A HOSPITAL has been permitted by the High Court not to resuscitate a permanently disabled child if his condition acutely deteriorates to an extent requiring invasive treatment which will not improve his condition and doctors advise is not in his best interests.
President of the High Court Mr Justice Nicholas Kearns ruled yesterday that resuscitation of the six-year-old boy – profoundly disabled as a result of a near-drowning incident four years ago – would involve undue pain and suffering to him and merely prolong his life with no prospect of improvement.
The near-drowning incident occurred when the child was almost two. It resulted in prolonged cardiac arrest and extensive irreparable brain damage. He has severe spastic quadriplegic cerebral palsy and is blind and incontinent. He is totally dependent with, doctors believe, no prospect of recovery.
Fed through a tube, he has lived in a children’s home with specialised facilities for about three years. He has also had many admissions to hospital due to difficulties including blockages of his feeding tube and infections. Both the home and hospital had afforded “exemplary” care to the child, the court noted.
The boy is now chronically ill and may acutely deteriorate at any time, when a decision would have to be made whether to resuscitate him via invasive ventilation. The court was told that this would not confer any real benefit but would cause him pain and suffering.
He has had seven emergency hospital admissions since October 2010. While the boy could not communicate, he appeared to feel pain and appeared soothed by contact with his parents, the court noted.
The hospital treating the child – who is a ward of court who cannot be identified – 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 boy’s parents expressed concern about such a direction and his father, following internet searches, suggested foetal stem cell transplantation might be an option for him.
In his judgment yesterday, Mr Justice Kearns noted the suggested stem-cell treatment was illegal in the US and Ireland and was advised against by doctors treating the child but a doctor was offering the treatment in private facilities in the Dominican Republic or Mexico for €30,000.
Having analysed the facts of the case, the law and the relevant legal authorities, the judge ruled that the hospital was entitled to the directions sought on grounds that they were in the best interests of the child.
“This is a tragic case and the misfortune which has befallen this young boy and his parents is of the gravest character,” he said. The boy was an energetic and bright child until the date of his accident but had no prospect of recovery and the medical evidence was “unanimous and uncontradicted”, that reventilation would not be in his best interests.
As the boy was a ward of court, the court had sole jurisdiction over all matters relating to his person and estate and the decision here no longer lay with parents or doctors, although their views must necessarily be taken into account.
In determining whether life-saving treatment should be withheld, the “paramount and principal consideration” must be the best interests of the child and the court must take account of all the circumstances, the judge said.
The proper test was to ask what the child would choose if he was in a position to make a sound judgment. The court should not impose its own view on whether the quality of life the child would enjoy would be intolerable but should determine the best interests of the child subjectively.
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.
The judge stressed the boy’s parents were dealing with a difficult situation, they honestly hoped it was in their son’s best interests to be ventilated should his condition worsen and had “demonstrated to the highest degree their great love and affection” for the child.
The option of stem-cell treatment in a faraway location offered, in his view, no real prospect of improving the child’s condition and he did not believe he was capable of making the journey. More importantly, that option was not supported on affidavit by any medical expert or by any reputable body of medical opinion, he added.
