A brain-dead woman was kept on a life-support machine in a regional hospital against her husband's wishes last month because she was pregnant. The Attorney General, who was drawn into the case by the hospital's lawyers, advised that life support could be withdrawn, but it continued.
The issue arose when a woman collapsed with a brain haemorrhage on May 13th and was taken to the local hospital. She was immediately placed on life support. She was 14 weeks pregnant.
The hospital's intensive care specialist found her to be brain dead. He expected her to die within the next few days, even with the life-support regime.
The hospital's neurologist believed the case could pose an ethical dilemma because the foetus showed movement. The normal course in this situation, in his view, would be to turn the ventilator off.
The hospital authorities believed they had to consider whether the woman could be maintained for a further 15 weeks to allow the foetus come to maturity.
It is understood that no brain dead person over the age of 30 has been sustained on life support for more than a month in this State.
External medical opinions were also sought by the hospital authorities. Dr Thomas Ryan, intensive care consultant in St James's Hospital, Dublin, suggested that efforts to keep her alive were futile.
Prof John Bonnar, professor of obstetrics and gynaecology in Trinity College and a proponent of the Pro-Life Campaign, also held the view that there was no reasonable prospect of sustaining the woman's heart and circulation to keep the baby alive to a stage of viability.
The regional health board decided to seek clarification of its legal position. Its Dublin solicitors, B.C.M. Hanby Wallace, sought advice from a leading constitutional lawyer, Dr Gerard Hogan SC. He advised that under no circumstances ought the ventilator be switched off in the absence of a court order.
The health board obtained another medical opinion from Dr Brian Marsh, intensive care consultant in the Mater Hospital, Dublin. He considered it extremely unlikely that the woman could be kept alive for the necessary 10 weeks, at least, needed to reach foetal viability. But he referred to a US report of rare cases where this had been achieved. This was therefore potentially possible, he said, though extremely unlikely.
In a formal written opinion, Dr Hogan acknowledged that the treatment the woman was receiving "can have no beneficial effects whatever for [her], but is simply designed to keep her body alive in order to sustain the foetus". He concluded: "Were it not for the existence of the pregnancy, these measures would never have been contemplated, still less attempted." Dr Hogan described the measures as "by any standards extraordinary".
The Attorney General, Mr Michael McDowell, was fully informed of the situation by solicitors for the regional hospital. They said that the health board intended to apply to the High Court for guidance about the continuance of treatment and that it would also seek to make the patient and/or the foetus a ward of the State.
The board also intended to join the Attorney General in the action as legitimus contradictor (that is, to argue the other side), they said. Mr McDowell told them, in a letter dated May 25th, that he considered this inappropriate.
He did not consider such proceedings to be necessary at all. "The facts of this case as now known would not prohibit the hospital from making its own ethical judgment and from acting on it even to the point of withdrawing the life support regime currently in place," Mr McDowell said.
The hospital continued the life-support treatment until nature intervened. The foetus died on May 30th.
Two days later, on June 1st, the ventilator was switched off. The woman was buried last Friday.