Court order permits hospital not to resuscitate brain-injured woman

A hospital has secured interim High Court orders allowing it not to resuscitate a brain-injured woman, aged in her 50s, with “a litany of conditions” and a “very poor” prognosis.

David Leahy BL said it was a “grave” application for orders permitting clinicians not to ventilate or resuscitate the woman should she suffer cardiac arrest as they considered that would further deteriorate her already very compromised position, was not in her best interests and would not alter her prognosis.

The hospital’s treatment plan involved what was “likely to be end of life care” with ward-based management, conventional oxygen therapy and no ICU admission or CPR, he outlined.

The woman’s family had expressed opposition to that plan and had argued she should be resuscitated if required but there was a more recent indication their position may alter and they had sought more information on the hospital’s proposals, he said.

The hospital’s application was being made in the clinical best interests of the woman and was not based on any consideration of scarce ICU resources, counsel stressed. On foot of medical reports the woman lacks capacity to make decisions on her treatment, the hospital wanted orders directing an inquiry into whether she should be made a ward of court, he said. Pending the inquiry, it wanted the interim orders allowing it treat the woman in accordance with what her clinicians considered in her best interests.

Mr Justice Mark Heslin said on Friday he was satisfied the evidence in this “very difficult” case was sufficient to trigger the court’s wardship jurisdiction and it was in the best interests of the woman to make the interim orders. He directed an independent medical doctor to assess of the woman’s capacity and returned the matter to next week.

He was told the woman’s family would participate in next week’s hearing. In his ruling, the judge noted the doctors considered resuscitation or ventilation would be futile given the woman’s condition and prognosis and had potential to worsen that prognosis and cause irretrievable deterioration to her quality of life and unnecessary suffering which was “impossible to justify”. Earlier, outlining the background, Mr Leahy said the woman has severe neurological damage as a result of acquired brain injury, extensive care needs and very compromised capacity.

She suffers from a range of conditions, is tube-fed, non-ambulant, sleeps some 22 hours daily and is doubly incontinent. She was admitted to hospital from a nursing care unit last March after experiencing respiratory arrest and was ventilated. She was again admitted to hospital earlier this month for surgical reasons and remains there.

Her treating clinician, and an intensive care medicine consultant, were both of the view the woman lacks the necessary capacity to understand and decide on her treatment. Both agreed her prognosis is very poor and that CPR or ventilation should not be administered in the event of cardiac arrest or further respiratory failures.

The hospital wanted to have the necessary legal framework to treat the woman in line with the clinical view as to what is in her best interests and wardship would provide that framework, counsel said.