Parents object to request for palliative care for brain-injured child



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A hospital wants Supreme Court orders allowing it to withhold invasive interventions and administer a palliative care regimen for a child they believe has little chance of a “meaningful” recovery after suffering a catastrophic brain injury in a car accident.

The young man’s parents oppose the orders, including those that would allow the hospital not to resuscitate him in the event of cardiac arrest. Your doctors say that such invasive interventions will not alter your prognosis, may cause you pain and distress, and are not ethically justified.

The parents, who are separated and represented separately, say the hospital’s request is “unprecedented” and too early in the context of an accident that occurred just a few months ago.

It is accepted that their son is not brain dead and the hospital should wait and see how his situation develops, they argue.

The mother’s attorney said the court cannot embark on assessing what exactly a “meaningful” recovery means or what constitutes “a meaningful or dignified life.” That’s the wrong legal test, and the mother believes her son is slowly improving and will make a recovery “that could be considered a lifetime,” she said.

Parents also want the child to be cared for in the mother’s home, with the necessary assistance, or to be transferred to their local hospital.

Conor Dignam SC, from the treating hospital, said Tuesday that it was seeking the disputed orders in the guardianship proceedings. He stressed that there are no disputes about parental love and care for their child, but, due to disagreement with doctors about his future care, guardianship was an appropriate mechanism to determine what was his best interest.

Parents objected to guardianship.

The Chief Justice of the Superior Court, Judge Mary Irvine, said she would admit the boy to guardianship and explain her reasons later.

A hearing was then opened to determine whether the orders requested by the hospital should be granted and is expected to last several days, with evidence from a variety of medical personnel and parents.

At first, the judge told the parents that he had decided not to visit the child in the hospital due to Covid-19 restrictions, his inability to communicate, and because he did not want his decision to influence their impressions of him, as he lacked of medical experience.

Opening the case, Dignam said that a team of doctors involved in the boy’s treatment supports the orders. He said the boy was on a ventilator for a few weeks after the accident. He can now breathe unaided, which doctors expected because the part of his brain that controls breathing is not damaged, but he is in a persistent state of altered consciousness, does not respond to voice or commands, and feeds on through a nasogastric tube.

The medical team believes that his situation will not improve significantly, the lawyer said.

High doses of drugs have controlled the dystonia, but the medication masks the dystonia rather than treating it, and there are major episodes during which doctors believe the child may be suffering from pain and discomfort, the attorney noted. Those episodes were triggered when he was touched, as was necessary for his care.

Invasive treatments only cause him pain and discomfort and his team believes they are useless because there is no prospect of a meaningful recovery, the lawyer added.

The mother’s lawyer said that her client did not accept that her parental responsibility should be interfered with by the intervention of another party, the rights of the mother and the child must be considered and the court can interfere only in exceptional circumstances of breach of duty to parents that does not apply here.

The orders requested were unprecedented in this case for a living patient with no diagnosis of a permanent vegetative state or brain death, he said.

This request, a few weeks after his accident, was to stop active care and driving, it was too early and the child should have every opportunity to recover.

The child’s father’s attorney argued that the orders are not in the best interest of the child.

The hearing continues on Wednesday.

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