How do the Courts View Clinical Ethics Committees?

Cite as: E Cave, ‘How do the Courts View Clinical Ethics Committees?’ (Durham CELLS Blog, February 5 2026)

Background: Clinical Ethics Committees (CECs) have evolved in trusts and hospitals in the UK to guide clinicians on cases, policy development and education. Professional guidance places emphasis on the role of CECs in resolving disagreement (RCPCH 2015, GMC 2020 para 92).

Method: Westlaw UK holds a database of court cases. A literature search using free text searches of “clinical ethics committee*” and “ethics committee*” revealed 27 sources referring to clinical (as opposed to research) ethics committees from judgments of the European Court of Human Rights and the courts of England and Wales. These sources were analysed.

Results: There are 5 categories of cases making reference to CECs:

1. CEC involvement establishing the credential of experts

Six cases ranging from 2008 – 2017 refer to the expertise of expert witnesses or panel members by reference to their role in an ethics committee.

2. Noting the lack of CEC involvement

Two early 2000s cases noted the absence of CEC involvement. In Re A (Conjoined Twins) [2000] EWCA Civ 254, Brooke LJ observed that in the United States, proposed separations of conjoined twins may be referred to hospital ethics committees rather than the courts, ‘no doubt because of features of United States law that are different from English law.’ In Ms B v An NHS Hospital Trust [2002] EWHC 429 (Fam) Butler-Sloss P said that the Trust lacked an ethics committee and therefore sought external advice. Although primarily factual, both judgments recognise that ethics committees could provide an alternative or additional source of support for clinicians that was lacking in those instances.

3. CECs advising clinicians in disputed cases involving adults

Meanwhile, six cases note the relevance of CEC advice in cases of dispute about adult treatment.

Four concern the lawfulness of assisted conception in novel situations (R v HFEA ex parte Blood [1997] EWCA Civ 946;  SoS for the Home Dept v Mellor [2000] EWHC Admin 385; R (IM, MM) v HFEA [2015] EWHC 1706 (Admin)), and one noted the relevance of ethics committee advice to the fertility regulator (R (Quintavalle) v HFEA [2002] EWCA Civ 667). Two further cases noted the relevance of CEC advice in matters relating to treatment of a Jehovah’s Witness refusing administration of blood products (Newcastle upon Tyne Hospitals Foundation Trust v LM [2014] EWCOP 454) and the question of whether confidential information should be disclosed to a family member against the wishes of the patient (ABC v St George’s Healthcare NHS Trust [2020] EWHC 455 (QB)).

4. CECs advising clinicians in disputed cases involving children

Ten cases referencing CEC involvement concern the treatment of children. Five of these involved Great Ormond Street Hospital (GOSH) for Children which pioneered the establishment of a clinical ethics service from 2000. Most of these cases simply note that ethics committee consideration was part of the process in trying to resolve disputes (eg GOSH for Children Foundation NHS Trust v NO & KK v MK [2017] EWHC 241 (Fam), [16]; Re R [2018] EWFC 28 Baker J [37]; Gard v UK (2017) 65 EHRR SE9 [6], An NHS FT v Kwame [2023] EWHC 134 (Fam), Alder Hey Children's NHS Foundation Trust v D [2023] EWHC 2000).

In Re NR [2024] EWHC 2400 (Fam) Poole J acknowledged the value of CEC involvement, along with second opinions and sometimes mediation, in resolving most disputes between clinicians and parents. However, variations across Trusts in availability and form of ethical advice are acknowledged by  RCPCH 2015, para 5.4 and by the High Court in Re X (a child) [2020] [21]. There, Russell J emphasised the lack of guidance for CECs and variation in their function.

Two cases are noteworthy. In Re AA [2014] EWHC 4861 (Fam) Mrs Justice King said:

AA's case has been considered with the upmost care by the Ethics Committee …  In my judgment the conclusion reached by the Ethics Committee and the courageous decision of her mother that it is no longer in AA's best interests to be hydrated, is undoubtedly correct and in her best interests. [19], [21].

This case notes the value of CEC involvement, but it also blurs the boundary between CEC advisory function and a decision-making role, stating at [11] that

A decision was reached at the Ethics Committee that, because of AA's intolerable and unmanageable pain, the time had come to stop giving AA nutrition; this decision was reached with the agreement of the mother and all the experts.

In Re X (A Child) [2020] EWHC 1958 (Fam) too, as I have discussed elsewhere with colleagues, the judgment seems to blur the boundary between advice to clinicians and a binding decision. Like Re AA, this judgment is positive about the potential for CEC involvement, but laments the lack of guidance, particularly around the involvement of parents in CEC meetings.

The importance of parental involvement was reiterated in two further cases. Manchester University NHS FT v Verden [2022] EWCOP 9 is discussed elsewhere. In NR (A Child: Withholding CPR) [2024] EWHC 910 (Fam) Poole J declined to direct the Trust on the organisation of its ethics committees and forums, but emphasised the need to involve families in decision-making on life-sustaining treatment and palliative care.

5. CECs safeguarding patient interests

Three cases recognise the relevance of CECs as a process by which the best interests of patients can be protected. One is a case from the European Court of Human Rights, Lambert v France (2016) 62 EHRR 2, which noted the involvement and advice of a clinical ethics committee ‘to overcome a problem or to resolve a conflict’ [66], and as a safeguard when considering the withdrawal of treatment from an adult patient [25].

In England and Wales, Lieven J in AB v CD [2021] EWHC 741 (Fam) [110] noted that CECs form one of a number of safeguards used by clinicians in cases of doubt as to what course of action is in a patient’s best interests. And in Wessex Fertility Ltd v University Southampton Hospital NHS FT [2024] EWHC 587 (Fam) the High Court noted that, in fertility treatment, the use of gametes from a donor with known genetic abnormalities ‘should normally have approval from a clinical ethics committee’ as part of protections of the welfare of future children.

Conclusion: Three overarching themes emerge. First, there is increasing reference to CECs in court cases describing processes to resolve finely balanced and disputed cases. Second, the most recent cases indicate the potential of CECs to advise clinicians making decisions on the best way to safeguard the best interests of patients. Third, there is a shift from a neutral description of processes to an expectation of CEC involvement in difficult cases, which has potential to generate impetus for additional support and structure of CECs in the NHS.