The president of the Medical Council has described as "exceedingly rare" the case of a paralysed man who died after doctors withdrew an artificial ventilator at his own request.
An inquest into the man's death was adjourned at Dublin City Coroner's Court yesterday so that the "end of life issue" can be explored at the resumed hearing in March.
Ronald Lindsey (61) of Iveagh Trust, a Dublin hostel for people who were previously homeless, died on April 22nd, 2005, at St James's Hospital.
Mr Lindsey was on anti-coagulation warfarin therapy for previous deep vein thrombosis and developed a rare complication that left him paralysed despite an emergency operation, the court heard.
Mr Lindsey presented at the hospital's A&E department on March 4th and was seen by a doctor after 10 hours. A severe kidney infection was diagnosed.
Mr Lindsey then remained on a trolley until a bed became available 36 hours later.
Dr Bernard Silke, a consultant physician at St James's, told the inquest that two days later an MRI scan found bleeding into the spinal area. There are just 300 documented cases of this occurring worldwide, Dr Silke said, and 40 per cent of those concerned patients on anti-coagulation therapy.
Paralysis of Mr Lindsey's legs had by now begun and he was transferred to the spinal unit at Dublin's Mater hospital for emergency surgery.
Mr Lindsey became depressed a few days after his surgery and saw a psychiatrist at the Mater before being transferred back to St James's. Dr Silke said there was "no prospect of weaning him off ventilation" and Mr Lindsey requested that the artificial ventilation be withdrawn. A written protocol at St James's Hospital states that three senior clinicians involved in a patient's treatment must agree to discontinue artificial ventilation at a patient's request.
A meeting was held and they unanimously decided to follow Mr Lindsey's wishes. The ventilation was switched off and he died the same day.
In extracts from a statement by one of Mr Lindsey's sisters, Winifred Leonard, she described how her brother communicated to his family with the help of a voice box.
"He said he could not take the pain any longer. I believe my brother was capable of making the decision to come off the ventilator," she said.
The President of the Medical Council, Dr John Hillery, said that in his experience, the case was "exceedingly rare".
Generally, he said, in cases where patients refuse treatment, "the main issue is whether the person is competent, and that their ability to make the decision to die is not influenced by their illness, or that there is not another illness there - such as depression - which has an effect on that competence," he said.
The chairman of the council's ethics committee, Dr Deirdre Madden, said it was a legal and ethical right of all competent adults to refuse treatment, even if the consequence of that refusal was death.