In a recent decision, the Court of Protection refused to permit withdrawal of life-sustaining treatment from a 60-year-old man in a permanent vegetative state, placing weight on his spiritual beliefs and values. The decision in The Hillingdon Hospitals NHS Foundation Trust v YD & Ors [2025] has important messages for NHS hospital trusts and Integrated Care Boards, particularly around timing of applications and resource allocation.
Background
YD suffered a catastrophic brain haemorrhage in October 2024, leaving him in a prolonged disorder of consciousness. By 2025 he was diagnosed as being in a permanent vegetative state and was being kept alive by clinically assisted nutrition and hydration (CANH).
The hospital trust applied to the Court of Protection for permission to withdraw CANH, supported by medical evidence that there was no realistic prospect of recovery. The trust argued that continuing treatment was futile and burdensome, and that a shift to palliative care would be more compassionate.
The application was opposed by YD’s two long-term partners, who, although unaware of each other before his collapse, both became daily carers and advocates for him. They gave compelling evidence of YD’s deep-seated spirituality, his belief in the power of the mind and body to heal, and his determination never to give up. Their accounts were supported by YD’s close friend and the Official Solicitor. YD had made no advance decision refusing treatment.
The court’s reasoning
Mrs Justice Theis found that the presumption in favour of preserving life had not been displaced. Although medical evidence pointed to irreversible brain injury and negligible chances of recovery, she concluded that YD’s own beliefs and values tipped the balance in favour of continued treatment.
The testimony of his partners and friend showed that YD was someone who valued perseverance and spirituality and would likely have wished to continue life-sustaining treatment in the hope of improvement, however small. The judge emphasised that the best interests test must be applied from the patient’s perspective, taking into account past and present wishes, feelings, beliefs and values. On that basis, she held that withdrawal of CANH was not in YD’s best interests.
Lessons for NHS trusts and ICBs
Timing and process of applications
The decision highlights the need for timely, structured approaches to these cases. The court raised the issue of whether patients in similar circumstances should be transferred to community placements sooner pending the outcome of an application. Leaving patients in scarce rehabilitation beds while applications are pending can create unintended pressures on services and fuel tensions with families.
ICB involvement
The wider aspect of this case raised the question of how far ICBs should be formally engaged in proceedings given their role as commissioners of care packages. Here, the ICB was involved behind the scenes but not as a party. The decision makes clear that ICBs should take a proactive role in future cases, both in terms of planning placements and making sure the court is fully informed of commissioning considerations. Early engagement helps to avoid delays, ensures funding is secured, and allows the court to focus on the best interests test rather than operational uncertainties.
Resource allocation pressures
The financial burden of caring for a patient in a PVS in a specialist nursing home is considerable. One doctor in the case provided evidence that YD had a 50% chance of living another five to six years, thus multiplying that cost.
The decision reinforced the principle that decisions about withdrawal of life-sustaining treatment must never be driven by resource allocation. The focus must remain solely on what's in the patient’s best interests. The court stressed the importance of transparency: if resource or placement concerns arise – for example, whether a patient should remain in a rehabilitation unit or be moved to long-term care – they must be proactively disclosed to the court and all parties.
Proactive planning, including early ICB involvement and identification of suitable community placements, will help ensure that patients don't have prolonged admissions in inappropriate settings.
Final thoughts
This case is a reminder that best interests decisions are highly individual and fact specific. NHS bodies are encouraged to make timely and transparent applications, involve ICBs early, and confront resource issues candidly. It is the applicant’s burden to rebut the presumption in favour of life, and evidence of a patient’s love for life can be decisive. The ruling shows that the Court of Protection will not lightly sanction withdrawal of life support where there is credible evidence that the patient, guided by their own values, would have chosen to live.
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