A hospital may withhold life-saving treatment from a child permanently disabled after a near-drowning incident if his condition deteriorates to an extent requiring invasive treatment which doctors advise against, the High Court has ruled.
The President of the High Court, Mr Justice Nicholas Kearns, said he believed ventilation of the six-year-old boy in the circumstances of this case would involve undue pain and suffering to him and merely prolong his life with no prospect of improvement.
The boy is severely disabled with severe spastic quadriplegic cerebral palsy, blind, incontinent and totally dependent with no prospect of recovery after a near drowning incident which occurred when he was aged almost two.
The incident resulted in prolonged cardiac arrest and extensive irreparable brain damage and the boy has lived in a children's home with specialised facilities for some three years. He is fed through a tube.
The child has had several admissions to hospital with difficulties including blockages of his feeding tube and infections, is now chronically ill. He may acutely deteriorate at any time when a decision will have to be made whether to resuscitate him via invasive ventilation which, the court was told, will not confer any real benefit and will cause him pain and suffering.
The hospital treating the child, who is a ward of court and cannot be identified, had applied to the High Court for directions relating to his care, including a direction permitting it not to resuscitate him in certain circumstances.
The boy's parents expressed concern about such a direction and his father, following searches on the internet, had suggested fetal stem cell transplantation might be an option for him. The judge noted this treatment is illegal in the US and Ireland and was advised against by doctors treating the child but a doctor was offering it in private facilities in the Dominican Republic or Mexico for €30,000.
In his important judgment delivered today, Mr Justice Kearns ruled the hospital was entitled to the directions sought on grounds they were in the best interests of the child.
"This is a tragic case, and the misfortune which has befallen this young boy and his parents is of the gravest character," he said.
This boy was an energetic and bright child until the date of his accident but has no prospect of recovery and the medical evidence was "unanimous and uncontradicted" that reventilation would not be in his best interests.
As the boy was a ward of court, the court had sole jurisdiction over all matters relating to his person and estate, the judge noted. The decision in this case was solely for the court and no longer lay with parents or doctors, although their views must necessarily be taken into account.
In determining whether life-saving treatment should be withheld, the "paramount and principal consideration" must be the best interests of the child, the judge said.
The court must take account of all circumstances, including, but not limited to, the pain and suffering the child could expect if he survives; the longevity and quality of life he could expect if he survives; the inherent pain and suffering involved in the proposed treatment and the views of the child's parents and doctors.
The proper test was to ask what the child would choose if he was in a position to make a sound judgment, he said. The court should not impose its own view on whether the quality of life the child would enjoy would be intolerable but should determine the best interests of the child subjectively.
Given the importance of the sanctity of human life, there exists in circumstances such as in this case a strong presumption in favour of authorising life-saving treatment, he said. That presumption could be deviated from in exceptional circumstances.
In exceptional circumstances, the court will authorise steps be taken not to prolong life but could never authorise a course of action which would accelerate death or terminate life, he stressed.
In this case, the medical evidence was that incubating and ventilating this boy was not in his best interests. It would involve unnecessary pain and discomfort and would be futile. Ultimately, it would appear such treatment would prolong his suffering without any long term benefit to him.
The judge stressed the child's parents are dealing with a difficult situation and they honestly hoped it was in their son's best interests to be ventilated should his condition worsen. They had demonstrated to the highest degree their great love and affection for the child.
The option of stem cell treatment in a far away location, in his view, offered no real prospect of improving the child's condition, the judge said. He also did not believe the child was capable of making the journey for such treatment. More important, that suggested treatment option was not supported by any medical expert on affidavit and not supported by any reputable body of medical opinion.
In those circumstances, he would grant the directions sought by the hospital. The care provided to the boy by the hospital and the children's home had been "exemplary throughout", he added.
