Brain-injured boy will make no meaningful recovery after road collision, High Court told

Three doctors have told the High Court they believe a young boy is in a vegetative state after suffering a catastrophic brain injury following a road collision some months ago. He will not make any meaningful recovery and his best prognosis would be a move to a minimally conscious state, the Court heard.

A neurologist who is part of the child’s treatment team said she is 90 per cent sure the boy is experiencing pain as a result of dystonic episodes.

The boy’s parents, who are estranged, say it is too soon after the accident last summer to say what will happen in terms of recovery and they oppose a hospital’s application for orders effectively allowing it to administer a palliative care regime and to withhold life-prolonging interventions such as CPR if they consider those not in the boy’s best interests.

His mother says her son has overcome other difficulties in his young life to date and has the “heart of a lion”, another neurologist told the court on Wednesday.

The mother, who wants him moved back home or to a nearby hospital, says her son is as a “home bird” and would get comfort from being home and having his beloved dogs near him, the doctor said.

It is unclear whether the boy would have any awareness of being home, he is in a precarious situation and needs a plan in place for the short-term, the neurologist said. Palliative care “triggers an emotional response in people” who think it “means being on the road towards dying” but it is not about bringing him towards death, it is about giving him the best quality of life now and supporting him and his family.

High Court president Ms Justice Mary Irvine is conducting a hearing to decide whether or not to grant the orders sought by the hospital.

Arising from the dispute between the parents and the hospital as to what is in the best interests of the child, the orders are sought in wardship proceedings.

The parents opposed wardship. The judge earlier this week decided the boy should be taken into wardship and will give her reasons for that decision later.

The judge has received several medical reports, including from doctors not attached to the hospital asked by the boy’s court-appointed guardian to give their views concerning the orders sought.

During Wednesday’s hearing, the judge said she wanted more information concerning the frequency of the boy’s dystonic events because she considered the information in that regard was insufficient.

In evidence, the boy’s treating neurologist was asked about the mother having said her son appeared to be smiling when he was told jokes or funny stories. The doctor believed, because his brain damage is to areas concerning movement and not his brain stem, what the mother sees is more likely reactive and a brain stem response.

The doctor’s belief was the neurological injuries and his physical disability are permanent and irreversible. When she saw him earlier this week, he had four-limb dystonia and an increased heart rate. His dystonia can be triggered by things like noise and being touched and the dystonic episodes could go on for a long period.

She was not optimistic about his living a life fairly pain-free from dystonia and considered interventions would not lead to any improvement or recovery in his condition.

She agreed with counsel for the father that doctors can refuse to carry out interventions if they believe the negative consequences exceed the benefits.

Doctors do their best to persuade parents of the most appropriate treatment and most times parents can be brought on board, she said.

She told David Leahy BL, for the guardian, she did not believe it was too soon to be deciding to withhold life-prolonging interventions. On the balance of probabilities, she was 90 per cent certain the boy is experiencing pain. He was also at risk of getting other infections and of suffering over the coming months, she said. She could not predict how he will recover in terms of consciousness but believed his trajectory is towards a vegetative state with perhaps minimal improvement towards a minimally conscious state.

A paediatric critical care specialist said he was concerned if the boy suffered a major aspiratory event and was placed on a ventilator he might not survive and, if he did, it was unlikely to improve his overall condition. If the boy deteriorated now, he would treat him in line with his clinical judgment but he believed, in light of the parents’ position, the orders are necessary for legal and other reasons. He rejected suggestions of behalf of the mother the application meant her son was not being given “a chance”.

A paediatric critical care specialist said he was concerned if the boy suffered a major aspiratory event and was placed on a ventilator he might not survive and, if he did, it was unlikely to improve his overall condition. If the boy deteriorated now, he would treat him in line with his clinical judgment but he believed, in light of the parents’ position, the orders are necessary for legal and other reasons. He rejected suggestions of behalf of the mother the application meant her son was not being given “a chance”.

The hearing continues on Thursday.