Time for the soul searching to begin


"YOUR clients must appreciate that apart from the upset caused to them by this case, grave upset has been caused and continues to be caused to the staff of our client's institution by reason of the action taken by your clients which was entirely contrary to the spirit of the institution. In these circumstances it is not appropriate that the patient remain in our client's institution."

This is an extract from one of three letters sent to the family of the woman in the "right to die" case last year, after the Supreme Court had ruled that this unfortunate woman should be allowed to die, 23 years after she had suffered irreversible, global brain damage.

They came from the institution in which the woman had spent the last three years of her life and which had gone to the High Court and the Supreme Court to oppose - unsuccessfully - the family's wish that she be allowed to die.

Yet, having lost in the Supreme Court, the institution, it appears, could not wait to get rid of her and the three letters caused immense distress to a family already trying to cope with nearly intolerable pressures.

It was a fitting end to more than two decades of cold and distant treatment by a medical profession which had made the family's ordeal much worse than it need have been.

As the woman's mother related in this newspaper on Saturday, it was an ordeal which began when her then 22 year old daughter went into a Dublin hospital for routine investigative surgery in 1972. It ended in catastrophe on the operating table when the young woman's heart stopped beating and she was resuscitated twice before the investigation was abandoned.

By then she had effectively, died, though her body was to be kept "alive" for more than two decades by hundreds of treatments with antibiotics and through pouring nutrients into her through tubes.

It was at that early point that she first major issue posed by this case arose. That issue is the apparent inability of the medical profession to communicate with the people whom it is there to serve. This attitude of non communication began on the afternoon of the tragedy when the woman's consultant informed her father that her case was no longer "my wicket".

The hospital never, not even once, asked the family to come to a meeting to explain what had gone wrong. To this day, the family says it does not really know what happened.

Some weeks after the tragedy, the woman was moved to another hospital run by the same religious order with little prior consultation. Procedures ranging from a brain scan to tube replacements were carried out without prior knowledge by the family. In her third and final institution a point came when staff would no longer talk to the family, when a request for nursing information was referred to the lawyers.

After the Supreme Court decision in the family's favour, the medical profession delivered a further blow when the Ethics Committee of the Medical Council issued an ambiguous statement which it never clarified in spite of requests from the family. The British Medical Journal interpreted this move at the time as meaning that it "could leave any doctor assisting in the removal of the artificial feeding open to disciplinary action".

This leads to the second major issue of the case: namely the failure by the medical profession or, indeed, society in general, to face up to the implications of the case. Since the woman died last year, hardly a word has been said nor has there been a word from the Catholic Church - and this unfortunate woman spent more; than two decades in institutions run by Catholic religious orders.

It is as if an embarrassing issue died with the woman. But in reality it did not die. The issue of whether a person who is, to put it crudely, "brain bead" should be kept "alive" by hundreds of treatments with antibiotics and by artificial feeding is crucial and surely should no longer be ignored. It is worth repeating here that the mother of this woman, in thousands of visits over the years, never saw the slightest sign of awareness or the slightest response from her daughter.

This is not an issue about euthanasia. It is about allowing people to die physically who have already died in every other sense of the word.

THE Supreme Court ruled on this one case and made it clear that; it was ruling on this one case only. Yet here another issues arises. In spite of the Supreme Court ruling, both the Ethics Committee of the Medical Council and the nursing regulatory body, An Bord Altranais, issue statements which appeared to rule out involvement by doctors or nurses in removing the tube through which nutrients were poured into this woman.

Where does this leave the standing of the Supreme Court vis a vis the professional body in these matters?

The issue is of crucial importance to the one doctor and eight nurses who helped this woman to die a peaceful death.

They acted in accordance with the ruling of the Supreme Court. Yet they must keep their identities secret. It is one thin g to have the Supreme Court on your side - it is quite another to face the possibility of financial ruin and emotional stress through having to fight the Medical Council and An Bord Altranais through the Irish courts to prove that you were entitled to do what the Supreme Court said you could do.

This case has left the public, the church and, above all, the medical profession with a great deal of soul searching to do. It is a shame that we have shown little inclination to do it.