Doctors have been granted permission to switch off a life-support machine that was keeping alive a clinically dead woman because she was pregnant.
In a landmark ruling, an Irish court said keeping the young mother alive would deprive her of dignity in death and subject her father, partner and two young children to “unimaginable distress” in a “futile exercise”.
The panel of judges said it was in the best interest of the unborn child to authorise the withdrawal of life support in what was a “tragic and unfortunate case”.
Dublin’s High Court added that it was a case of “great public importance”.
The unnamed 26-year-old was pronounced clinically dead on 3 December after suffering a trauma injury last month.
Her family had sought to switch the equipment off to preserve her dignity but doctors refused, fearing they might be prosecuted under Ireland’s strict
Catholic-influenced abortion laws, which give the 18-week-old foetus the same constitutional rights as the mother. Under the Irish constitution, the foetus is regarded as a citizen.
In their ruling yesterday, president of the High Court Mr Justice Nicholas Kearns, Ms Justice Marie Baker and Ms
Justice Caroline Costello agreed the unborn baby had little chance of survival.
“The condition of the mother is failing at such a rate and to such a degree that it will not be possible for the pregnancy to progress much further or to a point where any form of live birth will be possible,” they said.
Medical evidence showed the unborn child was facing a “perfect storm” with no realistic prospect of emerging alive.
Doctors with the best interests of both the mother and unborn child in mind did not believe there was any medical or ethically-based reason for continuing with the “grotesque” process, the court was told.
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The woman’s father took the case against Ireland’s Health Service Executive (HSE) after agreeing with the woman’s partner that the life support should be switched off.
“He wanted her to have a dignified death and be put to rest,” the court ruling stated.
“His daughter’s two children are aware that their mother is sick and believe she is being looked after by the nurses ‘until the angels appear’.”
There is to be no appeal of the decision by either side in the case.
Paul Connors, communications director with the HSE, said it was a very welcome decision at the end of a very traumatic number of days for the woman’s family.
“Certainly, it brings a great degree of clarity to these particular situations,” he said.
Irish health minister Leo Varadkar said he would carefully examine the ruling.
“I wish to convey my heartfelt sympathies to the family and partner of the woman at the centre of this case at this most difficult time – particularly given the season,” he said.
“This case and the judgment will need to be carefully examined before I can make any further comment on it.
“In the meantime, I would ask that the privacy of this family is respected, at this so difficult and challenging time.”
During the case, which was fast-tracked through the High Court, harrowing evidence was given by the woman’s father and her partner – who cannot be named in order to protect their privacy – as well as seven doctors.
The woman suffered a head wound in a bathroom fall in hospital on 29 November after being admitted for nausea and headaches. A catastrophic fluid build-up in her brain led to her being declared clinically dead four days later.
Such is her physical deterioration since then that one of her children was left very distressed at her appearance when she last saw her, the High Court was told.
Dr Frances Colreavy, an intensive care specialist, had told the court she inspected the woman’s body on Monday and found it unrecognisable compared to a photo of her by her bedside.
Having practised medicine for decades in Ireland and Australia, she had never witnessed a clinically dead person being kept on life support for so long, the court was told. She said the woman’s blood was becoming increasingly toxic.
Dr Peter McKenna, former master of Dublin’s Rotunda
Maternity Hospital, said if the treatment was not halted it would go “from the extraordinary to the grotesque”.
The case has reignited debate over Ireland’s constitutional ban on abortion which requires doctors to take all possible measures to protect the life of a foetus.
Irish doctors have appealed for decades for clearer legal guidelines on when they may terminate a pregnancy. In September, nine members of the Irish medical team that treated an Indian dentist who died after being refused an abortion were disciplined.
Galway University hospital said the nine were part of a larger medical team looking after Savita Halappanavar before she died from blood poisoning in October 2012.
Ms Halappanavar had demanded that her pregnancy be terminated after fearing the foetus was dead and likely to give her sepsis.
Her request was turned down after medical staff said they detected a foetal heartbeat. She was 17 weeks pregnant and miscarrying when she fell ill.
Thousands of Irish women travel to the UK every year for abortions.
Sheila McLean: ‘This will be subject of considerable debate’
This is a significant decision, although it is in line with many other jurisdictions that would not accord a foetus the status of a legal person.
However, it looks as if the critical issue may have related to the fact that the foetus would not, in any event, have survived, thus allowing the interests/rights of the woman to predominate.
I am less clear on what would have been the outcome had the pregnancy been further advanced and the woman’s foetus had a chance of survival.
Given what happened in the recent abortion case, it might have been assumed that the mere fact of the foetus having a heartbeat would have been sufficient to endow the foetus with the rights protected by the Irish constitution.
Arguably, this is a departure from that case and will doubtless be the focus of considerable debate, with – I imagine – the so-called “pro-life” lobby likely to oppose it.
• Sheila McLean is Emeritus Professor of Law and Ethics in Medicine in the School of Law at the University of Glasgow
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