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A hospital has told the Supreme Court that it is not seeking to “accelerate” the death of a seriously injured child by requesting permission to refrain from aggressive intensive care interventions in the event his condition deteriorates substantially.
The boy is in a “desperate” situation with no prospect of a meaningful recovery and his parents’ belief or hope that his condition can improve is “in the teeth” of the “overwhelming and unanimous” medical evidence about his prognosis, Conor Dignam SC, for the hospital, he said.
The right of a child to have his parents decide on the child’s medical treatment is not “overriding” and must be considered alongside other rights of the child, he argued.
This required the consideration and application of a “best interest” test, which involves considering issues such as the absence of pain and the right to natural death and to die with dignity.
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 child’s best interests, he presented.
Mr. Dignam objected to an appeal by the parents against those orders, including one that brought his son to guardianship.
The appeal, before a five-judge tribunal chaired by Judge Donal O’Donnell, raises important questions regarding the constitutional rights of the family and the child under article 41 and article 42 bis respectively, and the threshold for State intervention in relation to the medical care of a child. watch out. Other questions include whether a child can be placed under guardianship for the purpose of obtaining such orders.
The hospital says the boy, known as John, will not make a significant recovery from the catastrophic injuries sustained in a car accident last summer and needs “contingency” orders to treat him as it deems clinically and ethically appropriate.
These include commands that allow you to give pain relievers for dystonia, a movement disorder that causes muscles to contract uncontrollably.
Parents’ concerns include that the medications may compromise his respiratory function and that the hospital wishes to withhold ICU interventions if John’s condition deteriorates substantially and effectively administer a palliative care regimen. 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 guardian appointed by the court to represent the rights of John, said that the circumstances for the intervention of the State for breach of the obligation of the 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” in this case, he said. While there was no suggestion of “guilty” default by John’s parents, it did not follow that there was no breach of the parents’ obligation within the meaning of section 42A or that the Superior Court was not correct in granting the orders. The court’s intervention was appropriate and the use of the guardianship mechanism was not disproportionate interference with the rights of John or his parents, he argued.
The appeal continues on Thursday.
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