Life Support, Medical Ethics & Capacity

A three-year-old was struck by a motor vehicle in September 2018 sustaining multiple injuries, including a traumatic brain injury, spinal cord injury and suffered a cardiorespiratory arrest along with other serious injuries.

The Court was asked to make orders regarding the discontinuation of all life-sustaining treatment and medical support, and the replacement of that treatment by palliative measures. Proceedings were commenced in April 2019; to preserve the anonymity of all concerned, the plaintiff has been given the name the Hospital, the child has been referred to as S, and his parents are to be called the Mother and the Father.

The Hospital and treating medical professionals have provided various forms of medical treatment to S since the date of his accident and reached the conclusion that S has no conscious awareness at all; it is most unlikely S will ever achieve any awareness; his injuries are terminal without artificial, mechanical life-sustaining treatment; and that all further treatment will be futile.

Furthermore, there is a medical consensus that the prolongation of S’s life is inconsistent with his dignity, and that the further continuation of the life-sustaining treatment that is being given to S would be medically unethical. However, the Mother and the Father have hoped for a miracle, so that they have remained unwilling to give their parental consent to the discontinuation of all life-sustaining treatment for S, and its replacement by palliative measures, which will quickly lead to  S’s death.

As S is a minor, the  Mother and Father are responsible for giving consent to medical procedures; they have been unwilling to give consent to the course proposed by the Hospital. The Hospital has made the application, to ensure that, if it withdraws all life-sustaining treatment for S, replacing it with palliative measures, neither the Hospital nor participating medical practitioners will be guilty of unlawful conduct in respect of the treatment of the child.

The medical consensus is that the prolongation of S’s life is inconsistent with his dignity and that the further continuation of the life-sustaining treatment that was being given to S would be medically unethical.

Fundamental to the determination of what is in the best interests of an unconscious patient is that they receive ordinary reasonable and appropriate medical treatment, sustenance and support, however, this is not equivalent to a right to the perpetuation of life irrespective of the circumstances; it may not be in the best interests of the patient to be given medical treatment that is excessively burdensome, intrusive or futile.

When a Court order is sought the Court must consider that medical treatment is proper in the circumstances and is in the patient’s best interests;  medical evidence, in this case, justified the conclusion that it was in S’s best interests that the treatment to be discontinued

 “It is reasonable also that account should be taken of the invasiveness of the treatment and of the indignity to which, as the present case shows, a person has to be subjected if his life is prolonged by artificial means…”

the dignity of a person is a real and significant factor which the Court should protect in that person’s best interests.

The Court declared the Hospital may lawfully discontinue all life-sustaining treatment and medical support measures, (including withdrawal of mechanical positive pressure ventilation) designed to keep alive in his current state; that, once this has taken place, medical services to be provided by the Hospital to the S be limited to palliative measures specifically aimed toward comfort, pain relief and relief of anxiety or torment; and the Hospital may lawfully direct a “no cardiopulmonary resuscitation order” in respect of S.

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