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Supreme Court

Parents of brain-damaged boy lose Supreme Court appeal for control of medical treatment

The boy, known as John, suffered a devastating brain injury in road crash in 2020.

THE SUPREME COURT has dismissed an appeal by the parents of a brain injured boy to have control over his treatment rather than hospital medics.

The court published its 107-page ruling today and made orders, which will be reviewed in three months, to permit the hospital to withhold mechanical ventilation from the boy, who is a ward of court, in certain circumstances.

The boy, who is referred to as John in court documents, suffers from profound medical problems due to the brain injury suffered in a road crash. He is suffering from dystonia which causes the muscles in his body to contract violently.

The judgement said that this issue has been brought under control by doctors prescribing of medication.

The substantive issue centres around previous medical evidence at a hearing that the dystonia suffered by John could become so bad that his body will not be able to sustain it. This, the court said, would require Intensive Care Unit interventions which could cause problems for John’s respiratory system.  

The hospital had asked the High Court to make orders assisting them as they were in dispute with John’s parents around the care. The Supreme Court judgement said that John’s mother believes that he will rally and recover and will defy medical opinion.

John’s condition had improved recently, the ruling said, and that this was down to the administering of certain medication.

“In the light of the fact that there has been such an improvement in John’s condition since these proceedings were first initiated, it would be useful to explain just how severe his condition was in the aftermath of the accident.

“Clearly, the medical team looking after John felt constrained to initiate these proceedings in the light of his parents’ views that his life should be prolonged so far as possible, notwithstanding the fears of the medical team that this would merely prolong his pain and suffering,” it read.

The High Court, in the original judgement, had said that the parents of John were blinded by love for their boy and that this stopped them seeing the devastating reality of the condition.

The Supreme Court described the proceedings as “difficult, complex, and troubling”.

“It is important not to lose sight of the fact that at the heart of this case is a young boy, who is much loved by his mother and father, by his siblings and his extended family.

“For them, the circumstances of this case are nothing short of a tragedy, with which they have had to come to terms over the course of the last number of months and will have to deal for the foreseeable future,” it said.

The court considered their judgement in light of the dilemma between the wishes of the parents and what is in the best interest of the child.

When all was considered they decided that the “Hospital would not be acting unlawfully if the clinical director considered it to be in the best health and welfare interests of the ward, and if it was considered appropriate to do so, to withhold life-prolonging treatments or supports that are not considered to be in the best medical or welfare interests of the ward”.

The Supreme Court outlined several orders which included a number of medical interventions that could be used.

“We consider that it is appropriate, however, to maintain the possibility and primacy of parental decision-making in this case and, accordingly, the consent given and declarations made above are subject to the proviso that they would only become effective if, in each instance, the prior consent of John’s parents had been sought and refused.

“The consent given and declarations made should also be limited in time and will, accordingly, be subject to review in three months from today’s date with liberty to apply to the High Court in the meantime in the event of any unforeseen circumstance and the Hospital must reenter the matter before the President for the purpose of such review,” the judgement outlined.

The majority judgment was delivered by Mr Justice Donal O’Donnell, Ms Justice Elizabeth Dunne, Ms Justice Iseult O’Malley and Ms Justice Marie Baker. In a separate concurring judgment, Ms Justice Baker addressed issues concerning the wardship jurisdiction of courts.

Mr Justice William McKechnie, in a dissenting judgment, said that he believed the wardship order was “extensive” and should be set aside. He said he felt it failed to meet proportionality requirements.   

He made this view based on Article 42.1 of the Constitution which deals with the importance of parents in the lives of their children.