Judge adjourns application for DNR orders for brain-injured man

A father whose severely brain-injured son is at the centre of a case over whether doctors can opt not to resuscitate him if his condition deteriorates has said he wants his son to live and “be kept alive”.

“I want him to be kept alive. Where there’s life, there’s hope.”

"In Deo confidimus [in God we trust]," he added. "When the time comes for him to leave this world, it should come naturally and with the full support a civil and caring society can offer."

He wants his son to remain in a hospital high-dependency unit where he is getting excellent care and to get all necessary treatments “to keep him alive”.

He was giving evidence in the continuing hearing of the Health Service Executive’s application for orders permitting doctors not to administer increased ventilatory, CPR or other treatments to the man, aged in his 30s, if his condition deteriorates.

Negligence proceedings

The parents oppose the orders. They have separate medical negligence proceedings against the HSE arising from the man’s care and treatment following his admission to hospital more than four years ago.

The court has heard there is no unifying diagnosis for the man’s injuries and he suffered a significant brain injury some months after his admission to hospital with an acute lung condition.

The HSE application is not about withdrawing existing ventilation or other treatments but giving doctors discretion, if the man suffers a setback, not to apply CPR or increase ventilator support if they consider such treatment is not beneficial.

Doctors consider his condition has deteriorated over the past two years and will not improve but his parents disagree on that and other issues including his ability to communicate.

Because the man has been made a ward of court, the president of the High Court, Mr Justice Peter Kelly, must decide whether the orders are in his best interests.

Having heard all the evidence on Friday, including from the parents and medical experts, the judge adjourned the case to next month when he will hear legal submissions. He confirmed he will visit the man in hospital before then.

After the evidence concluded, Liam Reidy SC, for the parents, indicated he, as counsel, accepted the medical evidence did not support his side’s opposition to one of the orders sought – giving doctors discretion to withhold CPR or defibrillation. He stressed the parents maintain their opposition to that order.

The parents also oppose another order allowing doctors not to increase the existing ventilator support to the man.

The judge told Mr Reidy he was “behaving impeccably” as counsel with responsibility to the court as well as to his clients.

Stay

Mr Reidy indicated he may seek a stay on any orders concerning ventilation if those are made pending the hearing of the separate personal injuries case, expected to be heard before the end of July.

Peter Finlay SC, for the HSE, said he wanted to stress while the man’s condition was being managed, there were no certainties.

Earlier, a critical-care specialist told the judge that if he was leading the man’s care he would have concerns, if the court refused the orders sought, that he would be providing care for the man that was distressing for him and acting against his better judgment. He agreed the effect of some treatments was hard to measure.

In his evidence, the man’s father said the last words his son spoke to him more than four years ago, after he was admitted to hospital vomiting blood, were: “How are things?” He considered his son seems very stable and relaxed recently and did not think he was in discomfort.

While he has had deteriorations, the last was more than a year ago and, while he was quite ill then, he came through the treatment administered.

Asked did he believe his son gets enjoyment from life, he said he believed so. “I can see emotion, I can see happiness from time to time.”

The family still did not know what happened to his son and would like to. He was also sure his son “would love to know”.

Mr Justice Kelly expressed his sympathy to the man and family and said he would do his best to make the right decision.