The High Court authorised doctors treating J.M., a ward of court, to withhold increased ventilator support if his condition deteriorates and to withhold cardiopulmonary resuscitation and related emergency procedures in a clinical deterioration. The orders permit, but do not compel, doctors to act within their clinical judgment. They do not withdraw J.M.’s existing supports, nutrition, hydration, antibiotics or other antimicrobial treatment.
In a judgment delivered on 22 June 2017, Mr Justice Kelly, President of the High Court, said J.M. was in a minimally conscious state following a severe, irreversible brain injury. He could not speak or communicate his wishes, and required full assistance with daily activities. The judge found that J.M. had some fluctuating awareness of his surroundings and was likely able to experience pain. He accepted medical evidence that there was no realistic prospect of neurological improvement and that respiratory infections were likely to recur.
J.M. had been admitted to hospital in July 2012 and had remained there since. The Health Service Executive brought the application after his parents, identified in the judgment as G.M. and M.M., did not consent to the proposed limits on treatment. They were appointed as his committee after he became a ward of court in July 2016. The judgment records their wish for their son to live and their difficulty consenting to the proposed orders.
The court considered two forms of treatment escalation. J.M. received CPAP through a tracheostomy at night. An increase to BiPAP would mean continuous, 24-hour ventilation. The judge found that this carried substantial risks, including lung injury and possible adverse effects from increased sedation, without a clear medical benefit or improvement to J.M.’s underlying condition. He concluded that its burdens outweighed its likely benefits.
The second order covered CPR, vasopressor support, cardioversion, defibrillation and insertion of arterial or central venous lines to monitor cardiovascular variables. The judge found that these interventions were unlikely to succeed and could cause pain, distress, broken ribs, further brain injury or other harm. He ruled that neither category of treatment was in J.M.’s best interests.
The judgment stressed that the case was not about switching off life support or withdrawing care already being provided. If infection occurred, the plan was to continue treatment with appropriate antimicrobials and fluids, along with existing care. The orders addressed only whether specified additional interventions had to be provided following a future deterioration.