. Despite CPR being commenced immediately by her family it took 31 minutes to restore spontaneous cardiac output. On admission to hospital QM was ventilated through an endotracheal tube and a nasogastric tube was inserted at some point. She sustained extensive and severe hypoxic brain damage.

The CT scan on 3 January 2026 showed structural brain changes consistent with significant hypoxic brain injury. The cause of the cardiac arrest is thought to be due to low potassium, details of which can only be established at post mortem (if, indeed, it is possible to establish a cause).

Over the first few days in hospital while she was on a ventilator and sedated QM had a series of epileptic seizures. She was started on anticonvulsants, the seizures did not recur and the anticonvulsants were withdrawn by the end of January. QM remained unconscious and required continuing ventilation through an endotracheal tube. QM had a nasogastric tube for feeding and hydration. Since her admission QM has had episodes of aspiration pneumonia and ventilator-associated pneumonia on about six occasions each of which were treated with antibiotics.

A further scan on 6 January 2026 showed extensive loss of the grey-white matter interface and evidence of cerebral oedema. An electroencephalogram (EEG) on the same day showed severe suppression with no discernible cerebral activity.

On 7 January 2026 following discussions with QM’s family a Recommended Summary Plan for Emergency Care and Treatment (‘ReSPECT’) form with a Do Not Attempt Cardiopulmonary Resuscitation (‘DNACPR’) decision was completed.

On 16 January 2026 the clinical team requested a second review of the CT brain imaging which was undertaken by Dr F, Consultant Radiologist. He agreed with the original reports that the appearances are in keeping with hypoxic ischaemic encephalopathy. A further second opinion was given by Dr G, Consultant from Leeds Teaching Hospitals, who noted ‘severe hypoxic brain injury with early confounders that have now been ruled out at 13 days. Whilst continued time will almost certainly show small neurological improvements, these will not be enough for [QM] to ever have an acceptable outcome based on the severity of the changes on her CT brain scan’. He discussed these findings with GE.

Dr E, Consultant Cardiologist, also reviewed QM on 16 January 2026. He considered it was most likely the cardiac arrest was caused by low potassium, but the cause was not obvious and recommended a specialist heart post-mortem. No other cardiac investigation or support was recommended.

On 19 January 2026 QM was assessed by Dr D, Consultant in Rehabilitation Medicine, who recorded that QM has ‘emerged from coma in that her eyes are open and she appears to have some sleep-wake cycle. However she is in a very minimal part of the minimally conscious state spectrum’.

On 22 January 2026 a second EEG was performed and the report by Dr B, Consultant Physician in Clinical Neurophysiology, concluded ‘The findings are compatible with severe grade diffuse cerebral dysfunction. No convincing epileptiform abnormality is seen’.

By 6 February 2026 the clinical team considered QM was near-optimised for extubation. Agreement was reached with the family members to trial extubation, with the possibility of re-intubation if it failed in the short term.

A trial extubation took place on 9 February 2026. QM managed for about 10 hours without the ventilator and endotracheal tube but had increasing difficulty in maintaining adequate respiration and oxygenation and was reintubated. It was explained to the family that this failed due to QM’s poor cough due to her brain injury.

Dr G was updated following the failed extubation. He confirmed on 20 February 2026 ‘If [QM’s] conscious level has not shown any improvement at 48 days post injury, it is my opinion that she will never recover to any state which could reasonable be considered to be in her long-term best interests, and as such continuation of life-sustaining treatment is not in her best interests’.

QM remained deeply unconscious, recovered a sleep-wake cycle and a very weak cough but otherwise having very few responses to pain and other stimuli. A further review of QM was undertaken by Dr D on 23 February 2026 who recorded

On 4 March 2026 a best interests meeting took place between the clinicians and GE, his brother and QM’s sister. Dr A set out the benefits and burdens associated with QM remaining intubated and ventilated. GE stated he thought QM would go through anything in order to be there for her children and would rather be alive in any form than be dead. They met again on 25 March 2026 to talk through the proposed plan for withdrawal of life-sustaining treatment. The family view had not changed in that they wished for QM to continue to be ventilated and receive life-sustaining treatment.

During a joint review on with physiotherapy on 11 March 2026 Dr D further noted that QM had quite marked muscle wasting and loss, reflecting the severity of her injury and ongoing weakness. Dr D recorded that even if QM was to survive a move from ICU she would not be well enough to progress onto a rehabilitation pathway at this point and all her therapy interventions are maintenance.

QM’s case was referred to the Trust’s Healthcare Ethics Advisory Group (‘HEAG’). In March 2026 it set out its conclusions that it was not in QM’s best interests to continue active interventions, noting that she ‘has suffered a horrific irreversible hypoxic insult to her brain, one from which she will have no meaningful recovery’.

