Judgment in pregnancy & life support case

Not on the Irish High Court website yet but available online here is the decision in PP v Health Service Executive, a decision of the High Court of Ireland (Kearns P; Baker & Costello JJ) delivered on 26 December 2014.

A woman NP aged 26 years was 15 weeks pregnant when diagnosed as having suffered brain stem death, following a history of headaches followed by a fall in hospital. She was supported by mechanical ventilation, nasogastric feeding and a tracheostomy was performed in an attempt to attain foetal viability. However the life support was problematic, with blood pressure and infection issues.

The application by her father, PP, was to discontinue those measures. That application was supported by the father of the unborn child. NP had not signed an advance care directive.

Expert evidence provided to the court suggested that it would not be practical to maintain NP until 32 weeks gestation. The court concluded (page 18) that the prospects were ‘virtually non-existent’. The evidence did not require the court to consider the possibility that the child might be born alive but impaired (page 19).

Article 40.3 of the Irish Constitution provides:

The State acknowledges the right to life of the unborn child and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

The court said on page 23 that the mother’s right to retain in death her dignity and proper respect for her autonomy, with due regard to the grief and sorrow of her loved ones however:

…when the mother who dies is bearing an unborn child at the time of her death, who is living, and whose interests are not necessarily inimical to those just expressed, must prevail over the feelings of grief and respect for a mother who is no longer living.

The court on page 28, noting the constitutional guarantee of the unborn’s right to life, that it was a necessary part of vindicating that right to enquire as to the practicality and utility of continuing life support measures. As there was no real prospect of maintaining stability in the uterine environment, the court was satisfied that it should authorise the withdrawal of support at the discretion of the medical team.

A more detailed discussion of this decision has been posted by Mairead Enright.

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