The High Court president has approved a hospital's plan to perform an elective Caesarean section on a young pregnant woman under general anaesthetic against her will.
Mr Justice David Barniville previously made an order permitting doctors to carry out an emergency Caesarean section in the event of a threat to the life of the woman, who is 35 weeks pregnant and in her early 20s.
This is still permitted under the new orders he made this week, but the primary choice of the woman’s treating clinicians is to carry out an elective procedure under general anaesthetic before an urgent scenario arises.
The judge said the orders, sought by the Health Service Executive (HSE), were necessary to vindicate the woman’s constitutional rights to life, bodily integrity and equality, while the interests of the unborn child also benefit.
The woman was deemed by medical professionals to lack the capacity to make safe decisions about her health and obstetric care due to a delusional disorder. She is currently detained at a psychiatric unit under the Mental Health Act.
The court heard she has “consistently declined” basic antenatal care and many routine medical checks, such as blood pressure monitoring.
She has also disclosed that she has consumed alcohol, cocaine and crack cocaine during her pregnancy and said she is a victim of sexual assault, counsel for the HSE, Donal McGuinness, said.
Her doctors will move “quite swiftly” in carrying out the elective procedure with the court’s approval, said Mr McGuinness
A team of clinicians, including obstetricians and anaesthetists, were unanimous in concluding, following a meeting last week, that an elective Caesarian section was the “only reasonable” delivery method, he added.
Care plan
The new care plan requires that she undergoes a general anaesthetic and intubation, which carry their own risks. However, doctors believe the risks are less than in a natural delivery and their plan is the “most controlled choice in a very unpredictable situation”, Mr McGuinness said.
She will be admitted to intensive care after delivery to reduce the risk from the general anaesthetic, he added. There is potential that “reasonable force” will be required to administer the anaesthetic, but doctors hope this would be needed only “on this one occasion”.
Clinicians feel it is not possible for a natural birth to be carried out or for inter-muscular medication to be used instead of general anaesthetic due to the unpredictability of such a situation and the potential that the woman will not cooperate with life-saving medical advice.
An uncontrolled emergency situation could occur if she was to decline blood pressure monitoring and other checks during labour, and this would create a “high risk of maternal morbidity and mortality”, said Mr McGuinness.
The HSE’s application focused on the rights of the mother, but the unborn child’s interests were “of the same stream”, he said.
Mr Justice Barniville had “no doubt” the “far-reaching orders” were necessary and that a plan for elective intervention was in the woman’s best interests.
Spontaneous labour might not occur for seven weeks, over which time there is an increasing risk to the woman’s life without interventions, particularly from undiagnosed conditions such as preeclampsia and hypertension, he noted.
He accepted it would be “extremely impracticable and potentially dangerous to chemically restrain [her] during labour” and that she is “unlikely to cooperate” in the event of a life-threatening haemorrhage.
All the medical evidence before him showed the woman lacked the capacity to make decisions about her health and the safe delivery of her child.
He stressed there were “no competing rights” at play. The orders were sought to save the life of the expectant mother but they also have the benefit of protecting the interests of the unborn child, he said.
He made various orders under the court’s inherent jurisdiction to allow doctors to carry out their care plan, which, the judge said, was prepared with “huge care and attention”.
He will hear an update on the woman’s situation at the end of this month.