These proceedings were commenced on 30 March 2026.

At the request of GE a further EEG was undertaken on 7 April 2026. Dr F confirmed the lack of brain functioning in QM and that ‘no meaningful functional neurological recovery is anticipated’.

Dr A is the Consultant in Anaesthesia and Intensive Care Medicine at the hospital. He has been involved in QM’s care since 9 January 2026. In his written evidence, after setting out the history outlined above, he describes QM’s muscles are becoming increasingly contracted with the result she receives regular physiotherapy, and needs to wear splints on her arms to help manage the situation. To manage her secretions she requires daily deep suctioning down her endotracheal tube to clear them. He records that subjecting QM to these burdensome therapies is a source of moral distress for him and his colleagues on the ICU. In his written evidence he summarises QM’s current care on ICU as including: antibiotics (treating ventilator acquired pneumonia); CANH via a nasogastric tube; short courses of steroids to reduce swelling in her airway prior to extubation; deep suctioning via her endotracheal tube on a frequent basis during the course of each day; regular physiotherapy (daily passive stretches to try and maintain a range of motions and splints for her arms and legs to reduce contractures); as well as other standard nursing care (such as delivery of medication, mouthcare, re-positioning to reduce pressure areas). QM’s conscious level using the Coma Recovery Scale-Revised has shown that her conscious level has remained no higher than 5 since 27 February 2026. In his first statement he concluded that ‘Because of her invasive ventilation and immobility, it is inevitable [QM] will develop further infections and complications, which will become life-threatening. As such, if we were to treat [QM] as we currently are with ventilation and CANH, in all likelihood she would have to remain on ICU and will likely die from one of those infections, and this could occur at any time including when her family isn’t present. Common infections include ventilator-associated pneumonia; urinary tract infections; sinusitis from impaired sinus clearance around the endotracheal tube; infected pressure sores; and infections of bladder stones caused by immobility. Simple treatments such as antibiotics are not always successful in treating these complications and they may require more invasive or surgical interventions, none of which are felt by the ICU team to be appropriate. This is because they would not do anything to address the underlying and irreversible cause of [QM’s] deterioration, which is her severe brain injury’.

In Dr A’s second statement, which provides an update regarding QM’s condition, he confirms there has been no change in the GCS scales, which remain at 5. The statement describes the gradual worsening of the contracture process in QM’s upper limbs. The physiotherapy treatment has become ‘increasingly problematic. Her arms are held in a persistent flexed position – her elbows against her trunk, her arms flexed at the elbow, her wrists and fingers curled in a flexed position.’ The occupational health team had made some bespoke splints for her to use from 3 March 2026 to try and prevent the contracture process but her abnormal flexion was so profound that it damaged the splints and they could no longer be used. QM was started on baclofen, a muscle relaxant used for muscle spasticity, but it has not had any meaningful effect. Dr A reported that the concern is the contractures risk QM’s skin integrity due to her fingernails pressing down so hard and the difficulty in moving her elbows away from her trunk, making it difficult to clean the skin around her armpit, with an increasing risk of skin damage. After stretching, her arms return immediately to their flexed position. QM was prescribed oral morphine to be used around the time of the physiotherapy as there was a perception that the stretching was potentially causing her pain. Dr A examined her with one of the physiotherapists on 15 April 2026. The stretches caused QM to grimace or yawn but there was no change in her heart or respiratory rate and no other change in her conscious level. He confirmed QM had had another course of antibiotics which was completed on 5 April 2026 for a potential chest infection.

In his oral evidence Dr A described how the support QM receives for her breathing varies during the day. During the night he said the ventilator does all the breathing for her. QM’s swallowing and coughing is also impaired due to the extent of the damage to her brain and brain stem. He described the difficulties with the contractures, that they are getting worse and that her tendons are so tight they are at risk of bursting through her skin. He reported it had been noted recently that QM’s heart rate and breathing increases when the physiotherapy is being undertaken, which taken together with her grimacing, leads him to believe that QM is experiencing pain. She has been prescribed paracetamol and morphine as well as baclofen to manage these changes.

Dr A disagreed with GE’s view that there is nothing worse than death. His experience on ICU is that things are done to get better but with QM he considers there is no chance of recovery. He described it as ‘degrading and inhumane to no benefit – she is only suffering the burden. I am extending the process of her dying’.

In answer to questions from Mr Baldwin he said he considered the extubation was important to try, which they did. The only way the family would consider it again was if there was re-intubation, if required, which was not an option.

Miss Gollop raised the question of a tracheostomy for QM. Dr A stated that they are not willing to do that as changing the tube does not treat her underlying brain injury and he did not consider there would be any benefit to QM.

Miss Gollop pressed him on what the options would be if the application made by the Trust was refused and he said he would have to go back and consult with the team and the family as to what they felt they could offer.

