Best Interests in Paediatric Expert Witness Cases: Supreme Court Clarifies Legal Limits and Professional Protections

Understanding the Expert’s Role in Best Interests Proceedings

In April 2025, the UK Supreme Court handed down judgment in Abbasi and Haastrup v NHS Trusts ([2025] UKSC 15), offering critical clarification on the boundaries of parental rights, clinical decision-making, and the legal standard for anonymity in cases involving gravely ill children. For those working in the expert witness sector, particularly in paediatric, nursing, and critical care disciplines, the ruling reaffirms the primacy of a child’s best interests in treatment disputes and defines more clearly when clinicians can be shielded from public identification.

Empty hospital beds in a paediatric ward — a quiet symbol of the sensitivity and gravity in end-of-life care decisions.

At Apex Experts, our expert witnesses routinely contribute to complex cases where these principles are tested. This judgment informs how evidence should be approached in emotionally charged, high-profile cases—where clinical decisions intersect with legal scrutiny and public interest.

What the Judgment Means for Best Interests in Paediatric Expert Witness Cases

The Supreme Court’s judgment significantly influences how best interests in paediatric expert witness cases are assessed, reported, and understood. For clinicians, solicitors, and expert witnesses alike, the ruling solidifies the guiding legal principle: the welfare of the child outweighs parental wishes, no matter how sincerely held or emotionally charged those wishes may be.

This means that when expert witnesses are asked to evaluate care plans or the appropriateness of life-sustaining treatments, their findings must focus first and foremost on objective clinical indicators of the child’s best interests—not parental hope or fear. The Court also emphasised the legal mechanisms available to protect healthcare professionals when their involvement in such sensitive cases becomes the subject of public or media attention.

The Facts Behind the Supreme Court Appeal

The appeal consolidated two cases:

• Zainab Abbasi, who died in 2019 after protracted disagreement between her medically qualified parents and the treating NHS Trust over end-of-life care. Her parents later sought to publicly name the clinicians involved.

• Isaiah Haastrup, born with catastrophic brain injury in 2017. His parents opposed the withdrawal of life support, and after his death, contested an injunction preventing the identification of clinical staff.

Both cases challenged indefinite anonymity injunctions granted during the original care proceedings. The Trusts argued they were necessary to protect staff from harassment, especially in light of previous incidents involving public hostility, such as in the Charlie Gard and Alfie Evans cases.

A wooden gavel symbolising the legal authority of the court in best interests decisions involving children.

Chronology of Events

Abbasi Case

• 2013–2019: Zainab treated at Newcastle; disputes arose over her end-of-life care.

• 2019: GOSH obtained anonymity injunctions for staff.

• Post-2020: Zainab passed away; her family sought to identify clinicians in public statements.

Haastrup Case

• 2017: Isaiah suffered a birth injury.

• 2018–2020: Litigation ensued over continuation of treatment.

• Post-2020: The parents attempted to publicly name hospital staff and campaign on their son's case.

Key Legal Questions Considered

The Supreme Court addressed:

1. Whether parental rights override clinical decisions if those decisions are made in a child’s best interests.

2. When and how courts may continue anonymity orders after proceedings conclude.

3. Whether bereaved parents have a legal right to publicly name treating clinicians.

The Court’s Findings: Legal Clarity for the Medico-Legal Sector

The Best Interests Standard Is Paramount

The Court reaffirmed that the legal test in life-sustaining treatment disputes is what is in the child’s best interests. It explicitly rejected proposals to apply a “significant harm” threshold drawn from child protection law. Courts, not parents, determine the outcome where consensus cannot be reached.

“The question is always: what is in the child’s best interests?” — [2025] UKSC 15, para 1

Anonymity Must Be Justified, Not Presumed

While the Court acknowledged that injunctions during proceedings are often justified to prevent disruption to care and staff harassment, continued anonymity post-judgment requires case-specific evidence. A generic fear of reputational harm or morale damage is insufficient.

Clinicians seeking protection must be directly involved and should assert their own privacy claims under Article 8 ECHR. Trusts may not indefinitely invoke anonymity on their behalf.

No Absolute Right to Name or Shame

Parents and the press may discuss their experiences—but must balance freedom of expression with clinicians’ legal rights. The ruling confirms there is no automatic entitlement to publicly name clinical staff after proceedings end.

Two clinicians confer in a hospital setting — symbolising multidisciplinary input in complex paediatric care decisions.

Implications for Medico-Legal Experts

This ruling further refines how experts must frame their opinions in best interests in paediatric expert witness cases:

• Child-centred analysis is mandatory. The opinion must reflect objective medical reasoning rooted in paediatric best practice.

• Respect for clinician anonymity is not automatic but must be balanced against legal rights and public interest.

• Joined-up legal thinking is essential. Experts must now be prepared for their evidence to feature in proceedings where the potential for public attention—and therefore legal protection—is high.