Robert Barnor died before the Court of Protection could decide whether dialysis should continue. Days earlier, the Court of Appeal had rejected the proposition that disputed life-sustaining treatment could be withdrawn simply as a “clinical decision” beyond a best-interests determination. Now Professor Lynne Turner-Stokes, whose advice formed an important part of that litigation, directs the specialist unit proposed to manage the withdrawal of nutrition and hydration from FHR, the 28-year-old whose case Nuntiatoria examined last month. This is not a case for declaring personal guilt where no court has done so. It is a test of something larger: whether a system empowered to make irreversible decisions can provide the independence, scrutiny and humility necessary when the consequence of error is death.
When Nuntiatoria examined the case of FHR last month in “When Food and Water Become ‘Treatment’”, the central question was deliberately framed more deeply than whether modern medicine must preserve biological life by every technological means available. Catholic teaching has never required futile treatment or therapeutic obstinacy. The real question was whether nourishment and hydration, while still achieving their ordinary purpose of feeding and hydrating a human being, can morally be withdrawn because continued existence has been judged insufficiently beneficial.¹
A new development now places that question within an even more troubling institutional context. FHR is the 28-year-old man who suffered catastrophic brain injury more than six years ago and whose case came before Mr Justice McKendrick in the Court of Protection. On 26 August 2026 the judge determined that continued clinically assisted nutrition and hydration, or CANH, was no longer in FHR’s best interests. The judgment followed substantial evidence and an extensive hearing; it was not an administrative decision taken without judicial scrutiny. FHR’s family nevertheless contests the conclusion and his mother, FN, is pursuing an appeal.²
Christian Concern, whose legal arm supports the family, reported on 23 September that the proposed plan is to transfer FHR to the Regional Hyperacute Rehabilitation Unit at Northwick Park Hospital for withdrawal of CANH and subsequent palliative management. It further reported that the Court of Appeal had stayed implementation until 2 October pending his mother’s appeal. Those latter procedural details, together with allegations concerning proposed restrictions on family contact, presently come principally from Christian Concern and should be understood as such unless and until further court documents are published.³
The director of the Regional Hyperacute Rehabilitation Unit is Professor Lynne Turner-Stokes. That fact acquires significance because Professor Turner-Stokes also features prominently in another recent and exceptionally important end-of-life case: that of Robert Barnor.
Mr Barnor, aged 68, suffered a series of strokes which left him with extensive irreversible brain injury. He did not regain consciousness and also suffered severe kidney failure requiring dialysis. His treating clinicians eventually concluded that long-term dialysis should no longer be offered. His family disagreed and sought judicial intervention. The resulting litigation became Townsend v Epsom and St Helier University Hospitals NHS Trust, decided by the Court of Appeal in February with its written judgment handed down on 3 March 2026.⁴
The judgment deserves close attention because it records precisely what Professor Turner-Stokes did and did not do. Two external specialists, Dr John Prowle and Dr Rob Elias, examined Mr Barnor before giving their opinions. Professor Turner-Stokes did not visit the hospital, did not examine Mr Barnor and had no contact with his family. The Court of Appeal therefore said that, unlike the reports of the other specialists, hers was “of a different character”.⁴
The distinction is critical. Professor Turner-Stokes was not principally being asked to provide another conventional neurological assessment. The judgment records that she had been asked to advise upon the decision-making process for withdrawal of treatment. Before addressing that legal and clinical process, she expressed the view that Mr Barnor would not regain consciousness, that active treatment was clinically inappropriate and that his condition should be understood differently from a conventional prolonged disorder of consciousness. The Court of Appeal noted that her view appeared to have been based upon conversations with the treating team and stated that it was unclear whether she had access to Mr Barnor’s medical records.⁴