A second opinion was sought by the Trust from Professor Wade, Consultant and Professor in Neurological Rehabilitation. He visited the hospital on 2 March 2026, viewed the records, spoke to the clinical team, spoke to GE and MM and saw QM. The family informed him of the signs of improvement they had seen. QM now opens her eyes much of the time, whereas initially she did not. She has a sleep/wake cycle which she didn’t have at the start and has occasionally coughed, whereas initially she did not cough. GE considered that her facial expressions sometimes indicates that she is uncomfortable, particularly when blood is being taken but did not report any other behaviours indicative of experiencing pain.

In Professor Wade’s opinion QM is at the lowest possible end of the spectrum of responsiveness and awareness. He concluded ‘beyond all reasonable doubt’ she would never regain awareness and ‘would never be able to exercise any control over her life, participate in any functional activity, communicate any specific thought, or interact socially in any discriminatory way with family members’. He concluded that it was ‘no longer in her best interests to continue active medical treatment of any kind. This is a strategic decision, and the clinical team will need to decide on the details’. In his report he said he explained his conclusions to the family, including the severity and nature of brain damage. He did not consider there were any examples of behaviours ‘even approaching complex automatic behaviours, let alone indicating awareness’. When discussing prognosis Professor Wade reported that GE had stated ‘all he wanted was to take her home’ and asked Professor Wade to ‘state 100% absolute certainty that there would not be any improvement’. Professor Wade declined but explained that he was ‘certain she would never recover enough to interact with him or her children’ but he ‘would not wish to state 100% certainty about the absence of a minor change or improvement over time. [GE] replied that if there were a 0.01% chance she might improve, he would wish her to have that chance, stating that she would want it too (without evidence). He also argued that she is not experiencing pain. I explained that I thought it was unlikely, but that there was a low probability she might feel some discomfort or pain, which I estimated at 2%’.

In his report Professor Wade concluded that QM’s responses have been minimal describing them as ‘infrequent, and those responses seen have been very basic, simple movements. For example, blinking is a very basic eye reflect required to prevent the eye from drying out. Coughing, which is rare in her case, is a basic reflex that helps prevent food and fluids from entering the lungs. Withdrawal of an arm is also a very basic reflex. No movements or behaviours more complex that that have been reported or observed by any other person…There is no doubt that she is at the lowest end of the spectrum of both responsiveness and awareness.’

At the time of his report he noted that QM had not been recorded as showing any behaviours indicative of pain noting that ‘While this does not prove that she is not experiencing a feeling of pain of some type and severity, it does make it less likely’.

Looking ahead Professor Wade stated in his report ‘Changes will occur. Her tone will continue to increase, which in turn will make it more difficult to provide good nursing care and is likely to increase the risk of pain when attempts are made to stretch her spastic muscles, even if only to maintain skin integrity. Just as tone control mechanisms adapt and evolve after brain injury, so may pain pathways, and she may develop at least rudimentary feelings of pain over time.’

As regards life expectancy although the actuarial tables give a life expectancy of 10 years for a woman aged 30 who is in this state due to the wider range it covers Professor Wade did not consider it applied to QM. In his report he considered that QM’s life expectancy is likely to be much shorter as someone on an endotracheal tube and dependent on a ventilator is at high risk of recurrent infections. He considered with ‘all active care and support, she might live for two or three years’. If she came off the ventilator he considered it was difficult to predict how long she would live but it would be less than 50% that she would live for more than two or three days.

In the prognosis in his report Professor Wade stated that QM will never

In his report he concluded that it was no longer in QM’s best interests to continue active medical treatment for the following reasons:

In his oral evidence Professor Wade confirmed that due to QM having a sleep/wake cycle that is what took her to just above being in a coma. In the light of the recent changes he said he believes that QM has some feeling that is unpleasant, pain or an ache, in the moment when it happens but he did not consider she remembers it or is aware of it coming. He was asked about what is known about the experience of having CANH withdrawn, he said his view is that QM is more likely to die due to the ventilator being withdrawn rather than from the withdrawal of CANH.

The court has written evidence from GE, MM, QM’s mother, brother, sister-in-law and two of her friends. They each powerfully describe QM, how devoted she was to her children, husband, her family and wider community. She was outgoing and made friends easily. In addition to the written statements the Official Solicitor sent questions to the family which GE responded to. In addition to GE being at the hospital the family visit daily, in particular QM’s mother and MM.

