Guy's And St Thomas' NHS Foundation Trust v VA & Anor [2023] EWCOP 39

Best interests decision concerning VA, a 78 year old woman, who had suffered severe brain injury following a series of cardiac arrests.

The Trust had started proceedings after failing to agree with VA's family on her best interests. In essence, they felt the medical team's bleak assessment of VA's limited responses was overstated (though they did not contest the lack of meaningful recovery) as one of the treating consultants was clear that VA made eye movements and grimaced as a reflexive response. The family also felt the Trust has some responsibility for the cardiac arrests. The case had been the subject of several hearings and challenges before this hearing at which the issue was identified: whether VA should undergo insertion of tracheostomy and PEG tube or simply be extubated.

Hayden J reviews the law around the duties of doctors, consent to medical treatment and best interests before considering the family's evidence, which he concluded did not provide 'secure ground' for determining VA's wishes. He was clear though that privacy and independence were important to her and so at [46] 

"To justify continuing the invasive procedure of the tracheostomy, deep suctioning and PEG in circumstances where there can be no medical benefit and only physical burden, I would have to be satisfied that this is what Mrs VA would really have wanted. Even then, her wishes and feelings would not be determinative."

Accordingly he finds extubation and palliative care focusing on giving the best quality of life, at the end of life, is in her VA's best interests and granted the declaration sought by the Trust. He also emphasised that the Official Solicitor supported the Trust’s application, having heard all the evidence.

Read the judgment on Bailii