The boundaries of best interests: The case of Townsend v Epsom

In the case of Townsend v Epsom and St Helier University Hospitals NHS Trust, the Court of Appeal upheld the longstanding position that individual clinicians cannot be compelled to provide treatment that they consider clinically inappropriate, while holding that there is ‘no carve out for clinical decisions’ from the best interests framework for adults lacking mental capacity. Subsequent questions about who sets the treatment options; when and in what form there may be judicial scrutiny of their exclusion; and what follows if a court and clinicians disagree will be considered by the Supreme Court in January 2027. We argue that these questions are also pertinent to paediatric treatment disputes and warrant a consistent approach. Drawing on paediatric case law, we examine the boundaries of best interests decision-making to show that the breadth of best interests does not erase the different functions that contribute to a treatment decision. We invite the Supreme Court to recognise a distinct role for collective professional judgement in determining clinical appropriateness, while preserving the authority of the Court of Protection and Family Division of the High Court to scrutinise disputed exclusions. Judicial scrutiny should be proportionate to the nature of the dispute, protecting both patient welfare and professional integrity.