THE brain dead woman at the centre of the tragic life support case died on December 3rd last, but was maintained on life support because of the Constitutional protection for the unborn, the High Court has heard.
A specially convened three judge Divisional Court has heard that the young mother of two had chosen a name for her unborn - whether it was a boy or girl - and was looking forward to the pregnancy.
The court has also heard that the family were told about the interpretation of the constitutional law relating to the unborn on the day after she was declared dead.
This morning the High Court heard evidence from the father of the woman, described by Senior Counsel Mary O'Toole - for the family - as "the deceased".
The court also heard from the father of the unborn who supports the family's application to have life support no longer maintained.
Relatives of the woman wept as the court heard from an intensive case expert who said that amongst the patient's current difficulties, her body is no longer able to "obtain normal body tone".
Doctors are having difficulty maintaining her blood pressure and she also has a series of infections which could be a major factor, intensive care expert Dr Brian Marsh told the court.
"It is my best judgment that sustaining (her) is not feasible for a long period of time" said Dr Marsh, adding that the ongoing environment that the foetus is within is "a very abnormal environment".
Dr Marsh said that a patient being maintained in Intensive Care Unit (ICU) may appear benign, in many respects, but he said there was "a huge abnormality" in having a body maintaining a dead organ, namely the brain.
The woman died at 5.20pm on December 3rd last after suffering from a brain cyst and it was declared there was no intra cranial circulation, the court has heard.
Dr Marsh told the High Court: "From our perspective, the life became a corpse at that time".
Earlier, the father of the woman clasped his hands in the witness box as he told the court, led by High Court President Mr Justice Nicholas Kearns, that it was "distressful" to witness his daughter on life support knowing that she has died.
Judge Kearns, sitting with Ms Justice Marie Baker and Ms Justice Catherine Costello, extended the court's sympathies to the woman's family and her partner.
"My daughter is dead," the woman's father told the three judge court, "The chances of the foetus surviving is minimal. I just want her to have dignity and put to rest".
"There is nothing they can do for her," the father told the court, whose wife died a number of years ago, having suffered from cancer.
The High Court heard that the woman's young children had visited her and "know mummy is sick and being looked after by the nurses until the angels appear".
The father of the unborn also testified briefly and said that the couple had chosen a boy's and girl's name for the unborn.
He said he had been in a relationship with the woman for four or five years.
He had discussed the matter with the woman’s father and was supporting the application to switch off life support.
“I have no objection. We have talked to each other and it is the best decision we’ve come up with,” he said.
The man said his partner and he had been looking forward to the birth of the child.
He said she was very close to his heart. They had been planning to get a house together and had discussed baby names.
The court has heard that there is no reasonable prospect for survival of the unborn child.
Opening the case, former Attorney General John Rogers SC, for the woman’s father, outlined to the court how in late November, the woman was suffering from headaches and vomiting and was admitted to her local hospital on November 22.
On November 29, she suffered a fall in the bathroom and when she went back to bed, she was not very well.
She became unresponsive and was sent for a CAT scan.
It was discovered she had suffered a brain oedema, an accumulation of fluids in the brain.
After being transferred to a hospital in Dublin, instructions were given that in the event of her suffering an acute cardiac arrest, she should not be resuscitated.
She subsequently died and was declared dead at 5.20pm on December 3rd.
Lawyers for the HSE told the High Court that the HSE's position was that, based on the medical evidence, there was no reasonable prospect of the unborn being born alive if life support measures were continued.
Senior Counsel Gerry Durcan, for the HSE, told the court at the outset of the hearing that it was the view of the HSE was that it was not practicable to vindicate any right to life of the unborn child, Mr Durcan said that the HSE believed that the appropriate declaration for the court to make was the discontinuance of life support was lawful in the circumstances of this case.
Dr Brian Marsh, a consultant in intensive care at the Mater Hospital, gave expert evidence.
He said there was no evidence that the unborn could be sustained indefinitely.
“I don’t believe that the unborn can survive,” he said.
Dr Marsh, who was asked to review the case by the hospital caring for the mother, said medically speaking the woman was already considered dead.
“The brain is dead. It is not viable. At this point in time it is undergoing a process of liquefaction.”
Dr Marsh said he did not believe the unborn, currently at 18 weeks gestation, could develop safely to the point where it could be delivered at 32 weeks.
“I would be quite concerned that the situation would become quite unsustainable,” said Dr Marsh.
He said there were a number of infections afflicting the woman’s body.
These included a chest infection, a urinary tract infection and a wound and deeper infection in the head.
Dr Marsh said the woman currently requires ventilator support, hormonal support and nutritional support, which sees her being fed through a tube to her stomach.
He said it would be his best judgment that “sustaining the patient will not be feasible for a long period of time”.
He said 32 weeks would be the appropriate timeframe for delivering the unborn, but he thought it unlikely the woman could be sustained for that period of time.
The woman was currently stable, but the background infections being suffered her were likely to change that circumstance over an unknown period of time, he said.
He said the appearance one gets when walking into her hospital room was “very much a sense of being in a room with a dead person”.
Dr Marsh said there had been two previous similar cases in Ireland, one where the unborn was at 14 weeks and another where it was at 16 weeks.
He said the outcome of these was in line “with expectations” that the unborn would not survive.
The case continues.