Her report then addressed the distinction which became central to the subsequent litigation. In substance, Professor Turner-Stokes advised that clinicians first decide what treatments are clinically “on offer”; where a treatment is considered futile or clinically inappropriate, there is no obligation to offer it, and a family cannot compel its provision. On that analysis, the refusal of treatment could be characterised as a clinical decision rather than as a best-interests decision requiring the same judicial route.⁴
The Trust subsequently adopted that distinction in resisting the family’s attempt to secure continued dialysis. Its solicitors maintained that because a clinical decision had been made not to offer further long-term dialysis, there was no corresponding best-interests decision for the Court of Protection to determine and therefore no obligation upon the Trust itself to commence proceedings. The consequence was not theoretical: without dialysis, everyone understood that Mr Barnor would die.⁴
The Court of Appeal rejected the essential legal proposition with unusual clarity. Lord Justice Baker held that every decision concerning the treatment of an incapacitated adult, including withdrawal of life-sustaining treatment, must be governed by the patient’s best interests and that there is “no carve out for ‘clinical decisions’”. Where clinicians, family and any appropriate independent opinion agree that withdrawal is in the patient’s best interests, there need be no court application. But where serious disagreement persists and cannot be resolved, the matter belongs before the Court of Protection. The responsible NHS body cannot “pre-empt court proceedings by unilaterally withholding or withdrawing treatment on ‘clinical’ grounds.”⁴
That ruling requires an important qualification which strengthens rather than weakens the argument. The Court of Protection cannot compel an individual doctor to administer treatment which he or she considers clinically inappropriate. Doctors retain professional judgment and conscientious responsibility for what they provide. The Court of Appeal’s point was that this professional judgment does not create a legal enclave in which disputed withdrawal of life-sustaining treatment escapes best-interests scrutiny altogether. Where the proposed course will result in the death of an incapacitated person and those properly interested in his welfare disagree, judicial protection cannot simply be defined away by the terminology used to describe the clinical decision.⁴
Mr Barnor’s tragedy is that he obtained recognition of that principle but did not live long enough to receive the hearing it required. The Court of Appeal allowed his daughter’s appeal on 23 February and directed that the best-interests dispute be brought urgently before the Court of Protection. The hearing was listed for 27 February. The appellate court did not, however, order interim relief compelling the restoration or continuation of dialysis pending that hearing. Mr Barnor died on the morning of 27 February before the Court of Protection could determine the substantive question.⁵
His case is therefore unfinished in law as well as morally sobering in fact. The Trust has appealed the Court of Appeal’s decision to the Supreme Court, while Mr Barnor’s daughter has brought a linked appeal concerning the refusal of interim relief. Permission was granted on 29 June and the two matters are listed together for hearing on 12 and 13 January 2027. The Supreme Court identifies the central issue as whether an NHS commissioning body must apply to the Court of Protection when clinicians consider life-sustaining treatment clinically inappropriate but those acting for an incapacitated patient dispute that judgment.⁵
Precision is indispensable. The Supreme Court is not conducting disciplinary proceedings against Professor Turner-Stokes and it has not been asked to determine whether she personally caused Robert Barnor’s death. Nor did the Court of Appeal find her guilty of negligence, misconduct or unlawful killing. The legal appeal concerns the duties of NHS bodies and the proper operation of the Mental Capacity Act. Any account which transformed that into a judicial prosecution of one clinician would exceed the evidence.
That restraint, however, does not make Professor Turner-Stokes’s involvement irrelevant. Her advice formed part of the factual history from which the disputed distinction between clinical and best-interests decisions emerged. The Court of Appeal rejected the legal approach eventually adopted by the Trust, the Supreme Court will now consider the governing principle, and Christian Concern reports that a coroner is separately investigating the circumstances of Mr Barnor’s death.³ The issue for FHR is therefore not whether guilt has already been established; it manifestly has not. The issue is whether independence and public confidence are sufficiently important that a senior clinician institutionally connected with one unresolved and heavily contested withdrawal should direct the unit proposed to carry out another.
