A judge being asked by the HSE to permit doctors not to resuscitate a severely brain injured young man if his condition deteriorates must conduct an “awful balancing act”, lawyers for the man’s parents have said.
The parents, who have initiated a separate case against the HSE alleging the man’s injuries arose from his care and treatment after his admission to hospital more than four years ago, are opposing the “do not resuscitate” orders.
As the man has been made a ward of court following an application by the Health Service Executive (HSE), the President of the High Court, Mr Justice Peter Kelly, must make decisions concerning his future care.
The HSE wants various orders including permitting doctors not to resuscitate the man if they consider that is not in his best interests.
The judge has been given detailed reports by medical experts for the sides addressing the effects of certain resuscitatory measures and other issues including the man’s ability to communicate.
The judge’s task involves “an awful balancing act”, Liam Reidy SC, for the parents, said on Wednesday when cross-examining the senior doctor leading the team involved in the man’s care.
Counsel stressed the parents had no criticism of the care being afforded to their son since the particular doctor became involved and considered that had led to an improvement in his condition.
Doctor’s evidence
The doctor, who became upset during her evidence, said the man and his parents were enduring a “terrible time”.
The medical team were providing the best treatment they could within the resources available to them, she said.
The man was extremely disabled with a significant brain injury but the parents and medical team disagreed on his future care, she said.
Following failures over some time to reach agreement on issues including resuscitation, she recommended the man be made a ward of court.
In response to questions about the effects of certain respiratory treatments, including whether the man would survive if they were not administered, the doctor told counsel she considered he was asking her to “look into a crystal ball”.
She agreed there was a risk; in particular circumstances, he might not survive.
She also considered certain ventilatory measures were, on balance, less rather than more beneficial to him.
Improvement
Asked about the parents’ view that the man’s condition had improved over the past year, she said her view was his condition had not improved for reasons including brain atrophy, would not improve and he was slowly deteriorating.
The team want to continue existing therapies, she stressed.
She agreed a medical expert with experience of people with permanent disorders of consciousness had said in a report the man did not appear distressed and appeared alert in that he seemed to track the expert and others in his field of vision.
It was difficult to evaluate how much the man appreciated or understood commands or attempts to communicate, she said.
She agreed a leading expert who assessed the man last September had reported he had responded to some commands but said his reaction to commands was inconsistent.
She understood the parents fear the man might be let die in the absence of a full evaluation of his state of consciousness by the relevant national experts, she told Mr Reidy.
The consensus of experts who had viewed video and other material was that he was in a minimally conscious state, she said. “I have done all I can.”
The case continues.
