HSE seeks orders not to resuscitate severely brain-injured man

The Health Service Executive (HSE) wants court orders allowing doctors not to resuscitate a severely brain-injured young man if his condition deteriorates further.

Doctors consider the man, in his 30s and on ventilator support for some years, has irreversible brain injury with a poor prognosis. His condition is deteriorating and they believe he will most likely eventually succumb to a severe pneumonia and die.

The man’s parents believe he is communicating with them and do not want his existing status altered pending their consideration of two independent medical reports, which the HSE has agreed to commission, regarding his ability to communicate.

His status will remain unaltered pending those reports and unless and until any court order is made, Peter Finlay SC, for the HSE, told the President of the High Court, Mr Justice Peter Kelly, on Monday.

The judge made the man a ward of court and returned the matter to October to allow those reports be prepared and considered.

The parents have separately taken personal injury proceedings alleging their son’s present condition is due to medical negligence on the part of the HSE, its servants or agents. A defence to that claim is awaited, the court heard.

In the HSE’s separate application, it was stated doctors consider attempted resuscitation in the event of a repeat respiratory deterioration or cardiovascular arrest is not appropriate as repeated full ventilation and other resuscitation measures will only prolong the man’s suffering.

Doctors also propose, subject to court approval, an appropriate care plan, to include one-to-one dedicated nursing care, be put in place to move the man from the hospital high dependency unit (HDU) where he has been for some years to an alternative care environment such as a hospice or another ward.

The man has become colonised by multi-drug resistant micros organisms and doctors are concerned other critically ill patients are at risk of cross-infection if there is a lapse in standard infection control precautions, it was stated.

His parents want to retain the full resuscitation measures available to their son in the HDU and, because of that, do not want him moved from there.

Mr Justice Kelly noted a hospital visitor took the view the treatment being afforded to the man in the HDU is of the best standard and the man is in the correct place for him.

The HSE on Monday took the first steps towards seeking orders, which the man’s medical team and an independent medical expert say are in his best interests, allowing them, should his condition deteriorate, withhold an increase in his existing ventilator support.

They also want to be permitted withhold vasopressor support, cardiopulmonary resuscitation, defibrillation and insertion of arterial or central venous lines for monitoring cardiovascular variables.

Mr Finlay said the HSE had obtained an independent medical assessment of the man’s condition and prognosis but was happy to get further assessments from the two other independent experts identified by the parents. The family have been very co-operative with doctors and had engaged with his treatment at every stage, Mr Finlay added.

Counsel for the parents said their position as of now is they do not want his resuscitation status altered. When the parents have considered the two additional reports, she would take further instructions, counsel added.

When the judge asked did the parents believe there was insufficient evidence now for the orders sought, counsel said the family believe the man communicates with them. When they tell him a relative is coming, he will turn his head to the door and, if they indicate a picture, his eyes turn to that, she said. They wanted further evidence in relation to his ability to communicate.

In court documents, a consultant involved in the man’s care said parents had been consulted in relation to what the doctors are proposing.

She said the consensus medical opinion is the man has irreversible brain injury and is deteriorating slowly from a clinical point of view with a “very poor” prognosis. He experienced three major clinical deteriorations over the past year.

If the orders were granted, doctors would not increase the level of ventilator support beyond the level of his existing night-time support but would administer antibiotics as appropriate and perform tracheostomy and catheter changes, along with stoma wound care.

If he failed to respond to simple supports such as fluids and antibiotics during an episode of respiratory sepsis, the focus of his care will be on ensuring he avoids distress, she added.