That question becomes more pressing when the clinical history of FHR is considered carefully. It would be inaccurate to claim that every clinician presently involved supports continued CANH. The evidential position evolved before the August hearing. Nevertheless, the history recorded before the Court included an earlier multidisciplinary best-interests process which had favoured continued life-sustaining treatment and care at home. By the final hearing the ICB, the jointly instructed expert and the Official Solicitor supported withdrawal, while FHR’s parents remained strongly opposed and relied upon contrary professional evidence. Mr Justice McKendrick ultimately concluded that continued CANH was not in FHR’s best interests.²
The importance of this chronology is not that the August judgment can be dismissed as though no evidence supported it. It plainly cannot. Rather, it demonstrates that withdrawal was not some self-evident clinical conclusion which had existed unchanged from the beginning. Serious assessments changed; experts differed; the family disputed the characterisation of FHR’s condition and experience; and a court was ultimately required to decide between competing accounts of what continued treatment meant for him. That is exactly the kind of case in which institutional distance and visible independence matter most.
Here the argument developed in our earlier editorial becomes unavoidable. English law classifies clinically assisted nutrition and hydration as medical treatment. Catholic moral theology asks a prior and different question: what is the moral object of the act? A legal classification tells us how an intervention is regulated. It does not by itself determine whether the thing being supplied is morally equivalent to ventilation, dialysis, chemotherapy or extraordinary surgery.¹
Food remains nourishment because it enters the body through a tube. Water remains hydration because its delivery requires clinical expertise. The technique by which something is administered does not necessarily determine the moral species of what is administered. This does not mean that artificial nutrition and hydration can never become disproportionate or burdensome. It means that the moral analysis begins with what the intervention actually does to and for the human person.
Pius XII supplied the classical modern formulation of the distinction between ordinary and extraordinary means in 1957. St John Paul II applied the principle specifically to nutrition and hydration for patients in persistent disorders of consciousness in 2004. The Congregation for the Doctrine of the Faith then answered the matter formally in 2007: food and water, including when administered artificially, are in principle ordinary and proportionate means of preserving life insofar as they continue to accomplish their proper purpose of nourishing and hydrating the patient. Even certainty that consciousness will never return does not, by itself, justify their withdrawal.⁶
The Church is equally clear about the limits of that obligation. Nutrition and hydration need not be continued when the patient’s organism can no longer assimilate or metabolise them, or where their administration itself imposes serious harm or intolerable suffering. Samaritanus Bonus restated the principle in 2020 precisely to distinguish obligatory basic care from aggressive medical treatment. Medicine need not prolong dying by burdensome interventions which provide no proportionate benefit, but neither may the abandonment of futile therapy become the abandonment of those ordinary forms of care by which essential physiological needs continue to be met.⁷
This distinction exposes the weakness concealed by the vocabulary of “palliative care”. Proper palliative medicine is among the noblest forms of clinical care. It relieves pain, treats distressing symptoms, attends to psychological and spiritual needs, supports relatives and accompanies a person whose underlying disease is carrying him towards death. Catholic teaching explicitly commends it.⁷ The word “palliative”, however, cannot answer the logically prior question of why the patient is dying.
If a patient is dying because irreversible disease is destroying his bodily functions, palliation accompanies an independently occurring dying process. If nutrition and hydration continue to sustain essential physiological functions, are deliberately withdrawn, and death consequently follows from that withdrawal, symptom control during the resulting process does not settle the moral character of the antecedent decision. Calling the sequence a “palliative pathway” may describe the clinical management of the consequences. It does not resolve whether bringing about those consequences was morally justified.
That is why the Barnor and FHR cases illuminate one another even though they are medically and legally different. Barnor concerned dialysis and a dispute over whether treatment which clinicians no longer considered appropriate could be removed from best-interests adjudication. FHR concerns CANH after a full Court of Protection hearing in which the judge has expressly decided the best-interests question. No responsible argument should collapse those cases into one.
What joins them is the deeper question of safeguards. Who determines that an intervention is futile? Who decides when continued life no longer provides a benefit that outweighs its burdens? Who scrutinises the assumptions underlying those judgments? Who ensures that disagreement is not confused with obstruction, familial love with irrationality, dependency with indignity, or profound disability with a life lacking worthwhile human goods? Above all, who protects the incapacitated person when the conclusion reached by the system is irreversible?
