The president of the High Court has made orders permitting artificial life support to be withdrawn from a young woman in a persistent vegetative state for almost 10 years, and for palliative care to be administered, so she can die a natural death.
The woman’s mother, supported by her extended family, had sought the orders.
They were in court on Monday and wiped away tears as Ms Justice Mary Irvine read her judgment.
Aged in her twenties and referred to as Katie (not her real name), the woman has been in persistent vegetative state since she suffered severe brain injury in summer 2011 following several cardiac arrests.
Ward of court
She was made a ward of court last year at the petition of the HSE because doctors wished to perform surgery to release contractures in her arms.
Before the petition was presented, the HSE was advised the family, rather than surgery, wanted orders withdrawing the artificial life support, so Katie might be allowed to die.
The HSE and the general solicitor, Patricia Hickey, appointed as the committee to represent the woman’s interests in wardship, supported the mother’s application as in the woman’s best interests.
Today, the judge said the overwhelming and unanimous medical evidence is that Katie’s condition will never improve and the artificial feeding/hydration is of no curative benefit to her.
She was satisfied, having regard to the legal principles set out by the Supreme Court in its decision In re a Ward of Court, the law allowed the court to make the orders, including permitting doctors to take all steps necessary to allow Katie’s death to take place in the normal way as her family had asked.
Best interests
Taking the view of a loving and considered parent apprised of all the facts, it is in Katie’s best interests her life support be withdrawn and that she be allowed “to pass away”.
She took into account Katie cannot communicate with the outside world or with her family and cannot take part in a life she would have valued. She further took into account, prior to Katie experiencing the catastrophic injuries, she had expressed a wish not to be left on artificial life support in the kind of circumstances she is now in.
It was relevant to the court’s decision Katie has always been very private about her body, the judge said. Her current care and treatment is at odds with her wishes and preference in that regard as, while Katie’s carers have kept her body in good condition, the 24-hour nursing care, the invasive feeding and other treatment are an interference with her rights to privacy, dignity, autonomy and bodily integrity.
The judge also took into account Katie’s mother’s evidence about all of the things Katie loved to do, including fashion, singing, socialising and that she "will never again experience the love and joy of being part of a wonderfully kind and close-knit family who cherished her".
'Profoundly tragic'
She had further regard to the evidence of Katie’s sisters she wanted a full and meaningful life, enjoyed her job and had ambitions to have children and travel, “all entirely reasonable expectations so cruelly taken away from her”.
The judge noted medical evidence that Katie will not feel pain when her nutrition and hydration is withdrawn but may respond by demonstrating movements that might suggest pain. While doctors are firmly of the view Katie would not experience pain, they would administer pain relieving medication for the purpose of reassuring her family she was not experiencing pain, she noted.
The judge also noted evidence from doctors they considered there would be nothing unethical about withdrawing the treatment.
She said, this was not an appropriate case for the court to set down, as the general solicitor had sought, how the recent Supreme Court JJ decision, concerning a brain injured boy whose parents opposed certain treatments advocated by his treating doctors, might apply to other cases concerning medical treatment for those lacking capacity.
The judge described Katie's case as “profoundly tragic” and said she wanted to express her sincere admiration for the remarkable strength and fortitude the family have shown for so many years “in the face of what can only be described as the worst imaginable type of family catastrophe”.
When Andrew Fitzpatrick SC, with Patricia Hill BL, instructed by solicitor David Hickey, thanked the judge on behalf of the family, the judge said it was her privilege to have met them.
