A judge has ruled doctors can stop providing life support for a brain damaged five-year-old describing the case as "heart-rending".

Pippa Knight, from Strood, is in a vegetative state at the Evelina Children’s Hospital in London and doctors had argued that stopping treatment was in her best interests.

Her mum Paula Parfitt, 41, disagreed, saying she believed in "God's Law" and has vowed to appeal the decision.

Mr Justice Poole, who had previously visited Pippa's bedside, ruled in favour of medical teams today but stated it would be left to her mother to decide if removing her life support would be done at home or in hospital.

He said while Pippa, who was born on April 20, 2015, is a "much-loved" girl and has the "most dedicated and loving support of her mother" and family members. Ms Parfitt told the court they had formed a "powerful unit of strength for her and for each other".

The judge noted in his 51-page judgement "that strength has been needed" because of Pippa being "gravely unwell".

The little girl has been treated at Evelina hospital for the past two years where she has been kept alive by mechanical ventilation in intensive care since January 2019.

The judge said: "Expert neurologists and intensivists agree that she probably feels no pain and experiences no pleasure, that she is not conscious of her environment, and that there is no prospect of improvement in her condition.

"The NHS Trust responsible for Pippa’s care and treatment, whose doctors, nurses and therapists have exercised exceptional skill in looking after her, considers that she has been through enough."

Mr Justice Poole said the hearing, brought by the NHS, aimed to decide what was "in Pippa's best interests".

He described the visit to Pippa's bedside on the first afternoon of the hearing as important to "connect the forensic process within the court room with the real circumstances in which Pippa and her mother find themselves".

The judge said Ms Parfitt gave "very powerful" evidence in court.

In her early life, Pippa was "affectionate" and had been developing normally, Mr Justice Poole said.

Pippa's illness started to develop when she was about 18-months-old and she was taken to Medway Maritime Hospital in December 2016 by her mother because she was unwell.

The court heard how Pippa's condition deteriorated overnight and she was admitted to specialist paediatric intensive care at St George's Hospital in London after suffering seizures.

She was diagnosed with acute necrotising encephalopathy (ANE), a rare condition which leads to seizures following a disease such as influenza, and remained in hospitals for five months.

But when Pippa was discharged, she was severely disabled and had developed four-limb motor disorder and required feeding by a tube through her nose.

The court heard Pippa's father took his own life after struggling to come to terms with the diagnosis having lost a child from a previous relationship already to meningitis.

Pippa suffered another episode of ANE in January 2019 and was again admitted to hospital, where she has remained ever since and her mother by her bedside for 16 hours a day and is living in hospital accommodation.

"Considering the evidence, I am satisfied that it is not in Pippa’s best interests to continue to receive long term ventilation or other life sustaining treatment..."

Mr Justice Poole said: "Pippa currently receives video calls from her brother and grandparents, and Ms Parfitt’s brother and grandmother often sit with Pippa for long hours when Ms Parfitt is resting.

"The fact that Ms Parfitt has not been wholly ground down by her experiences is a tribute to her resilience and dedication."

Her mum argued it was in her daughter's best interests to be transferred back home and address whether it would be possible for long-term ventilation Pippa requires to stay alive can be provided at home.

Mr Justice Poole said this was "not a choice currently available, because no-one yet knows whether Pippa can be given ventilation at home for anything beyond a few hours, or a few days at most".

He considered three options: continuing life support in hospital, trial of portable ventilation and potentially moving treatment to Pippa's home and finally, withdrawing Pippa's life support.

During the hearing, Ms Parfitt said she wanted Pippa's life support to continue in hospital but if the trial to move her home was unlikely after six months that she would "consider consenting to withdrawal of

ventilation".

The judge said: "Even given Ms Parfitt’s new position it seems to me that there would remain the likelihood of a dispute about Pippa’s best interests in the future.

"Ms Parfitt already disagrees with the healthcare professionals’ views about the progress of Pippa’s condition, and there would be ample room for further disagreement about Pippa’s condition during the transition process, and whether 'real progress' had been made towards a return home."

Mr Justice Poole concluded that continuing Pippa's life support was not in her best interests and said the mechanical ventilation should be withdrawn.

He said Ms Parfitt had "fought as hard for Pippa as any parent could" adding the "responsibility for the decisions in this case lies with the court and not with her".

The judge concluded: "Considering the evidence as a whole and balancing all the relevant factors, I am satisfied that it is not in Pippa’s best interests to continue to receive long term ventilation or other life sustaining treatment.

"I have to consider Pippa’s best interests from her perspective.

"Ms Parfitt has fought as hard for Pippa as any parent could..."

"Notwithstanding the presumption that life should be preserved, it is not in her best interests that her life should be prolonged.

"Her welfare is my paramount concern. Pippa is in a persistent vegetative state and has been for well over a year.

"She has no conscious awareness and she gains no benefit from life but she daily bears the dual burdens of her profoundly disabling condition and the intensive treatment she requires to prevent it from ending her life.

"The evidence drives me to conclude that Pippa has no awareness of her environment nor of interaction with others, including, I am very sorry to say, her family.

"She receives exceptional care from her mother, others in her family, and from the healthcare professionals at the Evelina, but as all the medical witnesses have advised the court, there is no hope of improvement in her condition and no medical benefit from prolonging her life on the PICU (paediatric intensive care unit).

"I cannot identify any non-medical benefits to Pippa from continued ventilation on the PICU, whether social, emotional, psychological, or otherwise.

"Prolonging her life on the PICU will only prolong her burdens.

"Continued care on the PICU is not the primary wish of her family, although they would prefer her to live rather than to have ventilation withdrawn.

"I take into account their wishes and views. I also take into account the view of the treating team and the independent experts.

"Ultimately, however, the court has to take an objective view of Pippa’s best interests.

"Taking a broad view of Pippa’s medical and non-medical interests, but with her welfare as the paramount consideration, I conclude that it is not in her best interests to continue to receive mechanical ventilation on the PICU."

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