A consultant neurologist has told the High Court he believes a young woman has been in a persistent vegetative state for almost 10 years with “no hope of recovery”.
The doctor, who was giving evidence via video link, noted the woman’s family were in court listening to his evidence and said he understood this has been “a long and harrowing road” and wanted to send them best wishes.
However, he had no doubt about his clinical opinion that there “is no hope of recovery”.
While it is possible the woman may feel pain and discomfort at some level, he considered that is more likely to be at a sub-cortical level rather than a higher conscious level and in the context of a primitive response to, for example, loud noise or noxious stimuli.
"There is no evidence of any meaningful response from her to the external world."
This unfortunate tragic scenario has been extensively discussed in medical literature and it is not possible to be 100 per cent sure of the inner life of individuals in such situations, he added.
The young woman is a ward of court and High Court president Ms Justice Mary Irvine is conducting an inquiry as to whether orders sought by the woman’s mother, for the withdrawal of tube feeding and hydration, are in her best interests.
Aged in her twenties, the woman suffered a seizure in summer 2011 followed by cardiac arrest and her heart stopped for 45 minutes.
She was on a ventilator for 22 days in a hospital intensive care unit and was not expected to survive after the ventilator was switched off with her family’s consent.
However, she began to breathe on her own and has been kept alive since as a result of tube feeding and hydration and what her family and various medical experts described as excellent care.
Her mother consented in 2011 to the tube feeding in the hope there might be some recovery and because she feared stopping artificial feeding and hydration would mean her daughter would starve to death.
The mother says she did not fully understand at that time that a pain management regime would be administered.
The mother and family now want the tube feeding and hydration ceased so as to allow her daughter die a “natural and dignified” death and cease a “miserable existence”. Her daughter has no quality of life and would absolutely hate to be left in this position, the mother told the court.
The medical evidence in the case concluded on Thursday.
The judge has heard evidence from several doctors, including two neurologists and an anesthetist and intensive care specialist.
A consultant in rehabilitative medicine who prepared a report for the general solicitor for wards of court said the woman looks well and comfortable and, given her diagnosis, is extremely unlikely to have any pain or any awareness of her body or surroundings. Her current treatment is maintaining her life but will not lead to any improvement in her condition, she said.
Asked about ethical and medical considerations, the doctor said Medical Council guidelines provide doctors are neither obliged to start, or discontinue, artificial interventions.
Doctors are obliged to act in a patient’s best interests and to treat people in such situations with dignity and respect and doctors are ethically entitled not to give treatment they consider futile, she said.
The hearing continues on Friday.