The HSE is seeking a High Court order requiring that certain drugs be administered from birth to the child of a heavily pregnant HIV positive woman with a view to reducing the risk of transmission of the virus.
The HSE says the anti-retroviral (ARV) prophylaxis medication, if administered from birth for a four week period, will reduce the risk of transmission.
However, the woman, who the court heard had accessed information about HIV and the drugs on the internet, has expressed concern the drugs pose risks to the child.
Her counsel Fergal Kavanagh SC said today these were “black-label, highly toxic” drugs which had side-effects in some cases and had led to some deaths and their risks had to be “properly weighed”.
There was no conflict between the interests of the mother and child and, if it was determined it was in the child’s interests to be treated with the drugs, the mother would be happy with that, he said.
Felix McEnroy SC, for the HSE, said the case should be “reduced to common sense”. The HSE says its evidence is the ARV drugs reduce the risk of transmission of the HIV virus to a child to 0.01 per cent and, while the drugs can have side-effects, such risks are more than counter-balanced by the benefits of preventing HIV transmission.
The HSE wants the court order because it is concerned the woman was “in denial” of her diagnosis as HIV positive and the implications of that for her child. The woman had not ahdered consistently to the medical advice concerning her treatment, including she should have an elective Caesarean section this weekend, it said.
A further order restraining the woman breast-feeding the child, also with a view to reducing the risk of transmission of HIV, was initially sought by the HSE but the court was told today the woman would give an undertaking not to breast-feed.
The woman, who is in the latter stages of pregnancy will give birth at a Dublin maternity hospital. The court heard she has another child who was recently tested for HIV and found not to have the virus.
The father was represented in court today by Michael P O’Higgins SC.
Mr O’Higgins said his client had secured an order in the UK to have his child made a ward of court in an effort to have the child tested for HIV. Counsel also said the woman had left the UK for her home in Ireland when the wardship order was made so as “to frustrate” that order. A HIV test was later carried out on consent on the child, counsel added.
The doctors involved in the woman’s care and treatment claim it is in the best interests of her unborn child to be delivered by elective Caesarean section on Monday next rather than wait for either a natural birth of emergency Caesarean section. The international opinion is that elective Caesarean section carries less risks and leads to best outcomes for babies with HIV positive mothers, a doctor told the court.
Monday was already a “compromise” date and, “on balance, this baby can’t wait,” she added.
The woman has said she will not agree to an elective Caesarean section on Monday but will have an elective Caesarean section on Friday next. She wants the court in the interim to determine whether it is in the best interests of her child to have the ARV drugs administered.
Mr Justice George Birmingham has adjourned until tomorrow the further hearing of the HSE’s application so that the woman’s lawyers have an opportunity to call evidence related to the safety of the drugs. They want to call evidence from a Californian based toxicologist and arrangements were to be made yesterday evening to have his evidence heard via video-link.
Earlier, Mr Kavanagh said the issue in the case had narrowed to whether the court could order administration of these drugs having conducted an investigation into their toxicology and pharmacology.
Counsel said the woman could not be forced to have the elective Caesarean section and the judge confirmed no order could be made requiring her to undergo such a procedure.
Mr Kavanagh said he had been instructed by the mother to rerpresent the child at this stage. His side wanted to call expert witnesses and would need time.
Mr Justice Birmingham told Mr Kavanagh the qualifications of the witnesses sought to be called would have to be established and asked was counsel proposing to call any medical witness “as opposed to people on the Internet”.
Mr Kavanagh said one witness he hoped to call had given evidence in some 40 cases in the US and “should not be denigrated” because he had started out in life as a verterinary surgeon. That witness would give evidence about the toxicology of the drugs, he said. Counsel also said there were issues about the quality and reliability of HIV tests.
Mr McEnroy said the HSE were anxious to have the case decided and the woman had had adequate time to prepare as she had been consulting with clinical professionals and taking legal advice since August last. Up to November 10th last, she had agreed to undergo an elective Caesarean section this weekend but then said she had concerns about the ARV drugs and had also questioned her own HIV diagnosis, he said.