In his statement GE confirmed he had not left the hospital for over three months which has left him physically, mentally and emotionally exhausted. He sets out that before her collapse he and QM have had what he described as ‘what if’ conversations. he reports that QM has said that ‘she believes in God’s will. If she were meant to die, she would accept it’. She had said that if GE was on a life support machine she would not let anyone switch him off ’She said he was ‘ride or die’ and would want to fight on’. He considers QM would see removal of the ventilator as an interference in God’s will which would be strictly against their beliefs. He says this opposition ‘runs deeper within our integral cultural beliefs and religion which [QM] is a fervent part of’. He states ‘It is my wholehearted belief that [QM] would never want the removal of her life sustaining treatment and this would be in a direct violation of her religious views regarding God’s will. It would also be direct violation of her religious views regarding God’s will. It would also be direct violation of who she was as a person and her determination in everything she did. She would never want to give up the fight’. In response to questions from the Official Solicitor he said QM would not agree to removal of life sustaining treatment as for her it would mean ‘giving up her chance of eternal life’. He states he plans to stay by his wife’s bedside whilst she is in a critical condition ‘But in time and through the power of God, I would hope my wife would no longer need life support and when she is stable of course I would go and visit my children’.

GE has made clear from the start that his and QM’s faith is a central part of their lives. On 9 January 2026 he is recorded as saying ‘his faith made him believe that [QM] would walk out of hospital and he would continue to believe that until the very end’.

Following discussion with the family it was agreed that the court would hear from GE first. He gave oral evidence by video link from the hospital. GE provided details regarding the background to his relationship with QM. They are both part of the established Irish Travelling Community in their respective areas. Following their marriage they had two children who each have particular needs. GE described QM’s unconditional love to meet the children’s needs. GE outlined the importance of religion in both their lives, making it clear it was more to them than attending church each week, it was woven into their day to day lives. GE said ‘God is a strength – everything happens for a reason’. He described the regular visits QM would make to religious shrines to say prayers. In any situations they encountered or conversations they had about adversity QM would always deal with things exactly the same stating ‘It is what we do’. GE described the pressure he felt under in the days after QM’s collapse, he maintained that ‘switching that machine off was never an option’. He continued ‘We die trying – no such thing as a good death’. He said that QM ‘would want to fight until her last breath…under no circumstances would she give up. She would not leave my side if I was here’.

In her statement QM’s sister, MM, describes their closeness in every way, including age. They spoke every day and she describes QM as one of ‘the warmest and most loving people you could ever meet. She is fun, outgoing, generous, kind and incredibly proud. She has always been full of life and full of love for the people around her. She loves travelling and experiencing new places, but equally she is happiest at home with her family. She takes so much pride in creating a loving home for her husband and children…Above everything, [QM’s] children are her world…she has always been completely devoted to their care, their routines, their emotional needs and their happiness’. She continues ‘One of the strongest reasons I know she would want every chance to recover is because being their mum is the most important part of who she is. Faith has always been at the centre of [QM’s] life and of our whole family. We are a deeply religious Catholic family, and out shared belief has always been that life unfolds in God’s timing, not ours’. She describes how their faith has shaped their upbringing and that QM ‘lives her faith every day. She prays daily, regularly sends me prayers, religious quotes and Bible readings, and often speaks about trusting in God’s timing’. She says although they never discussed end of life care she is ‘certain that [QM] would believe that life and death are in God’s hands’ and that she has ‘always had an incredible fighting spirit’. She believes QM would want ‘every possible opportunity, no matter how small, to improve and recover. She would hold onto hope, because that is who she is. She would want every chance to come back to her children, her husband and all of us who love her’. This view as to what QM would want and why is echoed by QM’s husband, mother, sister in law and friends.They speak as one voice about her beliefs.

MM gave oral evidence on the second day of the hearing. She described how close she was to QM. Before her collapse they would see each other regularly and have children the same age. Since her collapse she has continued to visit her sister regularly. She agreed that in making a choice about whether to withdraw treatment QM’s first thought would be for her children ‘her number one priority if chance of recovery’. She agreed QM would want GE to make decisions about her treatment as he knows ‘her values and beliefs’. MM said she knew QM ‘even if tiny chance survival she will take her chances she would like every opportunity however small to at least try’. She continued ‘We believe God gives us the strength to carry on…life is a gift cherish it’. She said QM’s religious beliefs were not unusual in their family ‘faith is centre of life especially when making difficult decisions. We believe God will see us through’. She agreed with GE that life here is a test for life after death. She continued ‘We believe God is going to take her, don’t believe in testing God he works in his own time’. When pressed about how long it could take she said ‘We haven’t had that thought. Me and [GE] believe given time she will make some movement…I know she is aware and to give her time she will get better. It will be God’s will’.

The Official Solicitor’s representative visited QM in hospital the week before this hearing and set out QM’s daily care regime.

There is very little issue between the parties regarding the relevant legal framework. It is a well-trodden legal path.

As set out there is no issue that QM lacks capacity to make decisions regarding her medical treatment in accordance with the provisions of ss1 – 3 Mental Capacity Act 2005 (‘MCA 2005’)

The focus has been on what is in QM’s best interests.

