Hospital given permission to perform Caesarian on woman in emergency situation

A hospital can perform an emergency Caesarean section on a young woman against her will if an unanticipated life-threatening situation arises, the High Court president has ruled.

Mr Justice David Barniville said he was “instinctively very hesitant” about giving authority for carrying out such an invasive act on the woman, who is 34 weeks pregnant and in her early 20s.

However, he was persuaded by the medical evidence before him that the various treatment orders were necessary to vindicate and protect the woman’s constitutional rights to life, bodily integrity and equality.

He declared, on a short-term basis, that, due to a delusional disorder, she lacks the capacity to make safe decisions in the interest of her health and obstetric care. He gave her treating doctors permission to carry out necessary treatments and obstetric monitoring.

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The judge was earlier told by counsel for the hospital, Donal McGuinness, that the woman disclosed she has consumed alcohol, cocaine and crack cocaine during her pregnancy and that she is a victim of sexual assault.

The court also heard, from the woman’s court-appointed guardian, that she had been in and out of the care system as a child.

For the past several days she has been involuntarily detained under the Mental Health Act at a psychiatric unit, and this will be reconsidered by a Mental Health tribunal in the coming weeks.

Her treating obstetrician does not believe the court’s consent for an emergency Caesarean section will be acted upon before the case is due to return to court next Thursday, the court heard. The orders were required in the event there is a risk to the woman’s life or of significant injury to health, said Mr McGuinness.

The obstetrician believes the woman will not be able to give birth vaginally as she could behave in a way that prevents safe and proper delivery, such as potentially refusing to allow doctors to monitor her blood pressure during labour, the court heard. She might refuse medical advice even in a life-threatening situation, Mr McGuinness said.

The woman has been inconsistent in attending antenatal appointments and has refused many routine medical checks.

Counsel said she on an occasion threatened to kill herself if her baby was not delivered vaginally that day. She also made remarks about her desire for serious harm to be caused to her baby. A natural birth would not be possible at only 34 weeks, the court heard.

Her mental condition deprives her of the ability to consider what is best for her and her baby, which engages her constitutional right to equality, said counsel.

Mr McGuinness submitted that, while the orders will benefit and cause no harm to the foetus, the court was entitled - due to the repeal of the Eighth Amendment of the Constitution - to grant the orders “solely on the basis” that they vindicated the expectant mother’s rights.

Prior to the 2018 referendum that led to the repeal, such an application would have required a more two-pronged approach, with the court considering to a much greater extent the rights of the unborn child. Article 40.3.3 of the Amendment provided that the State “acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother”, the court heard.

Mr Justice Barniville said that, due to the repeal, he was principally concerned with the woman’s rights. However, he noted the hospital’s assertion that the orders “will not in fact adversely impinge” on the unborn child’s rights, “if they exist”.

The judge heard evidence that the woman’s treating consultant psychiatrist and obstetrician do not believe she has the capacity to make safe decisions about her health.

The judge made various orders under the court’s inherent jurisdiction. He adjourned the case to next week.