Kathy Walker, Child Care Director at Duncan Lewis Solicitors, represented the father in the recently published judgment of Cardiff and Vale University Local Health Board v SR & Ors [2026] EWHC 348 (Fam). These highly sensitive proceedings concerned the withdrawal of life-sustaining medical treatment for his young son, TR. The case raised complex issues relating to medical ethics, best interests, parental rights, and religious belief.
Background
TR is a young child with a diagnosis of Leigh Syndrome, a severe, progressive, fatal mitochondrial disorder, causing irreversible brain damage, absence of cognitive awareness, ventilator dependence, and no meaningful prospect of recovery. Medical evidence provided by experts confirmed that TR has sustained irreversible brain damage and that there is no treatment available to cure or attenuate the severity of his condition.
The Cardiff and Vale Health Board issued an application seeking a declaration under the inherent jurisdiction of the High Court that it was lawful and in TR’s best interests to withdraw invasive ventilation.
Parents’ Position
Both parents opposed the Health Board’s application and gave evidence to the Court.
TR’s mother explained that both parents were united in their love for TR and their concern for what was best for him. She described a positive and cooperative relationship with the treating clinicians and remained closely involved in TR’s daily care during his admission to intensive care. While acknowledging that she was not a clinician, she believed that TR showed meaningful signs of awareness and responsiveness, including eye opening, facial expressions and responses to familiar voices. She considered TR to be calm, settled and relatively stable, noting that he had lived longer than initially predicted and was not, in her view, suffering.
The mother stated that her Muslim faith was central to her position. She believed that life and death are determined by Allah and that withdrawal of treatment would be contrary to her deeply held beliefs, causing her profound spiritual distress and lifelong emotional trauma.
TR’s father also opposed withdrawal of treatment. He described TR as his only child and said that all decisions he made were guided by what he believed to be in TR’s best interests. While accepting that TR’s condition was severe, he pointed to periods of stability and previous instances where TR had outlived medical expectations. He believed that TR demonstrated some level of awareness and might again defy predictions.
The father, a practising Muslim, shared the belief that life and death are determined by Allah alone. He considered that withdrawing treatment would violate his faith and undermine TR’s religious identity. He questioned the certainty of the medical prognosis and expressed concern that the clinicians’ position focused on future risks rather than TR’s present condition.
The Law
The Court confirmed that the legal principles governing cases of this nature are well settled and adopted the framework advanced on behalf of the Health Board.
Mr Justice Garrido reaffirmed that the Court has jurisdiction to make declarations in relation to medical treatment where a child cannot decide for himself and there is disagreement between clinicians and those with parental responsibility. Although there is a strong presumption in favour of preserving life, that presumption is rebuttable.
The sole test to be applied is whether the proposed course of action is in the child’s best interests, requiring a holistic and objective assessment of welfare in its widest sense. Religious beliefs form part of that analysis but are not determinative.
The Court’s Analysis
In conducting his analysis, Mr Justice Garrido emphasised that TR’s welfare was the paramount consideration and that the Court was required to determine objectively which treatment option was in TR’s best interests. That assessment encompassed medical, emotional and all other welfare considerations. While there was a strong presumption in favour of preserving life, the Court was required to consider the totality of the evidence, including the parents’ views and religious beliefs.
The Court found an overwhelming and consistent body of medical evidence demonstrating the irreversible and progressive nature of TR’s illness. Although TR could at times appear superficially stable, the judge accepted expert evidence that he had suffered irreversible brain damage, had no cognitive awareness, would never breathe independently, and was in the terminal phase of a fatal condition, with no prospect of recovery.
The judge acknowledged the care, love and devotion shown by TR’s parents and accepted that perceived responses to interaction were entirely understandable sources of hope. However, the Court accepted expert evidence that such observations were consistent with the absence of cognitive awareness and an inability to experience pleasure.
In weighing the competing factors, the Court concluded that the defining features of TR’s condition weighed heavily against the continuation of invasive treatment. Set against this were the parents’ deeply held objections, the impact on their family life, and the importance of their Islamic faith.
The Court accepted that continued treatment was burdensome for TR, even if he was unlikely to experience pain, and identified significant physiological risks associated with ongoing invasive ventilation. The judge concluded that it could not be in TR’s best interests to continue treatment that was incapable of halting or alleviating the progression of his fatal illness, notwithstanding the profound emotional and spiritual impact of that decision on his parents.
The Court’s Decision
The Court declared that it was not in TR’s best interests for life-sustaining treatment to continue and approved the withdrawal of intubation and invasive ventilation. The Court also approved the implementation of an updated palliative care plan.
Significance
The decision reflects the well-established approach taken by the courts in cases concerning the withdrawal of life-sustaining treatment for children. It highlights the careful and sensitive way in which the Court considers parental views and religious beliefs alongside vast expert medical evidence when determining a child’s best interests.
The client was represented by director Kathy Walker, instructing Denise Gilling KC and Gemma Kelly of 1GC Family Law as counsel.
About Kathy Walker
Kathy Walker is a Director at Duncan Lewis Solicitors and a highly respected specialist in public law children matters, with over 20 years’ experience in complex and sensitive care proceedings. A longstanding member of the Law Society Children’s Panel, Kathy is recognised for her child-focused and empathetic approach, and for her expertise in some of the most challenging cases involving serious medical, welfare and safeguarding issues.