The statutory best interests ‘checklist’ under s 4 MCA 2005 provides:

The first question which the court should ask itself is whether it is in QM’s best interests to continue to receive invasive ventilation and clinically assisted nutrition and hydration (CANH). The second is whether it is in QM’s best interests to receive palliative care. Baroness Hale stated in Aintree v James[2013] UKSC 67 at [22]:

“The focus is on whether it is in the patient's best interests to give the treatment, rather than on whether it is in his best interests to withhold or withdraw it. If the treatment is not in his best interests, the court will not be able to give its consent on his behalf and it will follow that it will be lawful to withhold or withdraw it. Indeed, it will follow that it will not be lawful to give it. It also follows that (provided of course that they have acted reasonably and without negligence) the clinical team will not be in breach of any duty towards the patient if they withhold or withdraw it.”

The classic statement of how the court should undertake this task in reaching a decision as to what is in the person’s best interests under the MCA 2005 is set out by Baroness Hale in Aintree University Hospital NHS Foundation Trust v James [2013] UKSC 67 at [39] – [45].

The MCA 2005 Code of Practice (‘the Code’) issued under s.42 MCA 2005 came into effect in April 2007. Chapter 5 of the Code titled ‘How should someone’s best interests be worked out when making decisions about life-sustaining treatment?’ includes the following guidance:

“5.38.

In setting out the requirements for working out a person’s ‘best interests’, section 4 of MCA 2005 puts the person who lacks capacity at the centre of the decision to be made. Even if they cannot make the decision, their wishes and feelings, beliefs and values should be taken fully into account – whether expressed in the past or now. But their wishes and feelings, beliefs and values will not necessarily be the deciding factor in working out their best interests ...”

“5.41

The person may have held strong views in the past which could have a bearing on the decision now to be made. All reasonable efforts must be made to find out whether the person has expressed views in the past that will shape the decision to be made. This could have been through verbal communication, writing, behaviour or habits, or recorded in any other way (for example, home videos or audiotapes)”

“5.47

Section 4(6)(c) of the Act requires decision-makers to consider any other factors the person who lacks capacity would consider if they were able to do so. This might include the effect of the decision on other people, obligations to dependants or the duties of a responsible citizen.”

In a case of this kind, the fundamental starting point is a strong presumption that it is in a person’s best interests to stay alive. As Sir Thomas Bingham MR said in Airedale NHS Trust v Bland[1993] AC 789at [808], "A profound respect for the sanctity of human life is embedded in our law and our moral philosophy”. More recently Hayden J stated in Guy’s and St Thomas’ NHS Foundation Trust v A (a child) and others[2022] EWHC Fam 2250 at [41] “There is unique value in human life, frequently referred to as the ‘sanctity of life’. That does not dissipate where awareness diminishes, or the capacity of the brain becomes so corroded that all autonomy is lost. It is perhaps in these circumstances that it requires the most vigilant protection. …”

It is clear that wider considerations than merely clinical ones are engaged in cases of this nature and by definition these cases are highly fact specific.

In addition to Articles 2 and 8 ECHR, Article 9 (2) is also likely to be engaged. It states ‘Freedom to manifest one’s religion or beliefs shall be subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protections of the rights and freedom of others’.

A helpful list of issues requiring determination in an application of this kind were set out by Cobb J (as he was then) in PL (by her litigation friend, SL) v Sutton CCG & Anor[2017] EWCOP 22at [9]; namely:

In her comprehensive written and oral submissions on behalf of the Trust, Ms Scott submits that the court needs to make a number of factual findings before it is able to conduct a best interest analysis. Ms Scott summarises the findings as follows. That QM has suffered an extreme brain injury which includes her brain stem and has no purposeful movement, is unable to communicate and only retains basic brain function, she is unable to swallow and has impaired breathing. QM is in a permanent disorder of consciousness (‘PDOC’) in accordance with the National Guidance and is at the lowest end of the spectrum of awareness, just above someone in a coma in that QM has a sleep/wake cycle to some extent but has no awareness of herself or her surroundings. The consequences for QM of her brain injury are profound and the trajectory is one of deterioration, for example the evidence about the contractures. This results in an increased burden of daily care, such as the physiotherapy. There is evidence that QM suffers some pain during such procedures which is a change in the last month. The chance of any improvement in QM is very low and according to the evidence of Professor Wade, any improvement is only going to be very minor, for example turning towards sound. QM is not going to come off the ventilator or stabilise sufficiently to leave ICU, it is likely that QM will continue to deteriorate.

