Arrow left dark
Newsletter icon SUBSCRIBE

High Court: HSE granted application permitting doctors to withhold increase in ventilator support in event of MCS patient’s deterioration

Clock icon Reading time: 4 minutes

of the possibility of JM suffering either a respiratory or clinical deterioration.

Image

About this case:

Should either or both of those events happen, the court is asked to make an order which would permit, but not compel, JM’s treating doctors, in the exercise of their clinical judgment, to withhold an increase in his existing ventilator support in the event of a respiratory deterioration, and to withhold CPR and the other procedures identified in the event of a clinical deterioration.

President Kelly stated that the question of whether JM could experience pain was a matter of great concern.

Considering all the available evidence, President Kelly found that medical evidence supported the proposition that JM could feel pain.

Medical treatment

per Denham J. in In Re A Ward of Court 2 I.R. 79 at p.156, President Kelly stated that “Medical treatment may not be given to an adult person of full capacity without his or her consent. There are a few rare exceptions to this, e.g., in regard to contagious diseases or in a medical emergency where the patient is unable to communicate. This right arises out of civil, criminal and constitutional law.”

As such, every competent adult has a right to withhold consent to medical treatment

Findings on JM’s medical condition

  1. JM is in a MCS because of a severe, non-traumatic, multifactorial, irreversible brain injury. That brain injury is both severe and irreversible.

  2. JM is unable to speak or to communicate his wishes. He is tube fed and dependent for all activities of daily living.

  3. He does have an awareness to some extent at least, of his surroundings. He responds to stimuli by times. His level of awareness fluctuates and is compromised by the impairment of his physical functions. He suffers greatly from fatigue. As a matter of probability, he can suffer pain.

  4. There will be no improvement in his neurological position, his ability to function or his level of awareness. The brain volume loss demonstrated by MRI scanning is an indicator of poor prognosis.

  5. He breathes through a tracheostomy. He has a history of recurrent respiratory tract infections and he is at substantial risk of them recurring. Patients with altered states of consciousness with a long-term tracheostomy in place eventually succumb to respiratory sepsis.

    6. The plan of the hospital authorities is to keep all of his current supports in place and in the event of infection occurring to treat such infections with antimicrobial treatment and fluids.

    President Kelly accepted evidence that JM’s condition was likely to undergo further deterioration were escalated ventilation administered. There is the significant risk of barotrauma in an already compromised patient. He will sustain further deterioration if full mechanical ventilation is given. Such would very likely require an increased level of sedation with potentially adverse neurological effects. It would not return JM to his present condition and probably adversely affect brain function.

    Considering the best interests of JM, President Kelly therefore took account of:

    1. the negative prognosis,

    2. the benefits and burdens of this treatment,

    3. the presumption in favour of life, and

    4. in the absence of JM’s wishes being known or ascertainable those of his parents.

      5. President Kelly therefore found that it was not in JM’s best interests that he should have an increase in ventilator support in the event of a deterioration in his condition, as the risks involved in so doing were substantial.

      No clear medical benefit would be achieved.

      Notwithstanding his parents’ wishes President Kelly stated that he did not believe JM’s best interests would be served by refusing the application.

      Accordingly, this relief sought by the HSE was granted.

      • by Seosamh Gráinséir for Irish Legal News

        • Share icon
        Share this article: