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Paediatric End-of-Life Legal Judgments: Lessons from the MG Case [2025]

How the MG Case Shapes Future Paediatric End-of-Life Legal Judgments in the UK


In Great Ormond Street Hospital for Children NHS Foundation Trust v ZG & Ors [2025] EWHC 1042 (Fam), the High Court delivered a pivotal judgment on the lawfulness of withdrawing life-sustaining treatment for a severely brain-injured child. The case of MG, a three-year-old boy in a persistent vegetative state, has now become a key reference point in paediatric end-of-life legal judgments.


This case reaffirms the role of the courts in balancing parental beliefs, clinical expertise, and the child’s welfare in ethically complex decisions.


Empty paediatric hospital beds in a dimly lit room, symbolising stillness and clinical care decisions
A quiet paediatric ward—evoking the solemn realities underlying end-of-life legal decisions in children.

Case Summary


MG was diagnosed with acute lymphoblastic leukaemia in April 2024 and began chemotherapy. Following a catastrophic stroke in May 2024, he suffered irreversible brain injury. Despite high-level intensive care, including mechanical ventilation and the use of an external ventricular drain, MG never regained consciousness.


GOSH initiated legal proceedings in December 2024 seeking a declaration that continued treatment was no longer in MG’s best interests. The application was opposed by his parents, ZG and KG, who cited faith and hope of recovery. Independent medical experts—including one instructed by the parents—unanimously agreed there was no prospect of improvement.


Key Timeline


  • 19 April 2024: Diagnosis of leukaemia

  • 24 May 2024: Catastrophic stroke

  • 3 June 2024: EVD inserted following haemorrhage

  • July 2024: Hospital ethics review advises withdrawal

  • December 2024: Proceedings issued by GOSH

  • January 2025: Updated scans show no progress

  • 14–15 April 2025: Final hearing

  • 24 April 2025: Judgment delivered


Legal Analysis


The court applied the now-established five-part best interests test drawn from Re Fixsler, Aintree v James, and Bland. These “intellectual milestones” require:


  1. The court to determine the child’s best interests, with welfare as paramount

  2. Consideration from the child’s perspective

  3. Recognition of a presumption in favour of life, which may be rebutted

  4. A thorough balancing of burdens vs benefits of continued treatment

  5. Consultation with all stakeholders, including court-appointed guardians


Justice Trowell concluded that continued treatment was futile and burdensome, and that withdrawal would be lawful and in MG’s best interests.

Lady Justice figurine on a wooden desk, representing the balance of law in paediatric end-of-life cases
The law’s role in paediatric end-of-life legal judgments requires a careful weighing of ethical and clinical evidence.

Medical Evidence and Court Findings


All medical professionals, including the family’s instructed expert Professor Playfor, agreed that:


  • MG had no awareness or cognitive function

  • His condition would not improve and deterioration was inevitable

  • Continued mechanical ventilation would lead to further complications (e.g. pneumonia, scoliosis, bone disease)

  • MG would die within hours if ventilation were withdrawn, but could survive for months or years in an unconscious state if it continued


Justice Trowell found no evidence of meaningful improvement or awareness and described the burdens of ongoing ICU care as significant. The presumption in favour of life was rebutted.


Ethical and Professional Reflections


Mother holding a newborn in her arms, representing parental love and hope in critical care decisions
Parental devotion is central in paediatric care disputes—yet legal frameworks focus on the child’s best interests.

This case reinforces the gravity and structure required in paediatric end-of-life legal judgments, particularly:


  • The indispensable role of expert medical evidence, including independent instruction

  • The limits of parental authority, even when rooted in faith or love

  • The necessity of judicial oversight in cases of clinical consensus and ethical uncertainty

  • The importance of multidisciplinary engagement, including guardians, palliative specialists, and intensive care consultants


Conclusion


The MG case underscores the profound responsibility carried by courts, clinicians, and expert witnesses in paediatric life-sustaining treatment cases. The judgment demonstrates a sensitive yet resolute application of legal principles to a heart-breaking set of facts.

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