Thursday 23 November 2017

Doctors permitted to induced intellectually impaired pregnant woman, High Court rules

(Stock photo)
(Stock photo)

Tim Healy

Doctors are to be permitted to induce the birth of a baby of a young woman deemed to have the intellectual capacity of an eight year old, the president of the High Court ruled.

Mr Justice Peter Kelly granted the orders to the HSE permitting induction and, if necessary, emergency Casearean Section.

The orders were sought due to concerns about the woman's capacity to consent to appropriate management of delivery should a situation of foetal distress or medical crisis arise.

Recent scans showed the foetus is smaller than normal for late stage pregnancy, presenting a higher risk of foetal morbidity and mortality, the court was told.

The judge said he was satisfied in principle the orders were necessary in the best interests of the woman and her unborn baby.

Questions also "need to be asked" as to how a woman "with a mental age of eight comes to be pregnant at all", he said. 

While aged in her twenties, the court was not dealing with an adult that age but with a person with a mental capacity "well below" that.  

The court had heard the child's father also has an intellectual impairment.

Earlier, the woman's treating obstetrician said he never previously sought such orders in his long career but was concerned about the woman's "childlike" approach to her pregnancy and if she understood the implications of various modes of delivery and the small size of her foetus. T

The woman is 38 weeks pregnant and had told him she was looking forward to the birth of her child and had agreed to induction, he said. 

He considered her "very childlike" and said she agreed to everything.

His concern, given her intellectual disability, was her mental state and response might change depending on progress of delivery. He was aware of psychologist reports stating she is eager to please but also can be "difficult" to deal with and he had seen her having "episodes" with her mother.

Where a foetus is small as here, he considered there should be induction after 37 weeks. If that did not work, delivery would be by emergency Casearean Section. 

He was particularly concerned, if acute foetal distress arose, he might wish to proceed to emergency CS and wanted to safeguard the hospital, himself and his colleagues.

Counsel for the woman's court-appointed guardian stressed the main concern was to do what is best for the woman and baby. 

While not opposing the orders, this application came as a "surprise" because engagement between the woman, her parents and doctors has been very positive during the pregnancy. 

The family had concerns whether court intervention was necessary and if this application was "a bit heavy-handed" and hoped there would be no need to implement the orders.

Mr Justice Kelly said he would make orders permitting induction of labour and, if necessary, a Caesarean Section, and associated treatments, as he was satisfied those were necessary in the best interests of the woman and baby. 

A psychologist's report of 2008 found the woman's intellectual capacity then was of a child aged about six while another report this year placed her intellectual capacity as of an eight year old, he said.  

While a psychiatrist who assessed her for the first time this week expressed a "carefully guarded" opinion she has capacity to consent to treatment for her health and welfare, the validity of the consent of an eight year old was "doubtful", he said.

He also considered as "impractical" the psychiatrist's suggestion an application to court concerning mode of delivery should depend on developments in the pregnancy as there would not be time in some situations to await a court application.

The HSE had acted prudently in coming to court when there was an issue whether there would be consent to any necessary treatment and the validity of any such consent, he said. 

This application was not "heavy-handed", the doctor's approach indicated sensitivity and he also had a natural concern, given the woman's impairment, to have legal certainty. 

The judge, who was told the Child and Family Agency is aware of the case, said issues about the future care of the baby would be addressed later.  

The woman will also be assessed for the purposes of considering if she should be made a ward of court.

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