Supreme Court to hear urgent appeal over treatment of profoundly injured child

The Supreme Court has agreed to hear an urgent appeal by the parents of a profoundly brain-injured boy against orders allowing a hospital to withhold invasive interventions and effectively administer a palliative care regime should his condition substantially deteriorate.

The invasive interventions aspect of the High Court orders are expected to remain stayed pending the appeal.

The Supreme Court earlier this week agreed to hear a “leapfrog” appeal, one directly to that court rather than the Court of Appeal. The appeal will be heard later this month, on a date expected to be fixed during a case management hearing on Friday.

An indication of its importance is that the Supreme Court has said the Attorney General and the Irish Human Rights and Equality Commission should be put on notice of it.

The boy — a ward of court referred to as John – suffered catastrophic injuries in a road incident last summer and is said to have no prospect of a meaningful recovery from those.

Arising from disagreement with his parents over his treatment, the hospital applied for a range of orders, including to have John made a ward, and allowing the hospital manage his condition as it considers appropriate.

Medication

That included allowing the hospital to refrain from applying invasive treatments in the event of respiratory distress which may occur as a result of administering pain-relieving medication to address dystonia, a movement disorder which, unless fully controlled by medication, causes his muscles to contract uncontrollably.

The parents, who are separated, opposed wardship. They disagree with the hospital’s assessment concerning the pain being suffered by their son from dystonia and object to him being medicated to treat pain caused by dystonia if there was a risk that would cause him respiratory distress and possibly die.

They want him to receive all treatments that would prolong his life, regardless of side effects or consequences.

The hospital said invasive interventions would only damage John in the short to long term without improving his condition and were ethically unacceptable.

High Court president Ms Justice Mary Irvine last month found John could experience "unimaginable suffering" unless the hospital can manage his condition as it considers appropriate.

Having balanced the constitutional rights of the parents, the family, and John, she concluded the orders, including for wardship, were in his best interests and necessary to vindicate his rights.

The parents’ love for their son has blinded them to the reality of his condition and there is “as much certainty as there can be with any medical diagnosis” that he will not recover in any significant way from his injuries, she said.

She formed the view the parents were failing in their duty as parents to vindicate the rights which their son, because of his age and injuries, cannot himself protect and the State must step in.

She did not think it credible that John, knowing he will spend most of the rest of his life in a hospital bed, be doubly incontinent, will never walk, talk, see, feel love, happiness or pleasure, and, if he survives invasive measures, endure significant periods of pain, would say “do whatever is necessary to keep me alive” knowing this would only return him to a health trajectory worse than that which he faced before.

She also rejected arguments that the orders amounted to accelerating death.