St George’s University Hospitals NHS Foundation Trust v UJ & Ors [2026] EWCOP 39 (T3)
Judge: Mrs Justice Theis DBE
Date: 16 July 2026
Background
UJ was a 45-year-old man who suffered a severe traumatic brain injury after attempting to take his own life in April 2026 by shooting himself in the head with a crossbow arrow. Following emergency surgery, he remained under the care of St George’s University Hospitals NHS Foundation Trust. There was no dispute that UJ lacked capacity to make decisions regarding his medical treatment or conduct litigation, and the Official Solicitor was appointed to act on his behalf.
As a consequence of his brain injury, UJ developed hydrocephalus, meaning that his body could no longer adequately drain cerebrospinal fluid. Initially this was managed by a combination of lumbar puncture, a lumbar drain, and an external ventricular drain. Following the development of a large pulmonary embolism clinicians considered that the only viable option for long-term treatment of UJ’s hydrocephalus was the insertion of a permanent shunt.
The medical evidence was that, without the shunt surgery, UJ’s condition would continue to deteriorate with likely progression to a coma-like state and ultimately death. Conversely, the proposed surgery offered the best chance of recovery and rehabilitation, albeit with outcomes ranging from a largely independent life with some support through to complete dependence on others for all aspects of day to day care.
UJ’s family opposed the application. They described UJ as independent, free-spirited and someone who valued his autonomy, and that “to be trapped in a body which cannot move or function independently is a fate that he would consider a living torment”. They believed that he would not have regarded a life of significant disability, dependence on others and loss of independence as acceptable. Particular reliance was placed on the circumstances of his suicide attempt, including the fact that he had written “DNR” on his chest and arms before trying to take his life.
Decision
Applying the best interests framework under the Mental Capacity Act 2005, Mrs Justice Theis emphasised that the court’s task was not limited to considering medical welfare but required consideration of UJ’s wishes, feelings, beliefs and values, consistent with the approach set out by the Supreme Court in Aintree University Hospitals NHS Foundation Trust v James.
The judge accepted the medical evidence that the proposed procedure was clinically justified and gave UJ the best chance of rehabilitation and recovery. She also recognised the importance of the sanctity of life as a powerful factor weighing in favour of treatment.
However, the judge attached significant weight to the evidence of UJ’s family regarding his values and outlook on life. The judge found their evidence to be thoughtful, considered and reasoned. Whilst acknowledging the inherent difficulty of determining what UJ himself would decide in his present circumstances, she accepted that the available evidence strongly suggested he would not have wished to undergo treatment that might result in a life marked by substantial disability and dependency.
Theis J therefore concluded, albeit with “very great sadness”, that the surgery was not in UJ’s best interests and refused the Trust’s application.
Comment
The significance of this decision lies in the weight the court was prepared to place on the evidence of those who knew UJ best regarding his independence, lifestyle and deeply held values, notwithstanding that the proposed treatment represented the only realistic prospect of recovery. Faced with a prognosis that was uncertain and a spectrum of possible outcomes ranging from relative independence to complete dependency, the court attached considerable importance to the consistent and compelling evidence of UJ’s family as to the life he would have regarded as acceptable. The judgment serves as a reminder that the best interests assessment is a profoundly individual exercise, directed towards identifying the course that most closely accords with P’s own wishes, feelings, beliefs and values, rather than broader societal assumptions about the benefits of preserving life.
The judgment also illustrates the careful balancing exercise required by the Mental Capacity Act 2005 when determining best interests. Whilst the sanctity of life remains a factor of substantial weight, it is not determinative. Where there is cogent evidence that the likely consequences of treatment would be fundamentally inconsistent with P’s views of an acceptable quality of life, those considerations may outweigh the medical benefits of life-prolonging intervention.
The full judgement can be found here.
