A mother has indicated she wants to seek High Court orders which would effectively result in the death of her daughter who has been in a vegetative state for almost 10 years.
Now aged in her late 20s, the daughter has been in a vegetative state since she suffered a cardiac arrest or arrests when aged 18 arising, it is believed, from an overdose of an illicit substance.
High Court president Mr Justice Peter Kelly said on Tuesday there was "a great deal of tragedy" about the case and, if the mother proceeded as she had indicated she wished to, that raised "fundamental" medical, legal and ethical issues in wardship proceedings concerning the daughter.
The mother, and the daughter’s stepfather, had told the HSE they believed the treatment being provided to her daughter at a specialist unit should end.
Because the treatment includes nutrition and hydration, provided by peg tube, that would bring about the early death of the daughter, the judge said.
He was told by Donal McGuinness, for the HSE, that the executive had initiated wardship proceedings in circumstances where the woman was about to undergo surgery to relieve pressure on her brain.
She lacked capacity to consent to that and an issue arose whether a Do Not Resuscitate (DNR) notice should apply if there was any adverse problem with the surgery, counsel said.
The woman’s mother and stepfather had favoured a DNR notice but the situation developed into a “much bigger issue” as to whether it was in the woman’s best interests for her current treatment to continue, counsel said.
The mother and stepfather had said they believed the treatment should not continue, he said.
Mr Justice Kelly said medical reports all agreed the woman lacks capacity and met the criteria for wardship and he would take her into wardship. On the current medical evidence, the woman will not be able to regain ability to communicate or have any functional independence, he noted.
He said the mother and stepfather supported an end to the woman’s treatment and sought to be appointed as the committee to represent the woman’s interests in the wardship proceedings. This created a “very unusual” situation because, if they were appointed as committee, that would mean the committee, whose role is to seek what is in the best interests of the ward, would be seeking to bring about her early death.
This raised “fundamental” medical, ethical and legal issues and meant the wardship proceedings had evolved into something much more extensive than whether the court should permit the proposed surgery. It is essential the woman’s interests and rights, including her right to life, be independently represented in the wardship, he said.
In the circumstances, he believed it was more appropriate to appoint Patricia Hickey, general solicitor for wards of court, as the committee to represent those interests and with powers to procure independent legal representation and medical reports on behalf of the daughter.
Even if he was appointing the mother as her daughter’s committee, he would have appointed Ms Hickey to separately represent the ward’s fundamental rights, he added.
The judge said the mother has liberty to proceed with an application to end her daughter’s current treatment but it was not clear the stepfather has any rights in relation to such an application.
The mother is not required to proceed with the mooted application but, if she does, other parties may seek to be involved, he noted. Any such case will not be easy as there were “a lot of issues to be explored”.