Proceedings commenced initially by the father (“F”) in respect of his daughter, a young woman aged 20 (named ‘Lilia’ in the judgment), who had attempted suicide. Very sadly, this had resulted in a catastrophic brain injury leading to a prolonged disorder of consciousness, from which she had not emerged and remained in a vegetative state.
London NHS Trust v CD & Ors (Withdrawal of Life Sustaining Treatment)
F commenced proceedings on 26 January, seeking to be appointed her welfare deputy. Shortly after, her mother (“M”) applied to be appointed her welfare, property and affairs deputy. At the initial hearing, Mr Justice Newton joined Lilia, appointed the Official Solicitor to represent her and for the NHS to file evidence. Overall, the NHS, Lilia’s mother, sister and others felt that life sustaining care should be withdrawn. F wanted to seek further opinion and was given the opportunity to instruct an independent expert. Dr Chris Danbury, who concurred with the views of the treating NHS physicians.
Having reviewed the requirements of the Mental Capacity Act 2005, the European Convention of Human Rights, the UN Convention on the Rights of Persons with Disabilities and relevant case law, the judge held that he was satisfied it wasn’t in “Lilia’s best interests to administer life-sustaining medical treatment but rather that it is in her best interests to implement a palliative care regime the consequence of which (but not the aim) will be the end of her life but that I think will be an ending to her story essentially of her choosing and one which I feel confident she would endorse…” [Para. 68.]
The judge made observations about the impact of chronic high-conflict on Lilia. See, for example:
“I am concerned with a young woman, CD, who I shall call Lilia for the purposes of this judgment. As a judge assigned to the Family Division but also nominated to sit in the Court of Protection the facts of this tragic case bring painfully into the spotlight for me one dimension of the potential consequences of prolonged parental conflict for the children at the heart of a family dispute.”
The dispute between her parents that had dogged the lives of the family and most importantly their children at least since their separation therefore continued into this court but now on quite literally a matter of life and death. I simply note that as a fact; I express no views on who is responsible for the parental conflict; that is not the purpose of these proceedings, is not justiciable within them and would probably serve no purpose. Almost inevitably Lilia's mother and father must have been asking themselves could they have done anything differently which might have altered Lilia's trajectory in life which has led here. I doubt that they will find any answer to those questions and it is highly likely that the causes of Lilia's psychiatric and psychological conditions and her attempt to end her life are complex and multi-faceted; it seems that Lilia's psychological and psychiatric well-being was also significantly affected by the pandemic generated lock-down. Only the parents can have some sense of whether they might have done things differently and given Lilia a childhood less complex and troubled than that which she lived. They certainly owe it to their other daughter to try.”
The mother considers that Lilia felt overwhelmed by the demands her father placed on her and her letters to her father and extracts from her notebook illustrate some of the difficulties. She wrote;
"To Dad. For some time, you've wanted to understand how I feel about you, and why our relationship has deteriorated. So I'm going to explain how I feel. As a child, you would tell me many things about the animosity between you and mum that were very upsetting for me. Serious conflicts with terrible implications. Conflicts that I never needed to be involved in, that should have been kept between adults. You were frustrated, you wanted me to understand how you felt. But I wasn't your confidant, your friend or your counsellor. I was just a child, your child. All I wanted was to be protected…… When I raise a concern or say I don't like what you are doing, you assume the thought has been planted there by someone. You assume my feelings are not my own and immediately try to hunt down the puppet master instead of respectfully accepting and validating my feelings."
And at para 66:
“I do not have sufficient information available to me to draw any firm conclusions but the impression from what she has said about her childhood experiences was that it was marred by conflict between those who should have been the most important figures in her life; her mother and father. It seems likely that her enjoyment of experiences and sensations may have been some escape from the complex thoughts which troubled her.”
For more information about this, the impact on children of inter-parental conflict, and the importance of early intervention, there are the following reports: Annual Research Review: Inter-parental conflict and youth psychopathology: an evidence review and practice focused update, Gordon Harold and Ruth Sellers, Journal of Psychology and Psychiatry: https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12893 and the Early Intervention Foundation’s ‘What works to enhance inter-parental relationships and improve outcomes for children’: https://core.ac.uk/reader/74381020.