High Court president orders doctors to continue treatment to woman in coma for nearly 40 days

The President of the High Court has ordered that doctors can continue to give appropriate treatment to a woman who has been in a coma for nearly 40 days following a catastrophic brain injury suffered in a traffic incident.

Mr Justice David Barniville said care should continue until next week when the woman’s husband, son and court-appointed guardian will have an opportunity to address the court on the next steps that doctors believe are necessary.

This will include the removal of mechanical ventilation to see if the woman can breathe on her own and that there be no reintervention by intubating her again.

The court heard her husband and son are not agreeable, in accordance with their cultural and religious beliefs, that intubation should be removed once there are signs of life.

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The clinical director of the hospital applied to the court on Thursday (while only the hospital was notified of the application) for orders continuing the care policy adopted by the treating doctors pending further order of the court. These include non-resuscitation if she goes into cardiac arrest.

Barrister Donal McGuinness, for the hospital, said what was being sought was to maintain the status quo until there was a hearing by the court over the next steps doctors believe are necessary.

Counsel said the woman had suffered the “highest level” of brain injury.

She is on mechanical ventilation and has a breathing and cough reflex that is indicative of some brainstem function, he said. She also had an underlying renal problem and there was concern her brain injury was affected but doctors do not believe a dialysis programme would lead to any improvement of her neurological function, he said.

It is considered medically unnecessary to continue certain treatments and the plan is that the ventilation tube would be removed, he said.

In such cases it is often the situation that, if there is a possibility of recovery once intubation is removed, a tracheotomy would be applied to the patient, he said.

Counsel said it could happen that the woman would breathe spontaneously (once the tubes are removed) but that is not by any means guaranteed.

“This is where the problem arises because the family is not prepared to take the risk that there would not be intubation,” he said.

The hospital was seeking orders including that it would be lawful for the clinical director to provide such treatment as is necessary for the welfare of the patient in accordance with what is medically and ethically appropriate.

Mr Justice Barniville said the woman had been in a coma for 38-40 days and has not improved at all. There is some evidence of brainstem activity of a limited nature but he would consider all of the evidence at the hearing.

Doctors are seeking to withdraw some of the support but are asking the court to keep in place the existing position including that they maintain a certain “ceiling of care” including that they would not perform CPR and not provide renal treatment.

At next week’s hearing he will be asked to approve extubating her and discontinuing mechanical ventilation and she would then be discharged from intensive care and another ceiling of care would be applied.

He was satisfied to make those orders but was not expressing any concluded view on the matter. He said the husband and son should be notified by a social worker in the case that they have been made notice parties in the case.