St James's Hospital does not have a written policy on when to cease the artificial ventilation of patients, an inquest heard yesterday.
The absence of such a policy was discussed at Dublin City Coroner's Court, which heard that a paralysed man died after doctors withdrew an artificial ventilator at his own request.
Ronald Lindsey (61), of Iveagh Trust, Dublin 8, a hostel for the homeless, died on April 22nd, 2005, at the Dublin hospital.
Mr Lindsey was on anti-coagulation warfarin therapy for previous deep vein thrombosis and developed a rare complication that left him paralysed despite an emergency operation.
He requested that his artificial ventilation be withdrawn and three senior clinicians involved in his treatment agreed. Mr Lindsey died the same day the ventilation was switched off.
A brief session of the inquest heard that St James's does not have a "written protocol for end of life issues" but follows "unwritten guidelines".
Muireann Ó Briain, legal manager at St James's, told the court that the hospital is in the process of developing a written directive.
"The formal protocol is in relation to resuscitation. We do not have a formal written protocol in relation to end of life issues. We are in the process of developing one. There are guidelines doctors follow . . . It's an unwritten method of operation in the hospital where we try to arrive at a consensus with the family," she told the court.
Dr Bernard Silke, a consultant physician at St James's, told the inquest in January that a "written protocol" at the hospital states that three senior clinicians involved in a patient's treatment must agree to discontinue artificial ventilation at a patient's request.
Ms Ó Briain said Dr Silke's evidence was incorrect as no written protocol yet exists.
"Probably in six months' time there will be such a document and it will reflect the unwritten procedure," she said. Ms Ó Briain added that she would write to coroner Dr Brian Farrell outlining "how doctors reach a consensus with families" in relation to end of life issues ahead of the resumed inquest on April 17th.
Thomas Fallon, barrister for Mr Lindsey's sisters, Olive Cummins and Winifred Leonard, previously told the inquest that the family were "removed" from the decision to switch off their brother's artificial ventilation.
Mr Fallon said yesterday that another area he wished to explore at the resumed hearing was why there was "no availability" of MRI scans at St James's at weekends. Dr Silke told the inquest previously that it was "completely inappropriate" that MRI services were not always available at the hospital.
Mr Fallon said he also wished to examine why the hospital retained some of Mr Lindsey's tissue samples. Adjourning proceedings, Dr Farrell said that "in the public interest" blocks of tissue samples can be retained in case an inquest has to be "audited in the future".