Court of Protection finds continued clinically assisted nutrition and hydration is not in FHR’s best interests
The Court of Protection has ruled that continued clinically assisted nutrition and hydration (CANH) is not in the best interests of FHR, an incapacitated 28-year-old man who has been in a prolonged disorder of consciousness since January 2020.
The judgment was handed down on 26 August 2026 by Mr Justice McKendrick following a hearing on 17–20 August. The case, NHS North East London ICB v FHR and others, was heard in the Court of Protection under neutral citation [2026] EWCOP 43 (T3).
FHR lacks capacity to make decisions about life-sustaining medical treatment, care and residence. The central issue was whether continuing CANH remained in his best interests. The court concluded that it did not and directed that FHR should receive palliative care instead.
The judgment places particular emphasis on the statutory best-interests test under section 4 of the Mental Capacity Act 2005. Mr Justice McKendrick stressed that the question is whether treatment is in the person’s best interests, rather than whether withdrawal itself is in their best interests.
The court also confirmed that CANH is medical treatment rather than basic care. Its continuation must therefore be justified through the same best-interests analysis that applies to other medical treatment. Where continuation is not in a person’s best interests, withdrawal is lawful.
For solicitors involved in Court of Protection cases concerning life-sustaining treatment, the judgment reinforces the importance of assessing the individual’s circumstances rather than treating a particular clinical diagnosis as determinative. The court said the emphasis should not be simply on whether a person might regain consciousness, but on whether they could recover a quality of life that they would personally value.
The court considered evidence concerning FHR’s level of consciousness, prognosis, pain and discomfort, treatment needs, previous wishes and values, and the views of his family and carers. It also considered the strong presumption in favour of staying alive, while noting that the presumption is not absolute. The decision-maker must consider welfare in the widest sense, including medical, social and psychological factors, and weigh the burdens of treatment against its benefits.
The judgment records that FHR had undergone extensive assessments using tools including the Wessex Head Injury Matrix, the Coma Recovery Scale-Revised and the Sensory Modality Assessment and Rehabilitation Technique. Mr Justice McKendrick found that further testing would not alter the best-interests assessment.
The court found that FHR experienced pain and discomfort and concluded that, on the balance of probabilities, he could not recover a quality of life that he would personally value. The applicant Integrated Care Board, the single joint expert on best interests and the Official Solicitor, acting as FHR’s litigation friend, all agreed that CANH was no longer in his best interests.
The court directed that FHR should receive palliative care. Mr Justice McKendrick said he favoured palliative care at home if a safe and appropriate care package could be arranged. However, because no complete home-care package was available at the time of judgment, the court ordered that it was in FHR’s best interests to receive palliative care at the Specialist Unit, which had experience of palliative care for patients with prolonged disorders of consciousness.
The judgment also provides that the parties may apply to vary the order if an appropriate home palliative care arrangement can be agreed. The proceedings were otherwise concluded, with the transparency order to cease 21 days after FHR’s death