Life support to be turned off for 'no smile' baby girl
A judge has ruled that medics can stop giving life support treatment to a seriously ill baby unable to smile - despite social services bosses wanting the treatment to continue.
The ruling means the six-month-old girl will move to a palliative care regime, allowing her to die.
Doctors believe her inability to smile indicates a lack of cognitive function.
She is in the care of Nottingham City Council, which opposed the medics' request to move her to palliative care.
'Allow her to die peacefully'
The girl's mother wanted her daughter to "pass away peacefully", while her father wanted a judge to decide.
High Court judge Mr Justice Keehan ruled in favour of Nottingham University Hospitals NHS Trust, which has been treating the girl and wanted her life support to be withdrawn.
"I am completely satisfied that the only course to be taken in [her] best interests is to withdraw her current life-sustaining treatment and to move her to a palliative regime and allow her to die peacefully in the arms of her loving parents," he said.
The significance of a smile
The girl was born about 14 weeks premature and suffered brain damage during birth.
She has never left hospital and doctors thought she would die before she was five.
Mr Justice Keehan said evidence showed she felt pain but did not experience pleasure - and doctors feared they would not be able to relieve her pain.
One specialist said the little girl could not make "meaningful" noise and did not seem able to smile.
Babies initially acted on instinct and the emergence of a smile was an indicator of cognitive function, he said.
"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."
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 said the "significant burdens" that continued treatment would place on her outweighed any benefits, but lawyers for Nottingham City Council said bosses there disagreed.
Barrister Lawrence Messling said: "The local authority believes it is far too early to conclude that she will not be able to derive benefit from continued life.
"It has experience of other children who have confounded that initial very bleak prognosis."
Parents did not want baby to suffer
The judge was told the girl's parents had health problems and learning difficulties.
Both were represented by lawyers at the hearing.
Her father had said that he loved his daughter deeply and he did not want her to suffer unnecessarily, but he could not bring himself to say treatment should be withdrawn, and wanted a judge to decide.
Her mother said she thought medics had done the "best possible" and she wanted her daughter to "pass away peacefully".
Lawyers for the trust said staff would make the little girl's final days as comfortable as possible - and said she would be placed in the "best possible setting" for her parents.