Turning to QM’s wishes and beliefs and values Ms Scott submits there are two aspects to her character and her life. First her devotion to her husband and children and second her deeply, long held religious beliefs. The Trust accept the evidence that QM would want to do anything to return to her role as mother and wife but Ms Scott submits the medical evidence is clear that that is not a possibility. Ms Scott submits the evidence is less clear as to what QM’s wishes would be if she is going to continue on a ventilator with GE by her side and the children being cared for by the wider family. GE’s evidence was that he would remain with QM whilst she is on a ventilator.

As regards QM’s beliefs and values the Trust accept the evidence about QM’s deep and abiding faith in God. Ms Scott submits this is relevant in the following ways: QM’s belief for God to decide when life comes to an end and her belief in miracles irrespective of medical evidence. For QM to withdraw treatment would mean she would expect God to save her which is impermissible in her beliefs and values. For QM to ‘give up’ would be the equivalent of her accepting that God cannot heal her and the chance of eternal life.

Standing back Ms Scott submits whilst recognising the importance of the sanctity of life, QM’s wishes and feelings, beliefs and value and those of the wider family and community those important considerations need to be weighed in the balance against the medical diagnosis and prognosis. Put starkly QM will never resume her role as mother and wife. The progressive nature of her condition and the increasing burdens of the treatment and the consequences for her children being without the care of their parents over such an extended period of time. Ms Scott submits that the evidence establishes the treatment is futile as it is not treating the underlying brain injury. There is no evidence that continuing the treatment will bring any benefit to QM, rather it prolongs her death.

On behalf of GE Mr Baldwin confirmed that GE accepts the medical evidence and has done so from the start. He is very appreciative for all that has been done for QM by the clinical team however he strongly objects to the order sought by the Trust being granted. Mr Baldwin submits the evidence from GE and the wider family and friends are clear about the depth of QM’s religious beliefs and values being rooted in the Roman Catholic faith and underpins his submissions that QM would want every chance to be given for her recovery which, he submits, is ‘core to her identity’. The statements from her family and friends provide a very clear picture of QM’s character and faith and provide an evidential foundation for the court to conclude that QM would not want life sustaining treatment withdrawn.

These values are not limited to her religion but are part of the values of her wider family and community. GE’s written and oral evidence, Mr Baldwin submits, demonstrates the depth of QM’s values in that he feels what is being proposed puts QM’s faith and values in jeopardy. Any chance of life is a chance in accordance with the evidence about QM’s beliefs and values and any concept that QM would benefit from coming off the ventilator would be contrary to those beliefs and values that are deeply held by QM. Mr Baldwin submitted that GE’s evidence was more nuanced than had been suggested. GE would return home to his children if he considered the jeopardy to QM was removed. In any event, Mr Baldwin submits the children are well cared for by the wider family.

Miss Gollop KC confirmed at the start of this hearing that the Official Solicitor reserved her position until the evidence had been heard. The Official Solicitor was able to join the hearing for GE’s oral evidence. Miss Gollop submits the Official Solicitor is acutely aware of how much is at stake in this case bearing in mind QM’s relatively young age and the impact on her family. The possibility of re-calibrating the current ceiling of care to exclude antibiotics was put forward by the Official Solicitor. This was rejected by the Trust as not being in QM’s best interests or being clinically appropriate, due to the lack of any timeframe, the realities of that for someone of QM’s age and for the family and those caring for her, including that it is not clinically appropriate to continue to ventilate someone who is dying from sepsis and allow them to die on the ventilator.

The focus of Miss Gollop’s submissions was on the choice for QM now as to what is in her best interests. What is in her best interests needs to factor in what she would do and whether that is in her best interest. Her best interests are informed by her wishes. Miss Gollop relies on Re Thirumalesh Deceased [2024] EWCA Civ 896 where the Court of Appeal determined that it was not necessary for P in that case to believe the medical evidence (in that case) that her death was imminent. At [138] the Court of Appeal stated ‘..it will take a great deal to displace the principle of autonomy and the presumption of capacity, no matter how unwise her decision to eschew palliative care may have seemed to a more mature mind’.

In that context Miss Gollop considers that GE and the family accept the medical facts and the prognosis but the law does not require them to believe it. It would still be open to a person to say they would, as she put it, ‘ride or die’ however unwise that decision is.

Here, submits Miss Gollop, the evidence shows that QM’s belief in God was deep and integral to her life. She believed that for God, nothing is impossible and that made sense of her practice of praying frequently and the family’s belief that she would want to be alive rather than dead. In that context it is not necessary to believe the medical prognosis. Those wishes are an integral part of her faith, values and duty as a wife and mother.

Miss Gollop submits that the Trust has looked at the issues in this case from a more limited medical perspective. If the treatment cannot deliver medical benefit it is regarded as futile. That was the focus of the questions to the ethics committee. Miss Gollop submits this was demonstrated by the question she asked Dr A as to what would happen if the Trust’s application was refused. She submitted ‘it was clear they had not looked round that corner’. They had made the strategic decision as advised by Professor Wade with a medical focus. Miss Gollop submits best interest requires a wider focus relying on what Baroness Hale stated in Aintree at [43] regarding futility ‘…A treatment may bring some benefit to the patient even though it has no effect on the underlying disease or disability’. She submitted in cases such as this the importance of human life requires particularly vigilant protection and careful consideration.

