When the Court Decides: Understanding Forced Medical Orders

When families are faced with decisions about life-sustaining treatment, the emotional weight is immense. Disagreements on what is in the Child’s best interests can arise between the clinicians involved in the Child’s treatment, and the Child’s parents. Where parents and the clinicians are unable to agree on the best course of action, and the disagreement has not been resolvable through a process of mediation, the Clinicians may progress matters through the NHS ethics board, resulting essentially in an application to Court for a Forced Medical Order (FMO).

A forced medical order generally refers to a court decision authorising or confirming a particular course of medical treatment where there is disagreement. This can include authorising treatment to continue, despite family objections or confirming that doctors may lawfully withdraw life-sustaining treatment where medical evidence suggests it is no longer in the patient’s best interests. These applications are not routine. They tend to arise only where there is a genuine and serious dispute, and where clarity is needed to ensure that medical professionals can act lawfully and ethically. These applications can be made out of hours and on an urgent basis to the High Court under the Inherent Jurisdiction.

In cases involving children, the legal framework is governed primarily by the Children Act 1989. Under this legislation, a child’s welfare is the court’s paramount consideration. Parents ordinarily have parental responsibility and make medical decisions on behalf of their children. However, if parents and medical professionals fundamentally disagree about whether life-sustaining treatment should continue, the court can be asked to decide.

High-profile cases such as Great Ormond Street Hospital v Gard and Alder Hey NHS Foundation Trust v Evans, and our reported case of Cardiff & Vale University Local Health Board v SR & Ors [2026] EWHC 348 (Fam) brought national attention to this issue, highlighting the painful reality that, in rare circumstances, the Court may conclude that withdrawing life support is in a child’s best interests despite parental opposition.

Although this list is not exhaustive, applications for forced medical orders may arise in a range of serious and complex medical situations, including:

• Catastrophic brain injury, including cases involving life sustaining treatment, withdrawal of treatment, or disputes about prognosis and quality of life
• Severe hypoxic or traumatic brain injury following accidents, birth complications, or medical emergencies
• Mitochondrial disease and other rare or life limiting conditions, particularly where there is disagreement about experimental treatment, continuation of invasive care, or palliative approaches
• Disputes over resuscitation or escalation of care, including decisions relating to ventilation, CPR, or intensive care treatment
• Serious burns or catastrophic physical injuries, where urgent surgical intervention, pain management, or ongoing treatment is required and consent is disputed or cannot be obtained
• Cases involving refusal of medical treatment on religious or cultural grounds, such as objections to blood transfusions or specific medical procedures
• Situations where a child or young person lacks capacity to make decisions about their medical treatment and there is disagreement between clinicians and family members
• Urgent or time critical treatment decisions, where delay may result in significant harm or risk to life
• Disputes between parents or those with parental responsibility, where agreement cannot be reached about proposed medical treatment
• Cases involving long term or invasive medical treatment, including repeated surgeries or ongoing intensive interventions

The concept of “best interests” is central to all of these cases. It is not a narrow medical test, nor is it based on financial considerations or public opinion. The Court will consider a range of factors, including the medical prognosis, their rights under the Human Rights Act, the likelihood of recovery, the level of pain or suffering involved, the patient’s quality of life, and any known wishes.

The Court will take into account the religious beliefs of the child or young person concerned, as well as those of their family. The views of family members are treated with respect and are carefully considered as part of the decision making process. However, they do not override the Court’s duty to make an objective assessment focused solely on the individual patient.

Religious beliefs are therefore one relevant factor in determining what is in a child or young person’s best interests, but they are not determinative. Ultimately, the Court must weigh those beliefs alongside all other relevant considerations when deciding whether a forced medical order is necessary.

At RWK Goodman, our Family Team advises and represents parents and the child of all walks of life and faith, in these complex applications concerning forced medical orders..  Where there is a serious disagreement about a child’s medical treatment, including cases involving life-sustaining care, we guide families through specific issue applications and urgent High Court proceedings with clarity and sensitivity.  We ensure that our clients understand how the Court approaches welfare and “best interests” decisions, and we work closely with a select group of specialist barristers  to make sure both the parents’ and child’s voices are properly heard.

Keeley Lengthorn is a specialist in complex children cases, including disputes relating to serious medical treatment.  Her experience in handling sensitive and high-stakes applications means families receive both strategic legal advice and compassionate support during what is an incredibly distressing time.