Legal and Ethical Lessons from Neonatal Best Interests Court Applications

How Neonatal Best Interests Court Applications Shape Medico-Legal Practice

Within the emotionally charged environment of neonatal intensive care, difficult decisions occasionally reach the courts - particularly where clinical consensus and parental wishes diverge. One recent High Court case, Philipa Hodgson v Dr Daniel Hammond & Anor, provides a deeply instructive view into how best interests court applications in neonatal care are assessed and adjudicated in practice.

In this case, the applicant hospital sought legal clarity over whether it would be lawful to withdraw invasive life-sustaining support from a newborn infant with profound neurological and respiratory complications. The baby, referred to throughout proceedings in anonymised terms, had suffered significant hypoxic ischaemic brain injury shortly after birth, followed by persistent seizures and near-total cerebral inactivity. Despite intensive neonatal support, there was no clinical evidence of consciousness or purposeful interaction with the environment.

The parents, understandably devoted and deeply distressed, initially opposed the withdrawal of life-sustaining treatment. However, as the case developed and independent expert evidence was reviewed, including paediatric neurology and intensive care testimony, the consensus solidified: continued ventilation and intensive treatment were no longer in the child’s best interests.

What followed was a thorough legal analysis applying the now well-established principles from cases such as Aintree v James, Re Fixsler, and Bland. The court reaffirmed that the best interests of the child must be the paramount consideration, not merely in medical terms, but encompassing emotional, social, and ethical dimensions.

The child’s own experience, if any, was considered from the perspective of how they might view their own life and treatment if capable.

Several days after the application was submitted, the court convened an urgent hearing. Evidence was provided by the treating consultants, an independent expert, and the child’s court-appointed Guardian. All were united in their conclusion: the child was unconscious, in a state of profound and irreversible injury, and incapable of experiencing the presence or care of family.

The judge ultimately ruled that the continued use of mechanical ventilation would serve no therapeutic benefit and would only prolong suffering. In the following week, arrangements for palliative extubation were made in consultation with the family and care team.

Ethical and Professional Implications

This case is emblematic of the complexity surrounding best interests court applications in neonatal care. It reinforces several key considerations for the medico-legal community:

• The critical role of independent expert evidence - especially in neonatology and paediatric neurology.

• The importance of family engagement, even when their views differ from clinical consensus.

• The court’s duty to consider the child’s experience and not merely apply a clinical standard.

At Apex Experts, we support instructing parties with balanced, compassionate, and clinically grounded reports in complex neonatal and paediatric cases. Our network of senior clinicians is experienced in end-of-life and treatment withdrawal applications, ensuring clarity and ethical sensitivity throughout.

To consult with an independent neonatal expert, email: info@apexexperts.co.uk