Court lets hospital give blood to baby if necessary

Doctors caring for a premature baby have been authorised to give the child a blood transfusion if necessary in spite of the objections of the parents, who are Jehovah's Witnesses.

At the High Court yesterday, Mr Justice George Birmingham said it would amount to "brinkmanship" and an "abdication of responsibility" if he did not extend an order giving the National Maternity Hospital in Holles Street, Dublin, the right to intervene with a blood transfusion if necessary.

The order was first granted on Christmas Eve and the case was adjourned to allow for a response from the parents .

The court was told that the baby could be at risk of heart failure unless doctors treating him are given the option of performing a blood transfusion.

The Polish parents of the baby boy, known as Baby B, are devout believers who live in the midlands and who do not speak English.

Baby B weighed just 980 grams (2lbs, 3ozs) when it was born 10 weeks premature at Portiuncula Hospital in Ballinasloe on December 20th. He was transferred to Crumlin Children's Hospital and then to the intensive care unit in Holles Street on December 23rd.

His parents told medical staff at Crumlin and Holles Street that their religious beliefs precluded the child from being given a blood transfusion. The parents, who were not in court for the original hearing, were in court yesterday. Dr John Murphy, a consultant neonatologist at Holles Street, said the percentage of haemoglobin in the baby's blood had dropped from 16.8 grams of haemoglobin per decilitre of blood (g/dl) on his arrival at the hospital to 10.5 g/dl yesterday.

He said that doctors usually perform a blood transfusion if levels drop to 8g/dl, when newborn babies have a very low tolerance of anaemia.

He said that when levels drop to 7g/dl, it can cause the heart rate to rise and lead eventually to heart failure. He predicted that a blood transfusion could be needed within four to five days.

Dr Murphy said 90 per cent of children who were born in the 1970s at Baby B's birth weight did not survive. The total amount of blood in Baby B's body amounted to just three fluid ounces and even the loss of the equivalent of two teaspoons of blood would spell trouble for him, he warned.

Dr Murphy also explained that it was not the practice of doctors to give a blood transfusion unless it was absolutely necessary.

Paul McDermott, counsel for the hospital, acknowledged that the couple involved were following their conscience, but he said the court had an inherent jurisdiction when there is a conflict between the rights of the child and the parents. He also said it was an established precedent in law that the court had a right to intervene where there was a risk to the life of the child.

Simon Mills, counsel for the parents, said the State should only contravene the wishes of parents in extreme circumstances and those circumstances do not exist at present. He said the hospital had acknowledged that Baby B was now stable, that the necrotising enterocolitis involving internal bleeding had been controlled, he was ready to be fed orally.

He suggested that the order be set aside and that the hospital, instead, should only return to court if the situation deteriorates.

Mr Justice Birmingham said there was no suggestion that the parents were culpable and were acting out of a "deeply held conviction".

The baby was improving but he was in "no doubt that we are dealing with a baby whose condition is grave in the extreme". He said if the baby's condition deteriorated the energies of the staff at the hospital would need to be focused on treating him rather than be distracted by the need for a further court application.

The judge extended the order directing the National Maternity Hospital to provide all necessary care for Baby B including, if necessary, a blood transfusion to all hospitals at which Baby B might be treated, but only if absolutely necessary. He adjourned the case for mention to March 7th.