Barking, Havering and Redbridge University Hospitals NHS Trust v AS & T

Summary

In Barking, Havering and Redbridge University Hospitals NHS Trust v AS & T [2026] EWCOP 15 (T3), Peel J considered an application for declaration that it was in the best interests of a woman identified as AS to continue ‘at risk feeding’, and to place her on a palliative care approach to ensure her comfort before discharging her from hospital, back to the community. The application was opposed by her family, who wished for her to have all treatments, including either nasogastric (NG) or PEG feeding.

In June 2025 AS had signed an ‘Advance Statement’ in which she stated that in the event she lost capacity and her health became poor, she would ‘want all treatments and care necessary to prolong’ her life.

AS suffered a massive stroke a little over two months later. She was provided with an NG tube for several weeks, but this was then removed. She was assessed as having an impaired swallow. The plan was for ‘at risk feeding’, which was carried out both in the community and during AS’s several stays in hospital over the following months.  During one of those hospital stays, AS refused the re-insertion of the NG tube. She was assessed to have capacity to make this decision.

AS was re-admitted to hospital at the beginning of 2026. She was by then very frail, with reduced oral intake. She was assessed as lacking capacity to make decisions about her medical treatment. The Trust made a decision that (i) further NG feeding was inappropriate, and that (ii) the risks of a PEG outweighed the potential benefits and so was also inappropriate. By the end of February 2026 the Trust had taken the view that IV fluids should also cease due to the risk to AS of fluid overload. AS was by this stage refusing oral intake and she was thought by the clinical team to be at the end of her life as a result of natural disease progression.

Peel J heard evidence from the treating consultant geriatrician (Dr G) that as a result of AS having a swollen gut, her ability to absorb feed and derive nutritional benefit from clinically assisted nutrition and hydration (CANH) was much reduced. CANH would likely cause her to suffer from diarrhoea, in circumstances where she already has broken skin on her buttock, and this would likely exacerbate dehydration and require uncomfortable repositioning, which in turn would increase the risk of pressure ulcers. Further risks from NG feeding included vomiting and regurgitation (which AS had suffered when she was considerably less frail) and refeeding syndrome. In short, it was Dr G’s view that NG feeding was unlikely to prolong life and could shorten it. Further, it would not rehydrate AS, as the fluids from the IV fluid were already leaking into her tissues.

Peel J accepted (i) that AS’s severe neurological and brain injuries were incurable and irreversible, and the cause of her presentation; and (ii) the risks of NG feeding were likely to occur and would represent an intolerable burden to AS who was extremely frail.

With respect to AS’s wishes and feelings, Peel J accepted that the Advance Statement represented her wishes at the time that it was made, but took into account the evidence that since that time AS had made it clear that she found the NG tube uncomfortable and painful, and that she had refused its re-insertion at a time when she had the capacity to make that decision.

Peel J concluded that in those circumstances it was in AS’s best interests to move to a palliative care plan.

Comment

This is an interesting case, because of the evidence of AS acting in direct contradiction to her Advance Statement. It is an important reminder of the need to be on the lookout for such evidence to try and help the court to unpack whether P’s current wishes and feelings are concordant with previous expressions.