Join Date: Apr 2006
''On examination, the lady who is deceased about three weeks does not look well.''
Brain dead woman kept on life support for 20 days to protect unborn child.
This afternoon Dr Peter McKenna, clinical director at the Rotunda - and the maternity hospital's former Master - told a specially convened three judge High Court "we are all in uncharted waters".
"I can see we are where we are, but I don't think that is a justification for continuing any further," said Dr McKenna, adding that he was firmly of the view that the appropriate course of action was not to continue life support for the woman who is 18 weeks pregnant.
The mother-of-two has been on life support since December 3rd last when she was 15 weeks pregnant and formally declared dead, the High Court has heard.
The judges will hear legal submissions tomorrow and the court will deliver a ruling on St Stephen’s Day.
Another of the country's leading obstetricians has told the President of the High Court that a repeal of the eight amendment would be "even more helpful" than medical guidelines to assist doctors.
Dr Peter Boylan, who gave evidence on the behalf of the family in the tragic case, said that doctors are unclear about what to do because of the eight amendment and are correct to seek legal advice.
Dr Boylan told the High Court that, in any other country, the woman in this case would be allowed to die with dignity.
"Just because something in medicine can be done doesn't mean that it should be done," Dr Boylan told a specially convened three judge court led by High Court President Mr Justice Nicholas Kearns.
Dr Boylan told the High Court that there was a distinction between abortion and what was proposed in this instance, namely the withdrawal of support for a brain dead woman.
There were emotional scenes in court this afternoon as medical experts who have reviewed the dead mother of two's current clinical position, outlined a series of medical risks involved with continuation of somatic support to the woman.
The woman died on December 3rd last, but has now been on life support for 20 days because of the Constitutional protection for the unborn, the High Court has heard.
A neurologist called to testify by the Health Services Executive (HSE) said that the young mother of two meets the criteria for brain death.
Dr Timothy Lynch, who examined the young woman yesterday, said the case was tragic, but the woman's story was one with "a clear cause of collapse" of her brain stem.
The support extended to the woman includes a tracheotomy, the court heard.
She also has a head wound and a series of infections, including high temperatures.
Asked when he believed the woman had died, Dr Lynch said that once she met the criteria for brain death, "that is the day that she would be deemed dead".
Dr Frances Colreavy, an expert in intensive care medicine from the Mater Hospital, said she had concerns about the current situation being prolonged.
“I would describe it as experimental medicine,” she said.
She examined the woman yesterday and found her face to be puffy. There was an oozing wound to her head and a possible infection to her abdomen.
“On examination, the lady who is deceased about three weeks does not look well. There is a photograph on the windowsill in her room of her and her two children, but there is no resemblance,” said Dr Colreavy.
Make-up was applied to the woman’s face as her two young children, were visiting her yesterday for the first time since she had become brain dead.
“The little girl, when she saw her for the first time, was very distressed,” said Dr Colreavy.
Under cross examination, Dr Colreavy said there was no machine which could ensure the woman’s heart continues to beat.
She said the heart would eventually stop, but it was hard to anticipate when this would happen.Dr Colreavy said that if the heart failed, it could lead to further complications, including kidney, liver and lung failure.
She outlined how she observed six different syringe pumps beside the hospital bed and how the woman was being given a range of antibiotics to combat infections.
Dr Colreavy said she could not say what the long term effects of these drugs on the foetus would be.
She said there was a huge problem with fluid therapy. The woman’s bowels have to be stimulated, a wound to her head needs continual dressing and she needs to be turned regularly to avoid pressure sores.
Dr Colreavy said she was concerned about the woman’s temperature, which had been recorded at 38.5 degrees. She said it was likely the foetus would be even warmer, possibly 40 degrees.
The doctor outlined that when the woman was moved from a hospital in Dublin to her current hospital, she was showing signs of pneumonia.
Referring to the wound to the head, she said the woman was also being treated with an MRSA drug and had neurosurgical meningitis.
She said she did not want to upset members of the family present, but the “brain is rotting” and there was “evidence of fungus growing” on part of the brain.
Dr Colreavy said the woman’s abdomen was “unlike any” she had ever seen.
There were blue, red and purple colouring along the stretch marks, which suggested there may be an infection.
An MRI would be required to investigate this, but the facility is not available at the hospital.
A chest X ray indicated huge amounts of fluid inside or outside the lungs.
Asked if it was realistic to continue her care, Dr Colreavy answered: “I don’t think, in my clinical opinion, that is possible or is to be recommended”.
At the outset of today's > case, the HSE said that its position position was that, based on the medical evidence, there was no reasonable prospect of the unborn being born alive if life support measures were continued.
Senior Counsel Gerry Durcan, for the HSE, told the court that it was the view of the HSE was that it was not practicable to vindicate any right to life of the unborn child, Mr Durcan said that the HSE believed that the appropriate declaration for the court to make was the discontinuance of life support was lawful in the circumstances of this case.
The Divisional Court has heard that the young mother of two had chosen a name for her unborn - whether it was a boy or girl - and was looking forward to the pregnancy.
The court has also heard that the family were told about the interpretation of the constitutional law relating to the unborn on the day after she was declared dead.
This morning the High court heard evidence from the father of the woman, described by Senior Counsel Mary O'Toole - for the family - as "the deceased" The court also heard from the father of the unborn who supports the family's application to have life support no longer maintained.
Relatives of the woman wept as the court heard from an intensive case expert who said that amongst the patient's current difficulties, her body is no longer able to "obtain normal body tone".
Doctors are having difficulty maintaining her blood pressure and she also has a series of infections which could be a major factor, intensive care expert Dr Brian Marsh told the court.
"It is my best judgment that sustaining (her) is not feasible for a long period of time" said Dr Marsh, adding that the ongoing environment that the foetus is within is "a very abnormal environment".
Dr Marsh said that a patient being maintained in Intensive Care Unit (ICU) may appear benign, in many respects, but he said there was "a huge abnormality" in having a body maintaining a dead organ, namely the brain.
The woman died at 5.20pm on December 3rd last after suffering from a brain cyst and it was declared there was no intra cranial circulation, the court has heard.
Dr Marsh told the High Court: "From our perspective, the life became a corpse at that time".