Family consent to orders allowing hospital not to resuscitate brain injured woman

The president of the High Court has continued orders allowing a hospital not to resuscitate or ventilate a brain injured woman, aged in her late 50s, with “a litany of conditions” and a “very poor” prognosis.
Family consent to orders allowing hospital not to resuscitate brain injured woman

The president of the High Court has continued orders allowing a hospital not to resuscitate or ventilate a brain injured woman, aged in her late 50s, with “a litany of conditions” and a “very poor” prognosis.

The woman's family, who had previously wished ventilation/CPR to be pursued, consented to the orders.

The HSE had sought interim orders last Friday in circumstances where the family had wanted any treatment that could prolong the woman's life.

Two clinicians involved in her care disagreed, saying ventilation/CPR was neither clinically nor ethically appropriate, was futile given the woman's condition and prognosis and had potential to worsen that prognosis and cause irretrievable deterioration to her quality of life and unnecessary suffering which was "impossible to justify".

Although the woman had been intubated and successfully extubated after a respiratory arrest last March, any repeat of that was inappropriate and not in her best interests, they said.

Both supported an alternative treatment plan, described as "likely to be end of life care", comprising ward-based management, conventional oxygen therapy and intravenous treatment.

The interim orders, sought in the context of wardship proceedings, were granted on Friday on grounds they were in the woman's best interests and the matter was returned to court today.

Mr Justice Peter Kelly was told today the family, following discussions with the woman's court-appointed guardian and others, were consenting to the orders continuing and to the hospital treatment plan.

He was told by David Leahy BL, for the HSE, the woman is currently stable but "barely conscious" and will continue to require permanent oxygen support.

She has severe neurological damage as a result of an acquired brain injury, extensive care needs and very compromised levels of capacity. She suffers from a range of conditions, is tube fed, non ambulant, sleeps some 22 hours daily and is doubly incontinent.

Two siblings of the woman were in court today and were represented by counsel as was the woman's guardian.

Mr Justice Kelly expressed sympathy for the "very sad" situation the siblings found themselves in and said he did not underestimate the very hard decisions they faced.

The earlier disagreement with the doctors as to how their sister should be treated was "perfectly understandable" and other families who had come before the court had found themselves in a similar position.

He said the sort of treatment they had envisaged, ventilation and CPR, is very difficult and demanding on the body and the courts also confronted difficulties if asked to make orders requiring doctors to act against their clinical and ethical judgment.

He continued the orders and returned the wardship inquiry to next month.

He indicated he saw no reason why the siblings, in line with their wishes, could not be appointed as the committee to represent the woman's interests if she is taken into wardship. The guardian supports the wardship application, the court heard.

The judge agreed a capacity assessment of the woman by an independent medical visitor could take place, as her sister requested, in the presence of the sister.

While doctors are of the view the woman is of unsound mind and lacks capacity, the family consider she understands what is going on around her better than the doctors think, he was told.

On being told the sister wishes to care for the woman at home after discharge from hospital, rather than have the woman returned to the residential care unit where she has been for many years, he said the home option could be considered by the woman's treatment team.

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