A child has suffered irreversible kidney damage and will suffer more unless he undergoes surgery his parents object to because they do not accept his diagnosis, a consultant paediatrician surgeon has told the High Court.
The damage so far means the six-year-old boy will inevitably need a kidney transplant in the future but surgery could defer the need for a transplant for decades, the surgeon said.
The surgery is necessary to address the underlying cause of the boy’s renal failure, a blockage in his urethra causing kidney and bladder damage and hypertension, he said.
Because a catheter inserted in the child’s bladder almost seven weeks ago has reduced his abnormally high blood pressure, the surgery is not immediately urgent but should be done soon, he said.
Based on medical evidence, the president of the High Court, Mr Justice Peter Kelly, granted a hospital's application on Wednesday for orders permitting doctors perform a catheter replacement procedure next week.
Because the core surgery is not deemed immediately urgent, the judge told Paul Brady BL, for the hospital, he would defer making orders concerning that to allow the parents get another medical opinion on diagnosis and treatment.
The boy, he noted, has been under the care of paediatric surgeons since 2013 and three other specialists have all agreed on the diagnosis and proposed treatment.
The parents have had several months to get a different opinion but have not yet produced one, he also noted.
He hoped any further opinion, if it is the same as the existing undisputed medical evidence, would assist in persuading the parents the surgery is in the child’s best interests and also considered the surgery could not be deferred for “any appreciable period”. If the further medical opinion is different, “different considerations” would apply.
The judge had directed a full hearing of the hospital’s application after the boy was made a ward of court on an emergency basis arising from medical concerns for him due to the parents not accepting his diagnosis and objecting to the proposed treatment.
Diagnosis not accepted
The parents, from another European country, were in court on Wednesday and were represented by Natalie McDonnell BL, instructed by solicitor David Hickey.
The father speaks English, the mother has limited English and the father has been centrally involved in interactions with doctors concerning the child.
In his ruling, the judge stressed there is no dispute about the parents’ love and concern for the boy and their other children. Their objection was not on religious or philosophical grounds but because they do not accept the diagnosis or that their son is as ill as doctors say, he said.
The boy’s father had referred to the child being “normal” and playing with his other siblings but this was not inconsistent with a diagnosis of renal failure and various tests and scans had confirmed the diagnosis.
The judge noted the child has been so unwell, when he did not appear for a clinic when the hospital was aware his blood pressure was 160 over 121, gardaí were asked to get him there.
He also noted a court appointed guardian who visited the parents reported the father appeared to have a “blind spot” when it came to appreciating the severity of his son’s condition. The guardian believed the mother might consent to the surgery if it was left to her.
The undisputed medical evidence is the child has a serious condition with the most profound consequences for him as he goes through life and that surgical intervention is required to deal with it, the judge said.
He said the case raises issues of the rights of children, parents and the family and the court’s ability to intervene in the exercise of its wardship jurisdiction.
The test for intervention under the wardship jurisdiction “perfectly chimes” with the test under Article 42a of the Constitution, that intervention is required in the best interests of the child, he said.
He was satisfied the parents could not validly dispute the child’s need for a catheter and would permit that to be replaced next week as the doctors sought. The parents have “a deep seated but irrational belief” concerning that treatment and, in that regard, have failed where their son’s best interests are concerned, he found.
He deferred a decision on the core surgery to allow the parents get a further medical opinion.