When applications such as in this case have been refused it has invariably been due to the cogency of the evidence regarding the patient’s wishes, feelings and values. For that patient, the value of life itself is enough, and that value would endure. If the post-injury life was considered not meaningful, that would be immaterial for that person due to, say, religious beliefs. Miss Gollop submits the evidence from GE and the family can be relied upon by the court. There was no evidence of collusion. QM’s sister recognised this could go on for some time. She considered QM would be prepared to accept discomfort, would have accepted pain relief and she had risen to challenges before. As regards the impact of QM’s situation on the children and what her wishes would have been. Miss Gollop submits the children are being cared for by people known to them and can be maintained for as long as is necessary and so that should not weigh heavily in the balance.

In not supporting the application by the Trust Miss Gollop submitted the Official Solicitor’s starting position was the importance of the sanctity of life supported by the Article 8 and 9 EHCR rights in this particular case. The issue of dignity is subjective, as GE stated it has been explained to him that palliative care would provide dignity and what was described to him as a ‘good death’ but as he said ‘that’s no good for us’ as it did not accord with QM’s beliefs and values.

The issues raised in this case are both profound and extraordinarily difficult. The factual situation the court is faced with tests the limits of the concept of what is in a person’s best interests and how that is to be assessed in these tragic circumstances.

As was made clear by Baroness Hale in Aintree the court is required to undertake a holistic assessment having regard to the wide canvas of evidence that is available. That evidence includes the medical evidence and prognosis but also, importantly, evidence as to the wishes, feelings, beliefs and values of the person about whom the decision is centred on and those around her.

There is in this case very little factual dispute. Neither the medical evidence nor the evidence about QM from her family was significantly challenged but it was invaluable and right when such a serious decision is faced by the court for the evidence to be explored through oral evidence in the way that it was during the hearing. GE’s evidence was both powerful and compelling given the very difficult circumstances he is in. MM’s evidence conveyed the depth of QM’s faith and her love for her children and husband informed by a close lifelong sibling relationship. Dr A’s evidence conveyed the enormous care and compassion Dr A and the treating clinical team have and continue to provide to QM. The hearing was conducted with great sensitivity and care and those who attended from the wider family and community were visibly moved and affected by what was being said. GE’s brother spoke for them all at the end of the hearing.

The medical evidence is clear and supports the following findings.

On 3 January 2026 QM suffered profound and serious brain damage. The combination of the CT scans and EEGs demonstrate the significance and extent of the brain damage, that also damaged the brain stem. The consequence for QM is that over the extended period (in excess of 100 days) that she has been on ICU she is at the lowest level of consciousness. That conclusion is founded mainly on her having a sleep/wake cycle. I accept the medical evidence that in accordance with the guidelines QM is in a prolonged disorder of consciousness (‘PDOC’) and the prognosis is that she is very unlikely to emerge from it. If there is any improvement, which is unlikely, it will be limited to small changes, such as possibly turning her head to sound. The medical evidence establishes that she will not recover beyond, at the most, that very limited change.

QM’s condition is deteriorating and it is more likely than not she is now experiencing pain when certain procedures are undertaken. This is founded on the clinical changes noticed regarding her contractures, particularly in her arms over the last four weeks. They are becoming more fixed and increasingly difficult to manage through physiotherapy treatment. This risks QM’s skin integrity caused by increasing difficulty in the clinical team being able to wash QM, so the risk of infection increases. Also, it is becoming increasingly difficult to release QM’s grip so her finger nails are likely to break her skin, as are her tendons as a consequence of the contractures. There have been changes noted over the last four weeks when any physiotherapy procedure is being undertaken, namely an increase in heart and respiratory rate. This coupled with the grimacing observed when these procedures are undertaken has led both Dr R and Professor Wade to conclude that it is more likely than not that QM is experiencing pain during these procedures. This is due to the extent of the treatment required to try to counter the impact of the contractures. The evidence is less clear about QM experiencing pain during suctioning and taking blood tests.

