• Intensive Care Units, Neonatal
• Intensive Care Units, Paediatric
• Paediatrics

The common law provides helpful principles to follow when contemplating the withdrawal of medical treatment; paediatricians often seek guidance in these circumstances.1 The case of MB2 is particularly relevant; the judge, Holman J, engaged in detail with the facts of infant’s case, and demonstrated how a balancing exercise between risks and benefits of treatment can be formulated, while acknowledging future uncertainties. His approach could provide structure to medical decision-making.

M was born in 2004 and was well for the first few weeks of his life. His parents then noticed he was increasingly floppy, and he was admitted to hospital in the seventh week of life. At the time of the hearing, now 18 months, there he remained. M had eventually been intubated and ventilated at 11 months of age, fed via gastrostomy. He had been diagnosed with type 1.1 spinal muscular atrophy (SMA). The court was told by an expert in the field that this was ‘…the most severe of all amongst those (children with SMA) who are not born dead’. The court found a consensus among all the doctors involved that M’s disease was ‘very severe indeed’, and that his condition was degenerative, progressive, irreversible; it could only get worse.

The reason M’s case was heard in court was that the hospital, in these circumstances, applied for a declaration: that it was in M’s best interests to withdraw respiratory support, while ensuring …