High Court grants twins transfusion order

The High Court has made an order allowing doctors provide blood transfusions and other medical treatments considered “almost certainly” necessary to save the lives of or avoid serious injury to “severely anaemic” twin babies after their birth.

The delivery of the 32-week-old babies, whose Jehovah Witness parents objected to their getting blood products on religious grounds but have agreed to abide by the court order, is expected to be induced shortly in light of the suspected seriousness of their condition.

The HSE has said the "potentially critical" nature of the situation meant it had to get the court order now and could not wait until after the babies were born to seek it as that would take time and could risk the babies lives or health.

A consultant  said transfusion "is almost certainly going to be medically necessary to save the lives of Babies C & D".

The refusal of the mother to take Anti-D blood products herself or to allow blood be administered to the babies in her womb has placed the babies at risk of anaemia, which can lead to death, and has also risked them suffering jaundice, which can lead to deafness, cerebral palsy and lifelong severe disability, doctors told the court.

Doctors said the "ideal management" of the pregnancy would have benefited from a foetal blood sample to be taken and the unborn children to receive a tranfusion in the womb to treat any anemia.

However, that was not possible because of the preants beliefs and doctors say the babies will instead have to be delivered prematurely, raising "all the risks associated with immaturitand pre-term delivery".

In a letter read in court today, the babies 31-year-old mother said she and her husband "love our children with all our hearts" and did not want them "to die or cause them harm". Their religious beliefs meant they could not consent to blood products being administered but they understood doctors believed there was no alternative and the parents would not interfere with the court's decision.

The babies mother has a Rhesus D negative blood group while her husband is Rhesus positive. Their last baby, now aged four and healthy, was Rhesus D positive. The mother was advised to take anti-D blood products to avoid risk to future pregnancies but refused, on religious grounds, to do so.

A consultant said that, because of the mother's refusal to take anti-D, she had developed antibodies against Rhesus D positive blood cells, her twin babies are Rhesus positive and scans indicated the mother's antibodies are destroying the babies red blood cells, placing their lives and health at risk.

Doctors believed the twins would require transfusions, perhaps within minutes of their birth, to try and avoid risk of death or serious injury.

In those circumstances, Ms Justice Mary Laffoy today granted the HSE a final order allowing doctors administer to the babies after their birth blood tranfusions or other treatments considered "medically necessary" to avoid death or serious injury.

The judge remarked the approach to the case was "a prototype" of how such cases should be dealt with, noting the HSE had moved as soon as possible and the parents had had the opportunity to be legally represented. The babies father was in court, she noted.

The order was being made on the clear understanding that, as appropriate, there would be consultation with the parents, she added. She had no doubt that would happen, the judge said.

Earlier, the order was sought by Mr Brian Murray SC, for the HSE. Mr Richard Daniels, for the parents, who cannot be named by court order, said they could not, because of their religious beliefs consent to the order being made.

However, they recognised the court has power and authority to make such an order and it was "inevitable" the order would be made so as to protect their babies. He said the parents believed the order should address both the concerns of the medical treatment team and their own religious beliefs.

Mr Murray said there was a close working relationship between the parents and the medical team treating the mother and the team were well aware of the parents wishes.

Mr Daniels read a letter from the mother of the babies who said she would like to be in court but could not be as she was undergoing daily monitoring and, due to her medical condition, it was considered unwise for her to travel too far from the  hospital as she could be induced "at any point".

However, she said, she would like to address the court. "I am of sound mind, born and raised in Ireland and I understand the laws of this land as does my husband. We love our children with all our hearts".

She said they were already the parents of a healthy four-year-old child and did not want their chidlren to die or cause them harm.

They had been treated at all times in hospital and by the medical team in a respectful, honest and courteous manner, she added and they realised the seriousness of the situation of the babies.

Because of their "firm Scriptural beliefs" which she  herself had held for 20 years and her husband had held for 15 years, they could not consent to blood transfusions being administered.

However, she added, they undertsood the doctors fear they have no choice . "All we ask is that bloodless alternatives be tried first" and they would not interfere with the court's decision. She also asked the court for their anonymity to be  maintained for the sake of their children.

Outlining the basis for the application, Mr Murray said the babies were severely anaemic and the normal approach to that was to give a transfusion in the womb. However, that was not being proposed here and it was hoped instead to have an early  delivery after which it appeared it would be necessray to administer transfusions to the babies.

Mr Murray then read affidavits from consultants treating the mother. One consultant said that, as a result of the woman's refusal to accept Anti-D, she developed antibodies against Rhesus D positive cells. The babies were Rhesus positive and at risk from the antibodies of the mother who refused to consent to the babes receiving blood transfusions in the womb or after delivery.

The consultant said haemolysis is the disinetegraiton of red blood cells and affects the unborn child primarily in two ways - anaemia and jaundice. Severe foetal anaemia could lead to the child dying in the womb or cause heart failure leading to  hydrops, where the baby becomnes grossly swollen with fluid in the lungs, herat and abdomen. About half of all babies with hydrops die in the womb or shortly after birth, he said.