Updated 7.30am, 24 December

THE HIGH COURT will continue to hear legal submissions today in the case of the pregnant woman being kept on life support in an Irish hospital.

A decision will be made on St Stephen’s Day.

Representatives told the court yesterday that there is “no reasonable prospect” the child of the woman – who has been deemed clinically brain dead – will be born alive.

The woman was declared dead at a hospital in Dublin on 3 December, after being transferred from a hospital outside the capital where she had suffered a massive brain trauma days earlier and been placed on life support.

The woman’s father told the court that the family — including the father of the unborn child — had agreed that the life support should be turned off.

He said they wanted to be allowed put her to rest, and afford her the appropriate dignity.

The father of the unborn child said he had discussed the issue with the woman’s family and believed ended the support treatment was the best decision.

The woman has two other young children, the court heard.

Earlier, lawyers for the HSE said medical evidence showed there was no reasonable prospect of the child being born alive, and that in the circumstances the discontinuance of life support was lawful.

The unborn child and the woman were also represented at the hearing before High Court President Justice Nicholas Kearns and two other judges.

At the end of yesterday’s proceedings, Justice Kearns said legal submissions would be heard at 11am tomorrow. The three-judge court will rule on St Stephen’s Day on whether doctors treating the woman can accede to the family’s wishes and turn off life support.

President of the High Court, Mr Justice Nicholas Kearns. /Photocall Ireland /Photocall Ireland

Expert testimony

Intensive care specialist Dr Brian Marsh said care currently being provided to the patient was “being provided to a dead body”.

He said he was quite concerned that the situation would soon become unsustainable.

“I don’t believe that this unborn can survive,” Marsh said, after giving detailed medical evidence.

“There is a huge abnormality in having a body retain a dead organ,” he said, referring to the woman’s brain.

He said as the woman’s condition continued to deteriorate, the likely impact was “ongoing injury and damage to the fetus”.

Earlier, the woman’s father said his daughter — who had been living with him for the last two years — had been suffering from headaches from October.

She was admitted to the hospital outside Dublin on 27 November for treatment.

On 29 November she suffered a fall in the bathroom, and at 10pm that night was found to be unresponsive, a lawyer representing the family said.

The woman’s father said he had been told his daughter had passed away as he arrived at hospital later that night.

He was taken in to see her, and was told she had been put on ventilation support by a member of hospital staff.

The clinical declaration of death happened at 5.20pm on 3 December after the woman was transferred to Dublin, the court was told.

“Very in-depth care has been undertaken,” since then, Marsh said.

While the body had gone through an initial period of stability after she was declared dead, the specialist said, background infections meant that was likely to change in the near future.

He said that in his best judgement sustaining the patient would not be feasable.

‘Intensive care support’

A consultant obstetrician who talked the court through medical notes relating to the case said the doctors at the Dublin hospital, where the woman had been declared dead, had had little choice but to seek legal guidance.

“We are unclear what to do in light of the 8th Amendment,” the obstetrician said.

Giving further detail on the circumstances surrounding the woman’s initial admittance to hospital, he said she had complained of a severe headache after reporting her fall in the bathroom.

Later that night, a nurse wrote that she was “incoherent with pain”. She was intubated, and transferred to an emergency care unit.

Tests carried out showed it was likely a cyst had been developing in her brain, the obstetrician said.

In the following days, the family of the woman were told of ethical and legal considerations that would have to be taken into account in the case.

A medical note said the family had asked that CPR not be given in the event that the woman’s heart stopped.

On 3 December, as legal clarity was still being awaited, an angiogram (to check blood flow) was carried out, following the woman’s transfer to hospital in Dublin. It was found that no blood was flowing to the brain, and she was declared dead.

The family were spoken to at length about Irish constitutional law, and told of the difficulties regarding the case.

She was transferred back to the hospital outside Dublin where she had initially been admitted, once a bed became available, on 8 December.

Sam Boal Sam Boal

Tracheostomy 

Dr Frances Colreavy, a consultant in intensive care medicine in the Mater Hospital, said she had examined the patient yesterday, and that there were significant problems managing the woman’s infections.

She said the woman was now being kept attached to the ventilator via a tracheostomy tube inserted though an opening in her neck, and that there were six syringe pumps at her bedside providing drugs.

She has to be turned regularly by nursing staff to avoid pressure sores.

A photo of the woman had been placed at her bedside, she said — adding that “the deceased” in the bed did not bear much resemblance to that picture.

Make-up had been applied, as one of the woman’s children had been due to visit, Dr Colreavy was told by nurses. However, the patient’s eyes were so swollen they were no longer able to close.

“Her little girl saw her and became distressed,” the doctor said.

The patient had already been showing signs of pneumonia while in hospital in Dublin, Dr Colreavy said — and she had been treated with increasingly strong grades of antibiotics in recent weeks.

She said the effect on the fetus of all the drugs being pumped into the woman’s body to manage infection, blood pressure, and other issues was unknown.

Dr Colreavy said she had examined a wound in the woman’s head, and could clearly see through her skull that her brain was rotting.

The patient was “very hot,” she said, adding that if the woman’s temperature was being recorded at around 39 degrees “that of the fetus must be around 40″.

Dr Colreavy said that due to “very unusual fungal infections” combined with the other issues, it was “very unlikely” there would be a good outcome if life support continued.

If support measures continued, she said, there was a possibility that the woman’s limbs may start to move, due to the effects caused by the circuitry of the spinal cord.

She said that in almost 20 years working in intensive care medicine in Ireland and Australia she had never come across a case like this.

She had never met anyone who had.

‘From the extraordinary to the grotesque’

Consultant obstetrician Dr Peter McKenna, a former Master of the Rotunda, said babies were not designed be incubated in anything other than the normal temperature.

He said it was a concern that the fetus was being exposed to temperatures of 38 or 39 degrees for long periods, and that it was worrying that “the baby may be utilising the precarious supply of oxygen more quickly than it should be”.

He said that doctors were in “uncharted territory with the case” and agreed with Dr Colreavy’s assertion that it was not possible to say what effect the drugs being used would have on the fetus.

He said that while he could see why “we are where we are” he didn’t think there was justification to continue any further with with life support.

The chances of the child surviving were very small, he said, and the level of care required would be extraordinary.

Given from what I’ve heard today — for it to be continued, we’d be going from the extraordinary to the grotesque.

‘Perfect storm’

A senior specialist who is a member of the woman’s current care team said her condition was deteriorating daily.

Given the “storm in her body” he said he didn’t think there was any prospect of the baby surviving.

“I’d be giving up all hope for the baby,” he said, adding that — following consultations with the family — the hospital would not have a issue with turning life support off.