Doctors can withhold treatment from baby, judge rules

BMJ 2017; 356 doi: (Published 16 February 2017) Cite this as: BMJ 2017;356:j851
  1. Clare Dyer
  1. The BMJ

Doctors at Great Ormond Street children’s hospital in London will be acting lawfully if they withhold aggressive and invasive treatment from an eight month old baby with only weeks to live, a High Court judge has ruled.

The parents of the baby girl, who was born with hypoplastic left heart syndrome, want her to have “any procedure possible if that would prolong her life for one day,” said Ms Justice Russell.

But treatment such as cardiopulmonary resuscitation, intubation and mechanical ventilation, central venous lines, and further chest drains “are unlikely to succeed and will only cause elemental pain and distress for this baby who has already suffered so much,” the judge added. It was not in the best interests of the baby, named only as MK, to carry out such interventions, and therefore it was lawful for the interventions to be withheld, she said.

MK had hypoplastic left heart syndrome and restrictive atrial septum diagnosed before birth. Her parents were advised to terminate the pregnancy but decided to go ahead with it.

She has twice undergone surgery, after which she was very unwell. She has had “several clinical deteriorations requiring urgent intubation, ventilation and transfer to the ICU for a variety of reasons including infections, re-accumulation of fluid round the lung or generalised fluid retention.” She has to be injected twice a day with an anticoagulant, after which she is “very distressed and difficult to console.”

Doctors at two other leading children’s hospitals, which have been asked for second opinions, agreed with Great Ormond Street that MK’s lung arteries are too small and that she has no further surgical options.

On the weekend of 4-5 February she was moved to the ICU and was struggling to breathe. She was retching and vomiting with feed. The cardiologist treating her told the court that MK was “on a moving course towards death and that the team had been very worried over the past few days.” She was “unlikely to survive for more than a few weeks at most.”

Russell said it was obvious that MK was “a much loved and cherished baby” who enjoys interacting with her parents. Nurses described her as a “responsive, inquisitive and smiley baby.”

But fear was a recurring feature of her existence, from the distress caused by the injections to anxiety about the breathlessness that leaves her gasping for breath.

“She is a child who is dying and nothing can be done to reverse that process,” Russell said. “All the treatments that her parents want her to have . . . carry with them a substantial or greater risk of contributing to her death or causing fatality given her already parlous condition.”

If MK were to have the treatments, “the most that they might achieve is to delay her death by a very short time but in doing so she will be made to suffer very considerably when she could, and should, be allowed to end her life in as comfortable, pain-free and comforted a condition as it is possible to achieve,” Russell concluded.

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