Testing the limits of best interests: balancing burdens, beliefs and values in the Court of Protection

Mrs Justice Theis, Vice President of the Court of Protection, has recently handed down judgment in the case of Mid Yorkshire Teaching NHS Trust v QM & Anor [2026] EWCOP 22 (T3). The judgment provides useful insight into the difficult best interests balancing exercise the court must undertake when both the medical evidence and the patient’s beliefs and values are unambiguous but in clear opposition.

Background

This case concerns QM, a mother of 2 young children who tragically suffered a catastrophic hypoxic brain injury in January 2026 following an out-of-hospital cardiac arrest aged 33. At the time of the hearing, QM had been on ICU for over 100 days. She was intubated and ventilated and had a nasogastric tube for feeding and hydration. The medical evidence, which was not disputed, was that QM was in a prolonged disorder of consciousness (‘PDOC’) at the lowest end of the spectrum of awareness. QM’s prognosis was poor, with expert evidence indicating that the highest level of improvement which could possibly occur would be small changes like QM turning her head in response to a sound. QM’s condition was also deteriorating, with the evidence suggesting she was likely to be experiencing pain from certain clinical interventions, particularly those connected to severe contractures in her arms.

The Trust’s application to the Court of Protection sought declarations as to QM’s best interests and proposed that life-sustaining treatment be withdrawn and QM be provided with palliative care.

The position of the parties

The Trust’s position was that QM’s ongoing treatment was sadly futile as it could not treat her severe underlying brain injury. Such treatment was not, the Trust said, bringing any benefit to QM, but rather prolonging her death.

QM’s husband, GE, was represented in the proceedings and accepted the medical evidence. However, he and QM’s wider family strongly objected to the Trust’s application. He emphasised the depth of QM’s Roman Catholic faith and love for her children. He submitted that these were central to QM’s identity, and that she would want every chance to recover.

The Official Solicitor, in her role as QM’s litigation friend, did not support the Trust’s application, focusing on the importance of the sanctity of life and QM’s Article 8 and 9 ECHR rights. The submissions for the Official Solicitor focused on the strength of the evidence about QM’s wishes, feelings, beliefs and values, particularly around her views, as expressed by her family, on the preservation of life in and of itself, even if that life was felt to be limited in quality or quantity.

The court’s decision

Theis J characterised the issues in this case as being “profound and extraordinarily difficult” and a situation which “tests the limits of the concept of what is in a person’s best interests and how that is to be assessed”. She emphasised the need for a holistic assessment of QM’s best interests, having regard to the medical evidence and prognosis, but also the evidence available about QM’s wishes, feelings, beliefs and values, and those of her family and community. In doing so, Theis J noted that there was little factual dispute in the case, with neither the medical evidence nor the evidence from QM’s family about her views being significantly challenged.

Theis J made findings of fact about the medical evidence as sought by the Trust, in particular that it had been established that QM was not going to recover beyond possibly some very limited changes, and that her condition and experience of pain were getting worse. When considering QM’s wishes, feelings, beliefs and values, the court found that there was “detailed and reliable information” available about these, and that QM’s children, family and faith were “at the core of who she is”. The court accepted the evidence that withdrawal of life-sustaining treatment would not accord with QM’s beliefs and values, and that the sanctity of life must be given particularly close consideration in such circumstances.

However, in looking at QM’s best interests in “the widest sense”, the court was required to weigh QM’s wishes, feelings, beliefs and values against the considerable and likely increasing burdens of her continuing treatment. Ultimately, Theis J’s conclusion was that such burdens outweighed the benefits of life-sustaining treatment, even given QM’s established values and beliefs.

Discussion

This very sad case highlights the difficult balancing exercise which the court is tasked with when establishing what is in a patient’s best interests. It demonstrates that neither medical evidence nor a patient’s wishes, feelings, beliefs and values will be determinative on their own. In this case, despite the clear evidence that withdrawal of life-sustaining treatment would be contrary to QM’s beliefs, particular her deep Roman Catholic faith, the burdens of her treatment were considered to be so substantial, and the prospect for improvement so small, that the court decided life-sustaining treatment should not continue and QM should receive palliative care.

It also makes clear the need for prompt escalation to court of such disputes (as there was in this case), where the views of both the Trust and the patient’s family are well-established (and not contested), but are fundamentally at odds in a way which means that only the court will be able to make a final determination of best interests.

Flora Jago and Helen Claridge were instructed by the Trust in this matter, along with counsel Katie Scott of 39 Essex Chambers. The full judgement can be found here.