Irish Supreme Court has dismissed the appeal of parents of a boy with a catastrophic brain injury, thereby transferring control over his medical treatment to the treating hospital.
The case focused on the medical treatment of John (not his real name), an 11 year old boy who suffered life changing neurological injuries in an accident. The uncontested medical opinion was that John had suffered “devastating brain injuries” that were permanent and irreversible.
The hospital was of the view that it was inevitable that John's condition would worsen, and that he may be in pain due to dystonia – a condition causing muscles to involuntarily contract. The hospital argued it was not in John’s best interests to give him aggressive life-sustaining treatment, and sought to withhold invasive interventions such as CPR should his condition deteriorate. The family refused to consent to dystonia treatment as it may have resulted in John’s breathing being stopped. The parents believed it was too soon after the accident for a prognosis.
The hospital therefore commenced wardship proceedings in the High Court and sought orders which would allow it to withhold certain life-sustaining treatments and administer medication even if the secondary effect was respiratory failure. John was made a ward of court and the orders were granted, which were appealed to the Supreme Court in a leapfrog appeal.
The Irish Human Rights and Equality Commission exercised it amicus curiae function, arguing that any decision in respect of John’s treatment had to be made in a manner that balanced and protected his constitutional rights as a child, with due regard to the rights of his parents. The Commission also queried whether the decision to make John a ward of court was a proportionate interference with his rights in circumstances where, the Commission argued, it removed decision-making capacity from his parents.
In its decision, the Supreme Court assessed the appropriateness of the wardship procedure to protect the child’s interests, euthanasia and children’s rights under Article 42A of the Constitution.
The parents argued that the proper procedural action for the orders sought were by plenary proceedings, rather than through the wardship process. The Court ruled that the wardship jurisdiction was appropriate in this case, finding it no less appropriate than plenary proceedings seeking declarations. It identified that the wardship process had the advantage of providing for regular and informal review and appointment of a guardian ad litem. The Court acknowledged that wardship should not be used to take decision-making from parents in single issue cases, but upheld the wardship as it would minimally impinge on John’s life.
The parents also argued that they actions of the hospital in withholding treatment would violate the Constitution as it amounted to euthanasia. This was rejected on the basis that what the hospital proposed was palliative care, rather than a deliberate act to end John’s life.
The Court then considered the balancing of rights under the Constitution, namely the best interests of the child under Article 42A and the rights of the family under Articles 41 and 42. The Court set out a test for parental failure in medical cases, to include the nature and significance of the procedure involved, the extent to which the opinion of treating doctors is unanimous, is shared by independent experts, and the depth and conviction with which it is held.
While the Court acknowledged that the views of the family should be valued, it stated that parents did not have primary constitutional decision-making authority on the medical treatment of a child as it was an exercise in vindicating the rights of the child. The Court ultimately found that the hospital did not require the consent of the parents to withhold treatment but did require consent to administer the dystonia medicine which may stop John from breathing.
Giving consideration to both the medication evidence and the views of the parents, the Court concluded that the refusal to consent to pain-relieving medication for the dystonia was a failure of duty by the parents. Due to the pain and suffering which John was experiencing, it was in his best interests to receive the medicine.
Click here for the decision.