Tuesday 20 February 2018

Low-key ruling puts sharp focus on sensitive end-of-life care debate

The child was admitted to hospital at four months of age with serious brain damage and has been in State care almost since then
The child was admitted to hospital at four months of age with serious brain damage and has been in State care almost since then
Dearbhail McDonald

Dearbhail McDonald

In the tragic canon of end-of-life cases that have come before our courts, yesterday's ruling involving a profoundly disabled 10-year-old girl was remarkably low key.

The child's life was marked by tragedy. Born with a congenital heart defect, she suffered serious and extensive brain damage when she was four months old. The brain damage was the result of a non accidental injury and the child has been State care since.

Irish courts have refused to authorise positive steps to accelerate death or terminate life. But the Supreme Court has - when it authorised the withdrawal of treatment in the case of a woman in a near-persistent vegetative state - ruled that the right to life includes the right to die a dignified and natural death.

The ethical dilemma facing doctors treating this child is somewhat different from previous cases. Death is not immediately imminent, but the court heard it is "absolutely inevitable" that she will have another life-threatening illness soon.

Rather than seeking withdrawal of life-saving treatment, clinicians - supported by the Child and Family Agency and the child's mother - sought permission not to provide aggressive treatment including resuscitation, essentially approval to form a palliative care plan.

If she was treated in intensive care, clinicians said they would then face another ethical dilemma of withdrawing that treatment as opposed to withholding certain treatments now.

Instead, they want her to go to the residential care centre that is her home, where she can be attended by her devoted mother and staff.

In her ruling, Ms Justice Iseult O'Malley said it was necessary for the court to attempt to see the quality-of-life issues raised in the case from the child's perspective. Judge O'Malley also applied the best interests of the child principle which has gained greater force since the passing of the Children's Rights Referendum.

Noting that there is a strong presumption in favour of authorising life-saving treatment, the judge said that in exceptional circumstances, authorisation can be given to steps not being taken to prolong life.

The ruling is discreet, but it will no doubt contribute to the sensitive end-of-life care debate.

Irish Independent

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