A hospital wants High Court orders permitting it to withhold invasive interventions and administer a palliative care regime for a boy whom they believe has little prospect of a “meaningful” recovery after suffering a catastrophic brain injury in a car crash.
The young boy’s parents oppose the orders, including ones which would allow the hospital not to resuscitate him in the event of cardiac arrest. His doctors say such invasive interventions will not alter his prognosis, may cause him pain and distress and are not ethically justified.
The parents, who are estranged and separately represented, say the hospital’s application is “unprecedented” and too early in the context of an accident which happened just a few months ago.
It is accepted their son is not brain dead and the hospital should wait and see how his situation develops, they argue.
The mother’s solicitor said the court cannot embark on assessing what exactly a “meaningful” recovery means or what constitutes “a meaningful or worthy life”. That is the wrong legal test and the mother believes her son is making a slow improvement and will achieve a recovery “that could be considered a life”, she said.
The parents also want the boy cared for in his mother’s home, with the necessary care assistance, or moved to his local hospital.
Wardship proceedings
Conor Dignam SC, for the treating hospital, said on Tuesday he was seeking the disputed orders in wardship proceedings. He stressed there is no dispute about the parents love and care for their son but, due to the disagreement with doctors about his future care, wardship was an appropriate mechanism for determining where his best interests lay.
The parents opposed wardship.
High Court president Ms Justice Mary Irvine said she would admit the boy into wardship and give her reasons later.
A hearing to determine whether the orders sought by the hospital should be granted then opened and is expected to last several days, involving evidence from a range of medical personnel and from the parents.
At the outset, the judge told the parents she had decided against visiting the boy in hospital because of the Covid-19 restrictions, his inability to communicate and because she did not want her decision influenced by her impressions of him as she lacked medical expertise.
Medication
Opening the case, Mr Dignam said a team of doctors involved in the boy’s treatment support the orders. He said the boy was on a ventilator for some weeks after the accident. He can now breathe unaided, which doctors expected because the part of his brain which controls breathing is unharmed, but is in a persistent state of disordered consciousness, does not respond to voice or commands and is fed through a naso gastric tube.
The medical team believe his situation will not significantly improve, counsel said.
High doses of medication have brought the dystonia somewhat under control but the medication masks the dystonia rather than treats it and there are breakthrough episodes during which doctors believe the boy may be suffering pain and discomfort, counsel outlined. Those episodes were triggered when he was touched, as was necessary for his care.
Invasive treatments only cause him pain and discomfort and his team believe those are futile because there is no prospect of meaningful recovery, counsel added.
The mother’s solicitor said her client did not accept her parental responsibility should be interfered with by intervention of another party, the rights of mother and child must be considered and the court could interfere only in exceptional circumstances of parental failure of duty which did not apply here.
The orders sought were unprecedented in this case concerning a living patient with no diagnosis of a permanent vegative state or brain death, she said.
This application, just weeks after his accident, was to discontinue active management and care, was too soon and the child should get every opportunity to come to whatever recovery he can.
Counsel for the boy’s father argued the orders are not in the child’s best interests.
The hearing continues on Wednesday.
