Medics treating a 78-year-old man who has severe depression can refrain from pursuing invasive interventions in his future care even though it is likely this decision will lead to his premature death, the High Court has ruled. <\/p>\n
In a judgment published on Monday, Judge Emily Egan ruled a proposed ceiling of care, which would exclude CPR, coercive feeding and coercive medical treatment from the man\u2019s future care, was lawful.<\/p>\n
The judge made the finding in the \u201cdifficult and sensitive\u201d case in circumstances where she said it was \u201cunfortunately clear\u201d that the ceiling of care would \u201clikely result\u201d in the man\u2019s premature death.<\/p>\n
The case arises in circumstances where the man has a history of severe depression with psychotic features and has for a long period refused to engage with clinicians and \u201call medical treatment or interventions of any kind\u201d, the judge said. <\/p>\n
Recently, the man has become profoundly frail, has lost weight and spends most of his days in bed. He is being detained at a placement. <\/p>\n
The HSE brought the application in respect of the ceiling of care in circumstances where doctors believe coercive interventions in the man\u2019s care are \u201cfutile, harmful and disproportionate\u201d.<\/p>\n
The case engaged the man\u2019s constitutional rights \u201cat a fundamental level\u201d, the judge said, including his right to life, bodily integrity, dignity, autonomy and liberty.<\/p>\n
Adults with full capacity have a right to refuse medical treatment, even if that refusal may result in death, the judge said. <\/p>\n
However, in this man\u2019s case, medical evidence showed \u2013 and the court agreed \u2013 that he lacked capacity to make decisions about his care.<\/p>\n
In those circumstances, it was necessary for the court to undertake a \u201cproportional balancing exercise to determine whether to authorise non-intervention\u201d, the judge said.<\/p>\n
\u201cThe right to life does not exist in isolation from other constitutional rights and the presumption in favour of life-saving treatment can be rebutted,\u201d she said.<\/p>\n
Despite the man\u2019s lack of capacity, the judge said the court must still afford \u201cconsiderable weight\u201d to his long-standing will and preference to refuse medical treatment. <\/p>\n
The judge found it was appropriate to authorise refraining from coercive treatment and CPR.<\/p>\n
\u201cSuch authorisation respects the respondent\u2019s long-standing will and preference to refuse medical treatment, even if his life is in jeopardy and, to that extent, reflects his long-standing values,\u201d she said.<\/p>\n
The judge noted medical evidence that CPR in isolation would not necessarily be life-saving to the man and would \u201cinitiate a cycle of invasive and highly distressing treatment and restraint with no realistic prospect of meaningful benefit\u201d. <\/p>\n
She also accepted evidence that, given the man\u2019s frailty and fragile bones, restraining the man for the purposes of involuntary treatment or nutrition carries a \u201csignificant chance of causing injury\u201d. <\/p>\n
\u201cInvoluntary treatment and coercive feeding will not as a matter of probability have any lasting benefit,\u201d she said.<\/p>\n
Noting Supreme Court rulings, the judge said such interventions \u201cwill \u2018cause the patient more harm than benefit\u2019\u201d. <\/p>\n
The judge granted orders allowing for doctors to provide non-coercive palliative care to the man.<\/p>\n
The judge also granted an order allowing for the man\u2019s detention at the medical facility, noting his lack of capacity, extreme frailty and inability to appreciate risk.<\/p>\n","protected":false},"excerpt":{"rendered":"Medics treating a 78-year-old man who has severe depression can refrain from pursuing invasive interventions in his future…\n","protected":false},"author":2,"featured_media":79450,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[73],"tags":[79,18,10476,60,19,17,2324],"class_list":{"0":"post-479841","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-business","8":"tag-business","9":"tag-eire","10":"tag-high-court","11":"tag-hse","12":"tag-ie","13":"tag-ireland","14":"tag-supreme-court"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@ie\/116558140923827286","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/479841","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=479841"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/479841\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/79450"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=479841"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=479841"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=479841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}