Life-support can be cut to brain-damaged baby who cannot smile

Medics can stop providing life-support treatment to a seriously ill baby who doctors say does not seem able to smile, a London High Court judge has ruled.

Mr Justice Keehan concluded that the six-month-old girl should move to a palliative care regime after analysing issues at a two-day hearing in the Family Division of the High Court in London.

The girl had been born about 14 weeks premature and had suffered brain damage during birth.

The little girl - who is in local authority care - had a range of health problems and had never left hospital, the judge was told.

Doctors said the burdens that continued treatment would place on her outweighed any benefits, and wanted to move her to a palliative care regime.

Social services bosses, who have responsibility for her welfare, disagreed.

Mr Justice Keehan said the little girl could not be identified.

She is in the care of Nottingham City Council and being treated by medics who work for Nottingham University Hospitals NHS Trust.

‘Complex’ medical problems

Specialists said she had a “complex pattern” of medical problems and would have no meaningful sight, would not be able to communicate, would have no significant voluntary muscle movement and would not be able to feed herself or enjoy food.

They said she was likely to need long-term respiratory support or ventilation, a tracheostomy and a feeding tube.

Doctors thought that she would die before she was aged five.

One specialist told Mr Justice Keehan the little girl could not make “meaningful” noise and did not seem able to smile.

He said babies initially acted on instinct, and the emergence of a smile was an indicator of cognitive function.

“She does not appear to have a smile,” he told the judge.

“The first evidence that there is actually someone inside there is when a baby looks at something which it thinks is a face, processes that face and then smiles.”

‘Significant burdens’

He said long-term treatment would place “significant burdens” on her.

Lawyers for Nottingham council said bosses did not agree that the burden of treatment outweighed the likely benefit.

“The local authority believes it is far too early to conclude that she will not be able to derive benefit from continued life,” barrister Lawrence Messling, who led the council’s legal team, had told Mr Justice Keehan.

“It has experience of other children who have confounded that initial very bleak prognosis.”

He added: “The local authority would wish if possible for [the little girl] to undergo ... surgical procedures and then to be placed with [a] foster carer.”

Press Association