The court has detailed and reliable information about QM’s wishes, feelings, beliefs and values. Her children, family and her faith are at the core of who she is. Her devotion to her children and meeting their particular needs is clearly established. On the day she collapsed she had got up early to play with the children. The Roman Catholic religion is very much part of who QM is as it is with her husband, family and the wider community. These beliefs were evident throughout the way she conducted and lived her day to day life. These were not beliefs that sat in the background to be called upon when required. Her religious beliefs were every part of her life and the evidence demonstrates that she lived her life through them. GE has known her for many years and through his evidence was able to demonstrate how much those beliefs meant to QM. His evidence, which was not challenged, was that QM believed God brought her into the world and it was his decision when she left. His evidence was it would be contrary to those beliefs to withdraw treatment as it would, in effect, be asking God to save her which, through her beliefs, would be wrong. When asked about the consequences for her of treatment continuing GE was clear in stating that it is what she would want as it would accord with her beliefs, even if she suffered pain.

Standing back and weighing the burdens and benefits for QM in determining as I must what is in her best interests there is no straightforward route. On any view QM is in a parlous condition. Put simply, due to the extent and seriousness of the brain damage she is not going to recover, however much her family understandably want her to. Any improvement, even if it happens, is going to be very little, her awareness is minimal, described as being at the lowest end, and her current treatment, which is becoming increasingly difficult, is likely to be causing her pain. The evidence established her condition is only going to deteriorate with the likelihood of increased pain and/or heavier sedation with a continuing high risk of infections. Against those considerations the court must weigh the sanctity of life, which for QM needs to be viewed through the lens of her particular beliefs and values. There is evidence, which I accept, that such is the strength of her beliefs and values she would not wish for life sustaining treatment to end, for QM such a decision would not accord with those beliefs and values. Although she had not had the specific conversation with anyone of what she would do in the situation she now finds herself in, it would accord with her beliefs and values that she would not want her treatment to end if there remained any chance, however small, of an improvement or recovery. GE and MM consider this would remain her view even if such treatment was painful and/or hopeless or futile, due to those beliefs.

The court is required in these difficult cases to stand back and look at what is in QM’s best interests within the legal framework of s4 MCA 2005 and the guidance provided in Aintree.

The court is rightly reminded of the importance of the sanctity of life. In cases such as this, where QM lacks capacity, it requires particular vigilance. The powerful evidence from GE, MM and the wider family paints a picture of QM as a person whose primary focus was on her children, GE and her family. Although understandably, due to the young age of QM, GE and MM, there had not been a specific conversation with QM about what her wishes and feelings would be in her current situation their evidence was informed by knowing QM would want to be back with her family, or at least keep open that chance, however small it maybe. The evidence about her beliefs and values are informed by her deep Catholic faith. It reflects her upbringing and is grounded in the way she lived her day to day life. Those beliefs and values formed an important part of who she is. Both GE and MM were able to vividly describe QM’s beliefs and values prior to her collapse, how important they were to her, how she placed her trust in God and how those beliefs would inform her decision, if she had capacity, of not wanting the treatment to be withdrawn. On one view it could be said that in these particular circumstances for QM the treatment may bring some benefit for her, even though it has no effect on the underlying cause.

It is necessary to weigh in the balance the medical evidence. It presents a bleak and deteriorating clinical picture. The burdens of QM’s day to day treatment are considerable and include regular suctioning, re-positioning, blood tests and physiotherapy to manage the worsening contractures, particularly in her upper limbs. I accept the evidence of Dr A and Professor Wade that it is likely that the procedures to manage her contractures are likely to cause her pain at the time they are being done. That is likely to continue, the clinical evidence is this is likely to be required and will get increasingly more difficult. The risk to QM’s skin integrity is high with the consequent risk of infections, in addition to the continued risk of infection caused by her current treatment. I accept the clinical evidence that the burdens of QM’s current treatment are only likely to increase. I also accept the medical evidence of both Dr A and Professor Wade that there is very unlikely to be any improvement and the more likely is the continued path of deterioration. As they put it in their evidence QM’s current treatment is only delaying her inevitable death. In that sense it is futile.

Whilst fully taking into account the evidence about what QM’s wishes and feelings were and are likely to be, her beliefs and values and the importance of the sanctity of life, particularly in the context of this case, when I stand back and look at QM’s best interests in the widest sense I have to weigh in the balance the burdens for QM of continuing the treatment. Those burdens are considerable, very likely to increase as QM’s condition deteriorates with, in my judgment, no prospect of any recovery. Whilst the court has to give considerable weight to QM’s wishes, feelings, beliefs and values in my judgment when I consider her best interest in the widest and holistic sense the conclusion I have reached is that it is not in her best interests for the treatment to be continued due to the burdens outweighing the benefits even having considered her views and beliefs.

Having reached that conclusion I also conclude that it is in best interests to receive palliative care as set out in the care plan. In consultation with GE and the wider family the Trust will need discuss how and when that takes place.

In reaching this decision I recognise the very great distress this decision will cause to GE and QM’s family. It is a decision of the gravest responsibility for any court to make, however it is ultimately the court’s decision having weighed all the relevant considerations it is required to do in determining what is in QM’s best interests. GE, MM, the wider family and community could not have done any more for QM.