Court rules child who drowned should be extubated by Montreal’s Sainte-Justine Hospital
A six-year-old child who has been in an irreversible vegetative state since drowning last June will be extubated by an order rendered by the Court of Appeal at Montreal’s Sainte-Justine Hospital.
The boy was rescued from the family pool after spending 20 minutes under water, which led to severe brain damage he will never recover from. He has been in intensive care and intubated ever since.
“It’s been very difficult, but they have been very strong,” said Patrick Martin-Menard, lawyer representing the family. “It’s been a very long and emotional journey for the family.”
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Doctors have said since June 16 that the boy is breathing on his own and that the breathing tube should be removed because it is doing more harm than good. The child, doctors have said, should receive end-of-life care if the extubation is not successful.
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The hospital reportedly turned to the judicial system as they do not agree with the parents on how to proceed with treatment.
Doctors at Sainte-Justine would like to extubate the child, and offer care to keep him comfortable, if the procedure does not work.
The parents, on the other hand, would like the child reintubated to keep him alive.
“The parents have been willing to remove the breathing tube since July,” explained Martin-Menard. “Saying that, you know, lets try to remove it and see what happens.”
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“If there are issues, then reintroduce the breathing tube,” he added.
In the decision dated Tuesday, the province’s high court affirmed a November Superior Court ruling that permitted the Sainte-Justine Hospital to go ahead with the procedure despite the parents’ objections. His parents had appealed the Superior Court ruling
The three-judge appeal court panel unanimously ruled that the lower-court decision, while “difficult and heartbreaking’,” respected the rights and best interests of the child and that the parents’ refusal was unjustified.
“The principle of preserving life at all costs is not absolute when the conditions for maintaining life are unacceptable,” the high court wrote.
Quebec Superior Court Justice Bernard Jolin wrote in his Nov. 1 ruling that the parents’ objections were not in the child’s best interest and were based on the hope that God would miraculously return the boy to the way he was before he fell into the pool.
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The appeal court ruling said the boy’s prognosis is “grim” and that he suffered “serious consequences from which he will never recover.” His life expectancy is estimated to be at most five years, the court added.
The hospital argued that removing the tube would allow the child to return home and receive physical therapy; delaying the extubation, doctors said, would limit the chances of that happening.
“Without saying which side is right or wrong, the court has a duty to look at what the science is and what the expertise is,” said Geneviève Grey, a Human Rights lawyer. “This is one of those cases that is an incredibly difficult and painful decision that the court has to take.”
“These things are always tragic, but they’re even more tragic when they involve a child,” said Christopher Labos, Montreal doctor who is not involved in the case.
“When you extubate a patient, what you do is you remove them from the ventilator,” he explained. “You remove the tube that is pushing air into the lungs.”
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The appeal court decision cited testimony before the Superior Court from experts who said it would be the child’s severe neurological damage and not the extubation process that would end his life. “Unfortunately, when it occurs, death will be the inevitable consequence of severe irreversible neurological damage to the child and not of the removal of the mechanical ventilation device,” the high court wrote.
‘Extubation being only the manoeuvre which will confirm whether his condition is compatible or not with life.”
The boy is still connected to the breathing device, seven months after the accident.
The family has the option of appeal.
“We have not yet taken a decision as to what the next steps will be,” said Martin-Menard. “If any.”
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In a statement, Justine Mondoux-Turcotte, media relations advisor for the Sainte-Justine Hospital said: “The Court of Appeal confirmed our perspective in terms of what is best for the child. The time to extubate the child will be established considering the wishes of the family. Our hospital centre remains sensitive to what the family is going through and we will continue to assist them during this difficult period.”