Open verdict on pregnant woman taken off life support

An inquest jury has returned an open verdict on the death of a young pregnant woman at the centre of High Court proceedings over whether, given the anti-abortion amendment to the Constitution, doctors could cease keeping her artificially alive.

The inquest opened at Mullingar courthouse on Tuesday and heard evidence from the woman’s family and several medical witnesses before the jury was asked to consider its verdict at about 5pm.

Coroner Wilfred Hoover told them they could return a verdict of medical misadventure if they believed more could have been done by medical staff, or they could find death by natural causes if they believed medical staff did what they could in the circumstances.

If they were undecided, they could return an open verdict, he said.

Not about wrongdoing

He stressed the inquest was not about finding wrongdoing on anyone’s part.

Having heard from the medical witnesses, the coroner told jury members before they retired that the cause of the woman’s death was hydrocephalus or fluid on the brain, which was secondary to a large cyst of unknown origin in her brain.

When the jury foreman gave the verdict at about 5.10pm, the coroner recorded the cause of death and said the official date of death was December 3rd last at Beaumont Hospital.

He and all the parties including the Midland Regional Hospital, HSE and Garda expressed their sympathies and condolences to the woman’s family.

In a statement and evidence earlier to the inquest, the woman’s aunt said she took her niece, then almost 15 weeks pregnant, to Mullingar General Hospital on November 27th, 2014, after her niece became distraught, was crying, vomiting, “very unsteady on her feet” and complaining of severe headaches.

Her niece told a nurse she was feeling “terrible”, was dizzy and her head was “killing her”. Her niece was placed on a drip and examined by an obstetrician, who told her she would be admitted.

Her niece got sick a number of times, looked like she was “in a lot of pain”, was exhausted and had her hands to her head, her aunt said.

She kissed her niece on the forehead and her niece said “thanks so much”. That was the last time she saw her alive, she said.

Her niece also sent a text message saying she believed she was “on the way out”.

Her niece was later transferred to Beaumont Hospital in Dublin. Her official time of death was given as 5.20pm on December 3rd.

In her view, her niece was dead when she saw her on the night of November 29th/30th after the family were called in.

She was buried on December 29th after legal proceedings concluded on whether life saving treatment could be stopped.

The woman’s father earlier told the inquest jury that doctors at Beaumont Hospital had told him, because of the 8th amendment to the Constitution, they could not turn off the life-saving treatment. The 8th amendment provides for the equal right to life of the mother and the unborn.

Life support

His daughter was pronounced dead, for legal purposes, at 5.20pm on December 3rd, 2014, but she was maintained on life support at Beaumont until December 8th when she was transferred back to Mullingar. The life support treatment was turned off, following legal proceedings by the family, on December 27th.

The woman’s case came before the High Court due to uncertainty, given the 1983 anti-abortion amendment to the Constitution, as to whether doctors could cease the life supporting treatment for the mother. She was 15 weeks pregnant when declared brain-dead.

A three-judge High Court ruled last December the woman could be taken off life support because there was no genuine prospect of her baby being born alive.

Due to her rapidly deteriorating condition during December 2014, the prospect for the unborn was “nothing but distress and death”, the court said.

At Mullingar courthouse on Tuesday, her father and other members of her extended family were in court.

The woman had two other children by a previous relationship and her partner had supported her father’s High Court application for the somatic treatment to be stopped in order that the woman could be buried “with dignity”.

The woman’s father told the inquest his daughter’s partner felt unable to attend the inquest.

In evidence, Dr Rosemary Cunningham O’Leary said she was GP to the woman during her two previous pregnancies, which were normal.

During the woman’s third pregnancy, Dr O’Leary said the woman had attended herself, another doctor in an after-hours service and Mullingar hospital.

The woman was admitted to hospital on the evening of November 27th, the doctor said. She learned of that admission after receiving a phone call from Beaumont Hospital in Dublin.

‘Totally unexpected’

It would be “totally unexpected” that the cause of her headaches was anything other than dehydration due to excessive vomiting associated with pregnancy [severe morning sickness] complicated by a urinary tract infection.

She was unaware until some time afterwards that a cyst on the woman’s brain was diagnosed at Mullingar hospital on November 27th.

The doctor agreed with Adrienne Egan SC, for the hospital, that headaches and dehydration are a common side-effect of excessive vomiting in pregnancy.

In a statement , the woman’s father said she attended her doctor on three different dates from October 2014 on and on each occasion was referred to Mullingar hospital. He was unsure of the particular dates.

He said the hospital at no time examined her for her severe headaches, dizziness and vision impairment, and his daughter was upset she was not examined properly.

He saw his daughter in hospital on November 28th when she appeared very sick. She had told him on November 29th she was expecting a CT scan to be carried out on her the next day but it had been deferred to Monday, December 1st.

John Rogers SC, for the family, said it was clear there were discussions over whether a CT scan was required.

Ms Egan said it was decided, following a discussion of the woman’s presentation and symptoms, that a CT scan was not required.

The woman’s father told Ms Egan he was unaware of details of medical examinations of his daughter but did not accept that, after examination, there was a decision made not to carry out a CT scan.