Thursday 19 October 2017

Dispute between doctors and parents over resuscitating brain injured son, court hears

Stock picture
Stock picture

Aodhan O'Faolain

A severely brain injured young man is at the centre of a legal dispute between doctors and his parents over whether he should be resuscitated if his condition deteriorates.

The parents are opposing the HSE’s application for orders giving doctors discretion not to administer various treatments, including CPR, if his condition deteriorates further.

The President of the High Court, Mr Justice Peter Kelly, who described the case as “of major importance”, may visit the man in hospital.

As the man is a ward of court, the judge must decide whether the orders sought are in his best interests. The parents were in court for the case, which opened on Tuesday.

A senior doctor involved in the man’s care said, in line with Medical Council guidelines, she discussed his situation on many occasions over years with his parents. Those discussions were often difficult and the parents did not agree the man was minimally conscious or did not communicate.

She considered the discussions had reached an “impasse” and she recommended an application be made last year to have the man made a ward of court.

She always worried about “a gulf” between families and doctors and believed the parents would find it easier to live with a court, rather than a medical, decision in this matter. “Somewhere along the way, they lost their trust in us.”

The fact the parents have separate legal proceedings alleging negligence in the man’s care and treatment “complicates the picture”, she said in response to the judge.

Aged in his thirties, the man has been hospitalised for some four years with a very poor future prognosis.  His treating team say he has irreversible brain injury and is in a minimally conscious state.

If his condition continues to deteriorate, further ventilator or other interventions will be futile and will only add to his suffering, it is argued.

The parents disagree about a number of issues, including their son’s ability to communicate and his future care.  A medical expert for them has proposed the man could be cared for under a care plan in a “more sympathetic” setting such as a nursing home or his own home.

In evidence on Tuesday, a specialist in intensive care medicine also involved in the man’s care, said a major difficulty was the absence of a “clear unifying diagnosis” of the cause of his brain injury.

The man walked into her hospital some years ago but the treating team have been unable to restore him to that condition, she said. He suffered an acute lung injury and a later brain injury and cannot now walk or feed himself.

She agreed he previously had given “thumbs up” signs but considered that had changed. She agreed others had different views on his communication ability. 

She expected his condition will continue to gradually disimprove and he required intensive nursing care. She agreed that could be provided at home or elsewhere but that would require significant input and additional funding.

The experts on both sides all agree,  at the end of life,  he will suffer a fatal respiratory infection but don’t agree how that should be managed, she said.

Further infections may require the man to be aggressively ventilated and he may also require dialysis and might suffer multiple organ failure. To aggressively ventilate him again would be an escalation she “could not support” and which she considered not in his best interests and “not fair”.

It is the patient, not their family, who has to tolerate the treatment, she said. She disagreed life should be prolonged where there is structural lung damage and significant brain injury.

She would be “not only unhappy” but “upset” if the orders were refused but, while against her better judgment, would adhere to what the court decided. 

Earlier, Peter Finlay SC, for the HSE, said the case was not about withdrawing or scaling down existing services or supports for the man but allowing doctors not intervene with respiratory or other interventions to a point not medically justified.

The case continues.

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