A High Court judge has made orders allowing doctors to, if necessary, withdraw medical treatment and not resuscitate a three-week-old baby who has serious congenital deformities and whose life prospects are described as "bleak and remote".
The child was born on June 16th last and transferred to a children's hospital the following day due to his serious difficulties. He is in the interim care of the Health Service Executive which sought the orders, with the consent of the child's parents, in an emergency application yesterday evening.
The child was born with deformities including his heart, airways and kidneys not being fully formed, and is on a ventilator.
Mr Justice Paul McDermott, having heard evidence from the parents and medical experts, said the baby’s condition was starkly outlined as “hopeless”. He said it was “overwhelmingly” not in the child’s best interests to continue to ventilate him or proceed with aggressive treatments.
Doctors had said he would require multiple surgeries and interventions which would cause him further pain and probably not prolong his life. Morphine is being administered to the child to help him cope with the pain.
Mr Justice McDermott said the doctors and parents wanted to provide what comforts they could to the child in relation to the agonies he was enduring and, in all the circumstances, he would make the orders in the best interest of the child.
There was always a constitutional presumption in favour of life but, in this case, the treatments already afforded to the child were extensive and doctors had very carefully considered how far any further treatment could go, he added.
On the basis of the evidence, he said he was not satisfied further treatment was in the child’s best interests.
He also said earlier he did not consider it necessary, having heard submissions from a solicitor representing the child’s interests, to appoint a guardian at litem to represent the child. Having heard extensive medical evidence, he did not think that would advance the situation, the judge said.
He also refused the solicitor’s application for a stay on his order pending any appeal. The solicitor said he was making that application because there was no other party to do so but the matter was in the hands of the court.
The orders made give consent to the doctors involved in the child’s care to provide whatever medical treatment they advise as being in his best interests, including withdrawal of medical treatment. They may also not resuscitate him in the event of cardiac arrest or take any steps beyond what would be reasonable in any baby with such complex difficulties.
Earlier, the baby’s father told the judge his son was in a lot of pain. Speaking on the parents’ behalf, he said: “We don’t want to see him in pain. He is getting weak. He is crying every day. We don’t want him in pain.”
Mr Justice Mc Dermott told the crying mother and father he was very sorry for their situation The parents rushed to the baby’s bedside in hospital as the judge considered his decision.
A consultant neonatologist told the court the little boy had multiple and very complex congenital abnormalities including a hole in his heart. An MRI scan had shown brain abnormality and his prognosis was very poor. In the last few days, he had become unstable and would need surgery at his airways but it was not clear if would survive surgery.
The baby had tipped from the chronic to the acute level and it was felt that resuscitation was not in his best interests, she said. If treatment was withdrawn the baby would die in maybe 13 minutes to one hour, she added.
“My concern is if we delay he could go into cardiac arrest and could die in the ventilator rather than in his parents arms. If we can do this, he can die in a controlled situation and pass away in the arms of his parents rather than surrounded by a lot of machines,” she told the judge.
A medical report by three doctors also stated, in the event of cardiac arrest, it would not be in the best interests of the child to resuscitate him.
