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Lawyers for a hospital treating a child with a catastrophic brain injury have told the Supreme Court that a child’s right to have his or her parents decide on medical treatment is not “preeminent” and must be considered alongside other rights of the child. .
The hospital has said that it does not seek to “accelerate” the child’s death by requesting permission to refrain from aggressive interventions should his condition deteriorate substantially.
Lead attorney Conor Dignam told the court that the boy is in a “desperate” situation with no prospect of a meaningful recovery. His parents’ belief or hope that his condition will improve is “in the teeth” of the overwhelming and unanimous medical evidence about his prognosis, he said.
The court was asked to consider and apply a “best interests” test that involved consideration of issues such as the absence of pain and the right to natural death and to die with dignity.
He said that the Superior Court correctly ruled that the parents’ refusal to acknowledge the reality of their son’s condition and prognosis amounted to a breach of parental duty that justified the intervention of the State, through the Superior Court guardianship procedure, and that the orders requested by the hospital are in the best interests of the child, he presented.
Mr. Dignam opposed an appeal by the parents against those orders, including one placing him under the guardianship of the court.
The appeal, before a court of five judges, will examine the constitutional rights of the family and the child and the threshold for State intervention in relation to the medical care of a child and whether a child can be placed under guardianship for the purpose of obtain such orders.
The hospital says the boy, known as John, will not make a significant recovery from the catastrophic injuries sustained in a road accident earlier this year and needs court orders to treat him as it sees fit.
These include orders that allow you to give pain relievers for dystonia, a movement disorder that causes muscles to contract uncontrollably.
His parents are concerned that the medications could compromise their son’s respiratory function and that the hospital wishes to suspend ICU interventions if John’s condition deteriorates substantially and effectively administer palliative care.
They say it is too soon after the accident to determine your prognosis and that you should receive some treatment to keep you alive.
On the second day of Wednesday’s appeal, Dignam said it is “unfair” for the doctors treating John to suggest that his life is being treated as of less value than the lives of other children.
It was precisely because of the value placed on John’s life that doctors considered the benefit and burden of certain treatments. They considered that the benefit for him of pain relief medications that could trigger respiratory distress outweighed their burden, but that the burden for him of ICU interventions outweighed the benefit.
That was not an “acceleration of death,” but the result of a consideration of the problems that doctors face every day in hospitals and hospices across the country.
Douglas Clarke SC, for the court appointed guardian to represent John’s rights, said that the court’s intervention was appropriate and that the use of the guardianship mechanism was not disproportionate interference with the rights of John or his parents.
He said that the circumstances for the intervention of the State for failure to fulfill the duty of parents have been extended by Article 42a, the amendment of the rights of the child to the Constitution.
Parental breach of duty is no longer limited to physical and moral problems and now extends to situations where the safety and well-being of children is likely to be affected by such breach, he said. State intervention does not depend on the parents establishing guilty behavior and extends to the effects on the child of the acts and omissions of the parents.
The changes made by Article 42a are “very significant” for this case, he said.
While there was no indication of “guilty” breach by John’s parents, it was not followed that there was no breach of the parents’ obligation within the meaning of Section 42A or that the Superior Court did not act correctly in granting the orders. .
The appeal continues tomorrow.
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