Pregnant woman’s life support should be turned off, court told


http://www.independent.ie/irish-news/courts/pregnant-womans-life-support-should-be-turned-off-court-told-30860620.html

The family of the clinically brain-dead pregnant woman on life support will have to wait until after Christmas Day to learn if they will be able to bury their loved one.

The High Court said it would not rule until St Stephen’s Day on an application from the family to have the woman’s life support machine switched off so she can “be laid to rest with dignity”.

A three-judge sitting of the court is to take legal submissions on the case today, having already been told by several expert witnesses there is no reasonable prospect for the survival of the woman’s unborn child.

Despite being declared clinically dead 21 days ago, the young woman has been kept on life support against her family’s wishes as doctors were uncertain of the legal position.

One doctor treating the pregnant woman broke down in tears when testifying. “She is a little girl with painted nails. But she is dead… she is fully dead,” he told the court.

The decision to continue with life support was made as doctors feared they would be in breach of the eighth amendment to the Constitution, which gives equal status to the life of the mother and the unborn.

The court heard harrowing accounts of the 18-weeks pregnant woman’s medical status as several expert witnesses advised that the family’s wishes should be granted.

The former Master of the Rotunda, Dr Peter McKenna, told the court the continuation of life support for the mother of two would be “going from the extreme to the grotesque”.

One of the country’s leading obstetricians, Dr Peter Boylan, said doctors need clear medico-legal guidelines to assist them, but it would be “even more helpful” to repeal the amendment.

A leading neurologist, who cannot be named as he works at a hospital which cannot be identified under the terms of a court order, said he and colleagues had sought legal advice from authorities two days before the woman was declared dead on December 3, but none was forthcoming.

“We are not lawyers. We will, like all clinicians, err on the side of caution,” said the consultant.

“We were three clinicians trying to figure out the eighth amendment.”

Earlier, the woman’s father told the court there was nothing more doctors could do for her and he wanted to give her a funeral without further delay.

“The chance of the foetus surviving is minimal. I just want her to have dignity and be put to rest,” he said.

He was supported in court by his daughter’s partner, the father of the unborn child.

The woman was pronounced dead at a Dublin hospital on December 3 after suffering from a brain cyst. She had been afflicted with severe headaches in the previous weeks.

She is now being kept on life support at a hospital outside of Dublin.

Senior counsel Gerry Durcan, for the Health Service Executive (HSE), told the court it was not practicable to vindicate any right to life of the unborn child in this case.

Legal teams quizzed a number of expert witnesses for their views as to what was best course of action. As well as counsel for the family, there were also legal teams appointed to represent the interests of the unborn and of the mother.

One of the experts, Dr McKenna, told the specially convened hearing: “We are all in uncharted waters.”

However, he was firmly of the view that it was not appropriate to maintain life support for the woman.

“I can see we are where we are, but I don’t think that is a justification for continuing any further,” he said.

Earlier, Dr Boylan, who was called to give evidence by counsel for the family, said that in any other jurisdiction the woman would have “been allowed to die with dignity”.

Just because something in medicine can be done doesn’t mean that it should be done,” said Dr Boylan.

He said there was a distinction between abortion and what was proposed in this instance, namely the withdrawal of support for a brain dead woman.

There were emotional scenes in court as medical experts who reviewed the woman’s care outlined a series of potential medical risks involved with continuing somatic support to her.

Dr Frances Colreavy, an expert in intensive care medicine from the Mater Hospital, said she had concerns about the current situation being prolonged.

“I would describe it as experimental medicine,” she said.

She examined the woman on Monday and found her face to be puffy. There was an oozing wound to her head and a possible infection to her abdomen.

Under cross examination, Dr Colreavy said that even with life support, the woman’s heart would eventually stop beating and when it failed there would be further complications, including kidney, liver and lung failure.

Dr Colreavy outlined how the woman was being given a range of antibiotics to combat infections. She could not say what the long term effects of these drugs on the unborn would be.

She said she was concerned about the woman’s temperature, which had been recorded at 38.5 degrees. It was likely the foetus would be even warmer, possibly 40 degrees.

She said she did not want to upset members of the family present, but the “brain is rotting” and there was “evidence of fungus growing” on part of the brain.

Dr Colreavy said the woman’s abdomen was “unlike any” she had ever seen. There were blue, red and purple colouring along the stretch marks, which suggested there may be an infection.

An MRI would be required to investigate this, but the facility is not available at the hospital where she is on life support.

Asked if it was realistic to continue her care, Dr Colreavy answered: “I don’t think, in my clinical opinion, that is possible or is to be recommended.”

Intensive care expert Dr Brian Marsh of the Mater Hospital said doctors were having difficulty maintaining the woman’s blood pressure.

He also said infections she was suffering could be a major factor.

“It is my best judgment that sustaining (her) is not feasible for a long period of time,” said Dr Marsh.

The court heard the woman was declared brain dead at 5.20pm on December 3 after no intra cranial circulation could be detected.

“From our perspective, the life became a corpse at that time,” said Dr Marsh.

He said there was no evidence that the unborn could be sustained indefinitely. “I don’t believe that the unborn can survive,” he said.

The court will hear legal submissions from counsel this morning.

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