A desperately sick child is to be kept on life support for three weeks after his parents signalled they may appeal against a court’s decision to allow doctors to withdraw treatment and let him die.
Mr Justice Francis said it was in the best interests of eight-month-old Charlie Gard for his life support machine to be switched off.
He said Charlie, who suffers from an extremely rare and debilitating genetic condition, should be allowed to “die with dignity” after experts agreed the profound brain damage he suffers could not be improved.
But his parents have condemned the judge for refusing to give their son one last “chance of treatment”.
Chris and Connie Gard now have three weeks in which to lodge an appeal against the ruling. Only if they decide not to appeal - or if any appeal is subsequently dismissed - can Great Ormond Street Hospital begin the process of withdrawing treatment.
Mr Justice Francis’s ruling came despite Charlie’s parents raising £1.2 million to pay for him to be flown to a US clinic for pioneering treatment.
The ruling - which means Charlie will not be allowed to travel to the Unites States - prompted distressing scenes in the High Court on Tuesday, with members of his family bursting into tears.
On hearing the judge's conclusion Charlie’s father Chris Gard cried out: “No, no!” and buried his head in his hands as relatives in the public gallery leant forward to comfort him.
In a statement Mr Gard, 32, and his wife Connie said they were now facing “every parent’s worst nightmare” as they anticipated the day their son’s life support machine is turned off and he is allowed to slip away.
Their solicitor, Laura Hobey-Hamsher, said on their behalf: “They are struggling to understand why the court has not at least given Charlie the chance of treatment in America. The medical evidence is complex, and the treatment offered, potentially ground-breaking.”
Charlie was born with mitochondrial disorder, a genetic condition which saps the organs of energy and is so rare it only affects a handful of people in the world.
He is in its last stages and has been left deaf and blind, but according to his doctors still able to feel pain, and can only breathe through a ventilator.
Mr Justice Francis said experts at Great ormond Street Hospital (GOSH), along with a team of doctors in Barcelona, all agreed Charlie's damaged brain function "cannot be improved".
It was even the opinion of the US expert who Charlie's parents hoped would treat him that it was was "very unlikely that he will improve" if he underwent the pioneering therapy being offered.
A US doctor said in evidence submitted to the Family Division of the High Court that he would be happy to treat Charlie with experimental nucleoside therapy and that the baby would have received the treatment if he lived in the US.
But the doctor also added: “I can understand the opinions that he is so severely affected by encelopathy that any attempt at therapy would be futile. I agree that it is very unlikely that he will improve with that therapy. It is unlikely.”
In his summary ruling Mr Justice Francis said that Charlie’s parents “acknowledged and accepted that the quality of life that Charlie has at present in not worth sustaining”.
He concluded that it was lawful and "in Charlie's best interests” for staff at GOSH to withdraw artificial ventilation.
Mr Justice Francis said: "Subjecting him to nucleoside therapy is unknown territory, for it has never even been tested even on mouse models, but it may (or may not) subject the patient to pain, possibly even to mutations.
"But if Charlie's damaged brain function cannot be improved, as all agree, then how can he be any better off than he is now, which is a condition that his parents believe should not be sustained?"
He continued: "It is with the heaviest of hearts, but with complete conviction [. . .] that I find it is in Charlie's best interests that I accede to these applications that GOSH may lawfully withdraw all treatment save for palliative care to permit Charlie to die with dignity."
As the judge reached his conclusion there were sobs and cries from Charlie's relatives, several of whom had packed into Court 47 of the High Court.
One woman sobbed and repeatedly wiped away tears as the summary judgment was read out.
Speaking after Charlie’s distressed family left the court, Ms Hobey-Hamsher, of Bindmans, added on their behalf that they “remained utterly committed, like any parent, to wanting to do their utmost for their child” and that lessons had to be learnt by the medical professional as to how they dealt with such cases.
She said: “It is regrettable and inexplicable that much of the reasoning for their decisions only came to light after proceedings had been issued. It is too simplistic to say that had matters been handled better Charlie would be well, but undoubtedly it did not assist.”
Charlie's parents, who are considering whether to appeal against Mr Justice Francis's decision, have previously said that should they lose the case they would want to spend the money raised by the public on setting up a charity to fund research into the rare condition.
Mrs Gard said before Tuesday's hearing: "We'd like to save other babies and children because these medications have been proven to work and we honestly have so much belief in them.
"If Charlie doesn't get this chance we will make sure that other innocent babies and children will be saved."
In a statement GOSH said: "In Charlie's case we carefully considered the request for a therapy that had not been used to treat his condition. This included seeking multiple external opinions as to whether this therapy could improve Charlie's chance of survival or quality of life. The consensus, which has been confirmed by today's ruling, was that it would not."