The Court of Appeal’s answer in Townsend was juridical: professionals cannot remove a genuinely disputed withdrawal of life-sustaining treatment from the best-interests framework merely by calling it a clinical decision. The Catholic answer goes further because it concerns the anthropology underlying the decision itself. Human dignity does not increase with consciousness, autonomy or cognitive function. It does not disappear when communication becomes impossible. It is neither conferred by clinical assessment nor extinguished by judicial declaration. The profoundly brain-injured patient remains a human person whose weakness intensifies rather than diminishes the obligation of others to protect him.
This is precisely why institutional design matters. The question is not whether doctors are compassionate. The doctors in both cases may sincerely believe that they are acting compassionately. The question is not whether specialists possess expertise. Professor Turner-Stokes plainly possesses extensive expertise in rehabilitation medicine and disorders of consciousness. The question is whether expertise, when coupled with institutional authority over irreversible decisions, requires stronger rather than weaker safeguards against professional consensus becoming self-validating.
A system is safest when the person recommending a course of action, the institution implementing it and the mechanism scrutinising it remain meaningfully distinguishable. That principle is unremarkable in almost every other sphere of public decision-making. It should be more important, not less, where the consequence of a mistaken conclusion is that the person whose interests are being discussed will no longer be alive when the error is discovered.
The Barnor litigation demonstrates exactly why. The clinicians believed their position correct. The Trust defended the distinction between a clinical decision and a best-interests decision. A first-instance judge accepted that the Court of Protection had no substantive choice to make. Three appellate judges then concluded that the approach was contrary to established principle and practice. Mr Barnor nevertheless died before the best-interests hearing which their judgment said should occur. The point is not that clinicians acted maliciously. It is that intelligent, experienced and sincere people can be wrong, and death does not permit the system to revisit its mistake afterwards.⁴
Against that history, Christian Legal Centre chief executive Andrea Williams has called upon Professor Turner-Stokes to step aside from directing FHR’s end-of-life process until the unresolved issues surrounding Barnor have been examined.³ That is an advocacy position, not a judicial determination. Yet it raises a legitimate institutional question. Recusal in such circumstances need not imply guilt. On the contrary, it can protect the patient, protect the professional concerned and protect confidence in the system by ensuring that the next disputed withdrawal is not entangled unnecessarily with an unresolved controversy from the last.
There is therefore a serious case for asking why another suitably qualified team should not manage FHR’s care while the Barnor litigation remains before the Supreme Court. The issue is not whether Professor Turner-Stokes should be publicly condemned. No court has supplied grounds for such a conclusion. The issue is whether an avoidable appearance of institutional continuity between one profoundly disputed withdrawal and another serves anybody’s interests, least of all those of the vulnerable man whose life is at stake.
The deepest danger exposed by these cases is consequently larger than any individual doctor. It is the possibility that an end-of-life system gradually develops a self-contained vocabulary in which morally momentous acts acquire reassuring administrative names. Nourishment becomes “treatment”; its withdrawal becomes a “care plan”; the physiological consequences of withdrawal become a “palliative pathway”; profound dependency becomes absence of meaningful benefit; and the family which refuses to accept the prevailing assessment risks appearing not as the natural guardian of the vulnerable person but as an impediment to clinical resolution.
Language cannot decide morality. Nor can procedure alone. A decision may pass through the correct legal mechanism and still require profound moral scrutiny, because law and morality answer overlapping but not identical questions. The Court of Protection asks what English law understands to be the incapacitated patient’s best interests. Catholic moral theology must also ask whether the act proposed is itself morally permissible, whether its object is the withdrawal of disproportionate therapy or the deprivation of ordinary sustenance, and whether death is merely foreseen or has become the means by which the perceived burden of the patient’s continued condition is ended.
