The judgment of Mr Justice Holman in the case of MB [2006] EWHC 507 (Fam) has raised concerns amongst paediatricians that they are now compelled to treat a child against their conscience. MB was a child who had the most severe form of spinal muscular atrophy. An NHS Trust sought a declaration that the child MB lacked the capacity to make decisions with regard to his future treatment and that it shall be lawful, notwithstanding his parents’ refusal to consent, and in MB’s best interests, for the medical staff to (a) withdraw all forms of ventilation and (b) provide palliative care. The judge refused to grant the declaration. This paper explores the concern of paediatricians that they are now compelled to treat a patient against their wishes and may be liable to civil or criminal action if they withdraw treatment.

MB was a child who suffered from the most severe form of congenital spinal muscular atrophy (SMA), which is degenerative and progressive. He was admitted to hospital at the age of 7 weeks when his condition was diagnosed. SMA affects the voluntary muscles which become progressively weaker and ultimately cease to function at all. Because the respiratory muscles are affected, death is inevitable in the most severe cases. At birth MB could use many of his muscles in an age normal way and could cry, smile, breath and move his limbs. At the time of the hearing in March 2006, he could no longer open his eyes fully but could follow movement with his eyes, although his eyes movements were irregular. Other movement was limited to a slight frown and perhaps slight movement …