This case follows on from the series of cases considering intensive care treatment and deprivation of liberty (Ferreira, Briggs, M and Y). It will be of interest to commissioners, providers and care co-ordinators involved with patients receiving palliative care. Please see relevant links below:



PL (by her litigation friend, SL) v Sutton Clinical Commissioning Group and Another [2017] EWCOP 22

Relevant Topics

  • Withdrawing Clinically Assisted Nutrition and Hydration ("CANH")
  • Best Interests
  • Deprivation of liberty
  • Palliative care

Practical Impact

Drawing similarities between ICU treatment and palliative care – a DoLS Standard Authorisation/Court Order is unlikely to be required for palliative care in a hospital setting.

Arguably, the same principles would apply to palliative care in a non-hospital setting (but this was not the circumstances arising in this case).



This case considered whether it was in P's best interests to have CANH withdrawn. Having taken in to consideration the competing factors, Cobb J decided that it was in P's best interests to have CANH withdrawn.

In his judgment, Cobb J also gave consideration to the Court of Appeal decision in Ferreira when determining whether a deprivation of P's liberty would have to be authorised for the hospital where she would receive palliative care. Cobb J, affirming the decision in Ferreira, held that an authorisation would not be required in these circumstances.


P was a 79 year old woman. She had been left very severely physically disabled, brain damaged and significantly incapacitated following a catastrophic stroke and at the time of the application, was receiving care and treatment at a care home. P was being kept alive only through the provision of CANH via PEG. This was life-sustaining treatment.

P was not considered to be in a minimally conscious state ("MCS") but did display symptoms of a patient in a MCS.

P's son made an application to withdraw the CANH in his mother's best interests.

Key Findings

1. Decision to Withdraw CANH

Cobb J gave great weight to P's previous wishes and feelings on life-sustaining treatment. He held that the views which P had expressed to her family and friends about the prospect of being kept alive on life support or receiving artificial assistance in order to survive were clear – that being, P simply would not want it to happen. In reaching his decision, Cobb J also took in to consideration the strong (but not absolute) presumption of the sanctity of life, and the principle of self-determination.

After weighing up the competing factors, Cobb J decided that in P's best interests, and in exercise of her right of self-determination, she would have not consented to the continuation of CANH in the circumstances. Therefore the discontinuance of CANH would be lawful.

2. Deprivation of Liberty for Palliative Care

Having reached his decision on best interests, Cobb J gave consideration to P's move to the hospital where she would receive palliative care and the issue of her liberty once there.

Cobb J referred to the case of Ferreira in particular the reasoning of Arden LJ at paragraph 99:

P was paralysed down the right side of her body with minimal left-sided functioning. She could turn her head. She had no speech, was doubly incontinent and spent her days in bed or in a chair. She was increasingly less responsive. She had significant neurological deficits.

In the case of a patient in intensive care, the true cause of their not being free to leave is their underlying illness, which was the reason why they were taken into intensive care. The person may have been rendered unresponsive by reason of treatment they have received, such as sedation, but, while that treatment is an immediate cause, it is not the real cause. The real cause is their illness, a matter for which (in the absent of special circumstances) the state is not responsible.”

Taking into consideration the Ferreira case and the fact that P would be placed in to a coma-like state to anaesthetise her from any distress arising from the discontinuance of CANH, he concluded that an authorisation to deprive her of liberty would not be required.


This case summary was written by Lisa Mulholland, Paralegal.

Please contact Lisa Mulholland if you wish to discuss this case or any related topics further. 

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