Abbasi v Newcastle upon Tyne Hospitals NHS Foundation Trust (Rev1) [2025] UKSC 15 (16 April 2025)

The Supreme Court ruled on the case of a terminally ill child whose parents wished to pursue experimental treatment abroad. The Court affirmed that moving the child to palliative care was in her best interests, prioritising her welfare and dignity over parental wishes.

Facts

The case concerned Zainab Abbasi, a six-year-old girl suffering from Niemann-Pick disease, a rare and fatal neurodegenerative condition. Medical experts at the Newcastle upon Tyne Hospitals NHS Foundation Trust were unanimous in their opinion that her condition was irreversible, progressive, and that she was nearing the end of her life. They concluded that further life-sustaining treatment was futile and would only prolong her suffering. Consequently, the Trust applied to the High Court for a declaration that it would be lawful and in Zainab’s best interests to withdraw life-sustaining treatment and transition to a palliative care pathway, designed to ensure her comfort and dignity until her death.

Zainab’s parents, who were described as deeply loving and devoted, opposed the Trust’s application. They had researched an experimental nucleoside treatment available at a clinic in Italy and wished to transport their daughter there in the hope of a cure or at least a significant amelioration of her condition. They argued that their parental responsibility gave them the right to make this decision for their child.

Issues

The Supreme Court was asked to determine the following key legal issues:

1. What is the correct legal test for determining the “best interests” of a child in end-of-life medical treatment disputes between parents and treating clinicians?
2. What are the limits of parental responsibility when it conflicts with the medical assessment of a child’s welfare?
3. How should courts weigh a speculative hope of recovery from experimental treatment against the known and likely suffering caused by continuing life-sustaining treatment?
4. Does Article 56 of the Treaty on the Functioning of the European Union (TFEU), concerning the freedom to provide services, grant parents an absolute right to move their child to another member state for medical treatment, overriding a domestic court’s best interests determination?

Judgment

The Supreme Court unanimously dismissed the parents’ appeal, upholding the decisions of the lower courts. Lord Stevens, giving the lead judgment, delivered a detailed analysis of the law concerning the welfare of children in medical cases.

Lord Stevens began by reaffirming the fundamental principle established in cases such as Great Ormond Street Hospital for Children NHS Foundation Trust v Yates [2018] AC 1, that the child’s welfare is the court’s paramount consideration. The ‘best interests’ test is the gold standard, and the child’s own interests must prevail over the otherwise powerful and important rights of their parents.

He clarified that the best interests assessment is not a simple ‘balance sheet’ of pros and cons but a holistic inquiry. It involves considering the child’s a a whole person, not just as a medical case. He stated:

The best interests test is not a simple ledger of benefits and burdens. It is a holistic and intensely personal inquiry. It requires the court to place itself in the shoes of the child, with all their frailties and potential, and consider what is best for them. In cases such as this, that includes the right to a dignified and peaceful end, not merely the preservation of life at all costs.

The court meticulously analysed the evidence regarding the proposed treatment in Italy. It found that there was no credible evidence to suggest that the nucleoside therapy would provide any benefit to Zainab; on the contrary, the medical consensus was that it was futile and that the process of transporting and treating her would cause her significant distress and pain. The court contrasted this with the palliative care plan, which was designed to maximise her comfort and dignity.

Addressing the parents’ rights, Lord Stevens acknowledged their profound love for their child but drew a critical distinction between a parent’s wishes and the objective assessment of a child’s welfare. While parental views must be given great weight, they are not determinative. The duty of the court is to act as the ‘judicial reasonable parent’ and make the decision that is objectively in the child’s best interests.

On the European law point, the court held that the right to receive services under Article 56 TFEU was not absolute. It could be subject to limitations justified by overriding reasons in the public interest. Lord Stevens concluded:

The right to receive medical services in another member state under Article 56 TFEU is not an unfettered right. It is subject to overriding reasons in the general interest, and there can be no more compelling reason than the protection of the life, welfare and dignity of a vulnerable child as determined by a court of competent jurisdiction applying the paramountcy principle.

Implications

The decision in Abbasi reinforces the established legal framework for resolving intractable medical disputes involving children. It reaffirms the paramountcy of the child’s welfare, clarifying that this encompasses not only medical outcomes but also the child’s dignity and quality of life, particularly at its end. The judgment serves as a caution against pursuing ‘any hope, however remote’, emphasising that courts must ground their decisions in evidence-based assessments of benefit and burden. It also provides a clear statement on the scope of EU free movement rights in this context, confirming that they do not override the court’s protective jurisdiction over children when making best interests determinations.

Verdict: The parents’ appeal is dismissed.

Source: Abbasi v Newcastle upon Tyne Hospitals NHS Foundation Trust (Rev1) [2025] UKSC 15 (16 April 2025)