None of this requires medical vitalism. There are circumstances in which dialysis may rightly be discontinued. There are circumstances in which ventilation should not be commenced or should be withdrawn. There are circumstances in which surgery, chemotherapy, resuscitation or other interventions cease to offer proportionate hope of benefit and impose excessive burdens. Catholic teaching has recognised those distinctions for generations. What it refuses is the further step by which the worthwhileness of treatment is allowed imperceptibly to become a judgment upon the worthwhileness of the life receiving it.⁶ ⁷
That is why the central issue in these cases is not simply whether medicine can keep a person alive. It is what medicine understands itself to be doing when it ceases to do so. The physician is called to cure where possible, to relieve suffering, to recognise when treatment has become disproportionate, and always to care. The physician is not authorised to conclude that profound cognitive disability makes death a therapeutic solution.
Robert Barnor’s case should therefore be remembered not merely because he died, but because the legal safeguard he successfully invoked arrived too late to protect him. The Court of Appeal had concluded that the disputed decision belonged within the best-interests process, yet by the time the substantive hearing was due to begin the person whose interests were to be adjudicated was dead. The Supreme Court will determine the legal consequences of that history in January.⁵
FHR’s case presents the principle prospectively rather than retrospectively. He is alive. His family is appealing. Questions concerning the precise arrangements proposed for withdrawal and family contact remain contested and should not be reported as judicial findings unless the courts establish them. But the essential moral reality is already clear: if CANH is withdrawn and death follows, no later reconsideration can restore what has been lost.
This is why safeguards surrounding the incapacitated cannot be treated as bureaucratic formalities. They are not obstacles placed in the way of compassionate medicine. They exist because human beings exercising grave authority remain fallible, because institutional cultures can become accustomed to their own assumptions, because professional consensus is not infallibility, and because the person least capable of defending himself is precisely the person for whom the protection must be strongest.
Our earlier editorial concluded that Christians are commanded to feed the hungry, give drink to the thirsty, comfort the afflicted and accompany the dying, but never to make death the treatment. The Barnor case now adds the juridical corollary: where death is irreversible, scrutiny must precede it rather than explain it afterwards. FHR adds the urgency. He is not a precedent, a pathway, a neurological category or an ethical problem. He is a living human being, and whatever ultimately becomes of his appeal, every institution involved owes him something more demanding than certainty: it owes him justice, independence, humility and care.
¹ Nuntiatoria, “When Food and Water Become ‘Treatment’”, 28 August 2026. Previous Nuntiatoria editorial
² NHS North East London ICB v FHR & Ors [2026] EWCOP 43 (T3), Court of Protection, Mr Justice McKendrick, 26 August 2026. Courts and Tribunals Judiciary — FHR judgment
³ Christian Concern, “Controversial doctor to take over ‘palliating’ of 28-year-old”, 23 September 2026. Christian Concern — FHR and RHRU report
⁴ Townsend v Epsom and St Helier University Hospitals NHS Trust [2026] EWCA Civ 195, Court of Appeal, 3 March 2026, especially paras 9–18 and 68–73. Courts and Tribunals Judiciary — approved Townsend judgment
⁵ UK Supreme Court, Townsend v Epsom and St Helier University Hospitals NHS Trust, linked appeals UKSC/2026/0044 and UKSC/2026/0050; permission granted 29 June 2026; hearing listed for 12–13 January 2027. UK Supreme Court — Townsend appeal and cross-appeal
⁶ Congregation for the Doctrine of the Faith, Responses to Certain Questions Concerning Artificial Nutrition and Hydration, 1 August 2007, approved by Pope Benedict XVI; see also St John Paul II, Address to the International Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004, and Pius XII, Address to the International Congress of Anesthesiologists, 24 November 1957. Vatican — 2007 Responses on nutrition and hydration
⁷ Congregation for the Doctrine of the Faith, Samaritanus Bonus: On the Care of Persons in the Critical and Terminal Phases of Life, 14 July 2020, especially V.2–4. Vatican — Samaritanus Bonus
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