NHS North East London ICB v FHR & Ors [2026] EWCOP 43 (T3)
Judge: Mr Justice McKendrick
Date: 26 August 2026
Background
FHR was a 28-year-old man who sustained a catastrophic hypoxic brain injury in January 2020 after attempting to hang himself. Prior to his injury, he was described as a sociable and family-orientated young man, a practising Muslim, who worked as a mechanic and enjoyed close relationships with his parents and sister.
Following the injury, FHR was left profoundly disabled. He required PEG feeding, tracheostomy management, frequent suctioning, was mostly paralysed, likely blind and wholly dependent on others for all aspects of his care. There was no dispute that he lacked capacity to make decisions regarding his treatment and care.
The proceedings centred on whether it remained in FHR’s best interests to continue to receive clinically assisted nutrition and hydration (CANH). The issue followed extensive assessments of FHR’s level of consciousness over a number of years. There was a dispute amongst professional witnesses as to whether FHR was in a persistent vegetative state (PVS) or a or a minimally conscious state (MCS) with considerable debate about the tools used to assess patients in a prolonged disorder of consciousness (PDOC). Whilst the family and their clinical witness, Dr Allanson, considered FHR to be in a minimally conscious state with potential for further improvement, the applicant ICB and the court-appointed expert, Dr Nair, contended that FHR remained in a permanent vegetative state with no realistic prospect of recovery.
Decision
The Court concluded that continued CANH was no longer in FHR’s best interests and authorised its withdrawal, with palliative care to be provided.
An interesting feature of the judgment was the court’s emphasis that the precise diagnostic distinction between a persistent vegetative state (PVS) and low level minimally conscious state (MCS) was not determinative. The judge stated that although the extent of FHR’s unconsciousness was an important factor in the best interests analysis, it was only one part of the best interests picture. Consistent with recent authorities and the Royal College of Physicians’ guidance, the critical question was whether FHR could ever recover a quality of life that he himself would value.
The judge preferred the evidence of the single joint expert Dr Nair to that of the mother’s clinical witness, Dr Allanson. He found that repeated assessments undertaken between 2020 and 2026 demonstrated no reliable evidence of meaningful communication or awareness and no positive trajectory towards recovery. On balance, FHR remained in a permanent vegetative state, although the judge observed that even a diagnosis of low level MCS would not have altered the best interests outcome.
Particular weight was placed on the burdens of treatment. The court accepted that FHR experienced pain and discomfort, including from worsening contractures, regular suctioning and recurrent infections requiring repeated hospital admissions. By contrast, there was no reliable evidence that he derived pleasure, enjoyment or comfort from his existence or from interaction with family members, notwithstanding the family’s sincerely held beliefs to the contrary.
The court accepted that FHR’s Muslim faith and strong family values formed an important part of his identity. However, there was insufficient evidence to determine what FHR himself would have wanted in circumstances so profoundly different from anything he had previously experienced.
Comment
This decision adds to the growing body of Court of Protection jurisprudence concerning withdrawal of CANH from patients in PDOC. The judgment reinforces the modern approach derived from Aintree, namely that the focus is not on diagnostic labels but on whether treatment confers any meaningful benefit when balanced against the burdens it imposes.
The decision also serves as a reminder that whilst the views of loving and devoted family members remain of central importance, the court’s task is ultimately to assess matters from P’s perspective. Applying that analysis, McKendrick J concluded that continued CANH was merely prolonging a life characterised by pain, discomfort and profound incapacity, with no realistic prospect of recovery
The full judgment can be found here.
