Ceiling of care cases

Religious objections have also been raised where clinicians seek to introduce a ‘ceiling of care’, that is, where a Trust asks a court to order that withholding treatment above a certain threshold, or withholding specific types of treatment, is lawful.

In Great Ormond Street Hospital for Children NHS Foundation Trust v MBC Peel J granted declarations sought by the Trust to implement a ceiling of care for a 19-month-old child who was born with catastrophic brain damage with no prospect of cure. Her brain damage was not progressive but her life expectancy was said to be, at best, until her late teens or early adulthood.

A declaration was sought by the Trust which would permit it to withhold invasive ventilation from the child, which was necessary during her periods of deterioration. The treating clinicians were all in agreement that continuing to provide the child with non-invasive ventilation and intubation remained clinically appropriate and in the child’s best interests.

The child’s father was a practising Muslim and considered that he could not consent to the ceiling of care proposed by the Trust. On religion, he contended that the child (‘ABC’) would have been brought up in the Islamic faith and followed its tenets. He also contended that the parents’ Arts 8 and 9 rights should be taken into account in such applications.

Peel J held that:

‘I also take into account the family’s religious views, which merit the utmost respect. ABC herself would have been raised in [the] Islamic faith, but at this stage of her life, and in this condition she does not hold any concept of religion. ABC would no doubt be influenced by her parents’ views, but she remains an individual in her own right.’

In his overall conclusion Peel J held that the ceiling of care proposed was in ABC’s best interests. He considered that this was ‘consistent with human rights considerations to which I have referred, being necessary and proportionate.’

This case is indicative of the same approach to religious beliefs, and Arts 8 and 9 rights, in such applications. The parents’ Art 9 rights (including for example, a religious belief that nothing should be done to hasten death) must be considered by a court, but as Art 9 is a qualified right, interference will often be seen by a court as necessary and proportionate, especially where a child is known to be in pain or the treatment proposed will confer little benefit.