ProLife.ie - We are an education and awareness organisation committed to the promotion of the culture of life.

The High Court has ruled that a boy who received a serious brain injury in a drowning accident should not be resuscitated if his condition deteriorates. The six-year-old boy suffered prolonged cardiac arrest and irreversible brain damage when he nearly drowned in August 2007 when he was 22 months old.
 
The hospital treating the child—who is a ward of court and can only be identified as SR—had applied to the court for directions relating to his care and treatment, including a direction permitting it not to resuscitate him in certain circumstances. The court granted an order that he should not be resuscitated if an acute deterioration requiring invasive treatment occurs, if the medical advice is that not resuscitating him would be in his best interests.
 
The boy, who is fed through a tube, has lived in a children’s home with specialised facilities since January 2008. The order was opposed by his parents.
 
High Court President Mr Justice Nicholas Kearns said the boy was an energetic and bright child before the accident. He now has severe cerebral palsy, is incontinent, and has no method of communication. He does, however, appear to be soothed by contact with his parents. He also suffers from regular seizures and has developed chronic lung disease. He has no prospect of recovery.
 
The court was told that the boy’s father believes he would benefit from foetal stem cell transplantation and has identified a doctor from the US who offers this treatment in the Dominican Republic or Mexico. However, the boy is unable to travel by plane. Doctors say there is no evidence the treatment would help his condition and that the long distance travel could prove life threatening.
 
Mr Justice Kearns said it was a tragic case and the misfortune that had befallen the boy and his parents was of the gravest character. The judge said the medical evidence was unanimous that re-ventilating him if his condition deteriorated would not be in his best interests. He said the evidence was that it would cause unnecessary pain and discomfort and be futile. He said ultimately it would appear that such treatment would prolong the boy’s suffering without any long-term benefit to him.
 
The judge said he accepted the boy’s parents were dealing with a difficult situation and that they honestly hoped it was in his best interests to be ventilated if his condition worsened. He said they had demonstrated to the highest degree their great love and affection for their child. He said he did not believe that the option of stem cell treatment offered any real prospect of changing his condition, even if the boy was capable of travelling to avail of it.
 
A similar case was considered by the Supreme Court in 1995, when the family of a woman who had suffered severe brain damage 23 years earlier during a routine operation obtained the court’s permission to have her artificial feeding withdrawn. In that case the hospital opposed the application. Both cases concerned a ward of court, so it is up to the court to decide. However, as Mr Justice Nicholas Kearns pointed out, it does so taking into careful account the views of the parents and the doctors involved.
 
In this case Mr Justice Kearns stressed that the dominant and paramount consideration in such cases should be the best interests of the child. He said this gave rise to a balancing exercise taking into account a number of circumstances, including the pain and suffering the child can expect if he survives; the longevity and quality of life he can expect; the inherent pain and suffering involved in the treatment; and the views of the child’s parents and doctors.
 
The court, he said, should ask what the ward would choose if he was in a position to do so, not imposing its own views on the quality of life the child would enjoy but determining his best interests from his point of view. This involves the court attempting to put itself in the position of a person suffering from the disability.
 
Given the importance of the sanctity of human life, there was a strong presumption in favour of authorising life-saving treatment, but that presumption could be deviated from in exceptional circumstances when the court would authorise that steps be taken not to prolong life. The court could “never authorise a course of action which would accelerate death or terminate life”, the judge stressed. In this case, the medical evidence was that intubation and ventilation was not in the boy’s best interests, would involve unnecessary pain and discomfort, would be futile and would prolong his suffering without any long-term benefit to him.
 
F&L Comment: The court’s recognition of the sanctity of human life, and the strong presumption in favour of authorising life-saving treatment is to be welcomed. The life of a person, even one severely disabled, has a fundamental value. Subjective assessments of the “quality” of that life should not obscure that fact. This difficult and tragic case highlights the importance of recognising a clear distinction between an extraordinary medical intervention to prolong someone’s life, which may be unduly burdensome to the patient and so may be rejected, and normal nursing care which includes the provision of nourishment and hydration, even by artificial means. Such basic care should never be withheld if that will cause the patient’s death. 
The Irish Times. January 11. The Irish Times. January 12. RTÉ. January 11. The Irish Times. January 12. Irish Independent. January 12. Family & Life. January 13.