An acutely ill and profoundly disabled 10-year-old girl in State care should not be resuscitated or receive emergency life-saving intervention, the High Court has ruled.
Ms Justice Iseult O’Malley said a hospital had sought the order on the basis that it was highly unlikely that the girl would recover from her present condition.
Even if she did, she would have an extremely poor quality of life and would inevitably face another life-threatening event in the near future, the judge noted.
In coming to her decision in “such a terribly difficult case”, the judge said she was obliged to act in the child’s best interests.
The order means the girl will receive all palliative care but should she require cardiac resuscitation, surgery, artificial ventilation or general anaesthesia, doctors have been given permission by the court to follow their clinical judgment not to provide such treatment.
Her doctor wants her to be able to return to residential care, which has been her home for most of her life, where she can live out her last days in comfort and peace.
The court heard she was admitted to hospital at four months of age with serious brain damage and had been in State care almost since then.
Unable to communicate
She is profoundly intellectually disabled and unable to communicate verbally although she smiles when happy and cries when unhappy, the court heard. She cannot be fed orally and lacks any capacity to look after herself.
She is wheelchair-bound, suffers from severe spastic quadriplegia, epilepsy, scoliosis, a congenital heart condition and suffers recurrent life-threatening infections.
She had been happy in residential care, had attended a special school and, in particular enjoyed music. Last year, she made her First Communion and went on holiday.
Her mother, who attended court, supported the doctors but said, as part of her palliative care programme, her daughter should not be “pumped full of morphine unnecessarily”.
Her father has not been involved in her life to any great extent and was aware of the court application but expressed no view on it, the court heard.
Ms Justice O’Malley said making orders in the child’s best interests included taking account of her illness, the length and quality of life she could expect and the suffering inherent in the course of treatment or in any possible future aggressive treatment, she said.
She was also taking into account the views of doctors and the girl’s parents. The judge said it was not for her to impose her own views as to whether potential quality of life would be tolerable but to ask what would the child do if she were in a position to make a sound judgment.
There is a strong presumption in favour of life-saving treatment and the courts will never authorise positive steps to accelerate death or terminate life, she said.
However, in exceptional circumstances, authorisation may be given that steps not be taken to prolong life.
She accepted the doctors’ view that further aggressive treatment was not in her best interests. It might prolong life but the likelihood was that that would be futile, she said.
The court was told by a paediatrician treating the girl that further invasive treatment would be painful and undignified.
Severely unwell
Her health had been deteriorating since last year. She had to receive treatment for infections, remained severely unwell and tests indicated evidence of liver and kidney impairment.
Her doctor did not think it would be right for her to die in intensive care and she should be returned to her residential care, where she knows the staff.
