CHU Sainte-Justine will be able to extubate a 5-year-old child who was placed in a deep coma after being found at the bottom of a swimming pool last June. The hospital has gone to court because the parents oppose the treatment plan. They fear the extubation will result in the death of their boy and wish for God’s intervention and a miracle to save their son.
Posted at 5:00 am
Emilie Bilodeau The press
The boy was found on June 12 at the bottom of the family pool. He stayed underwater for between 15 and 20 minutes.
” Of [son arrivée à l’hôpital], the prognosis is grim and depressing,” read Tuesday’s decision by Judge Bernard Jolin of the Superior Court of Quebec. The child is ventilated via a tube, he is force-fed, his brainstem is severely damaged. In the days that followed, he suffered from acute respiratory distress syndrome, cardiac dysfunction and seizures, among other things.
PHOTO ROBERT SKINNER, LA PRESSE ARCHIVE
The CHU Sainte Justine in Montreal
However, there are signs that the child can breathe independently. The Sainte-Justine medical team therefore proposed on June 16 to remove the endotracheal tube that allowed mechanical ventilation of the boy. “This ventilation is contraindicated for his condition. Useless to improve his neurological condition, it is likely to cause serious damage, even fatal,” the doctors say.
However, the child’s parents are against this extubation.
If [les parents] understand the consequences of the status quo, they fear above all that the maneuver will lead [la] dead [de l’enfant].
Excerpt from Judge Bernard Jolin’s decision
“The reaction of the mother is particularly strong. Her faith in God gives her hope that her child will wake up from the coma she has been immersed in.”
The parents also believe the treatment plan is based on financial considerations to “save on costs and burdens on society.”
Second opinion requested
On August 1, a second opinion was obtained from a specialist at Montreal Children’s Hospital. dr Sam Shemie proceeds with a full exam of the patient to review his medical records.
The doctor claims that the child does not regain quality of life as a result. “He will remain unconscious, that is [qu’il n’aura] no thoughts, no hearing, no seeing, no intentional movements, [il sera] dependent in all aspects of daily life, he will never walk/talk/eat,” he wrote in his report.
“My recommendation from a medical perspective is simple extubation and end-of-life comfort care if that fails. However, as the parents made clear, it is God who decides, not the doctors,” he adds.
At a meeting with Sainte-Justine doctors on August 17, the parents expressed their disapproval of the doctor’s methodology, who was asked to give this second opinion. They also question his qualifications in court.
Parents want their child reintubated at all costs if extubation fails. A “trial” would “maximize the chances of success for subsequent extubation,” they argue. However, doctors say that reintubation would lead to risks such as pneumonia, inflammation of the trachea, infectious complications and muscle deconditioning.
[L’]objective [des parents] is to be maintained [l’enfant] intubated for as long as possible so that a miracle can happen.
Excerpt from Judge Bernard Jolin’s decision
“The father senses that [son fils] the first case will make a full recovery and be able to return to his baseline condition,” said a document supporting the parents’ view and submitted in evidence by the defense.
A refusal “against the best interests of the child”
On Tuesday, however, Judge Bernard Jolin ruled: he authorized the doctors at Sainte-Justine University Hospital (CHU) to proceed with the treatment plan, which includes extubation. The child is given oxygen, medication, and especially his secretions are removed.
“Despite any empathy it may feel, the court concludes that the parents’ refusal to consent to the plan [de traitement] is unjustified and contrary to the best interests of the child,” Judge Jolin wrote.
He also recalled that the moral or religious values of the holders of parental authority “cannot prevent the court from intervening when the interests of the child require their care”.
a few more days
The family’s attorney, Me Patrick Martin-Ménard, has asked for a few days for his clients to learn of the decision.
The CHU Sainte-Justine has confirmed to La Presse that it will respect the deadline provided by law for the family to appeal. The hospital has also indicated that it has the option to appeal to the courts “on an exceptional basis”.
“The Hospital Center remains sensitive to the drama this family is going through and continues to support them during this difficult time,” the Hospital Center said in a written statement.
First of all, the interest of the child
Jean-François Leroux, a lawyer specializing in medical responsibility, confirms that hospitals more often resort to psychiatric courts when patients are unable to give their consent to the treatment received. In pediatrics, cases are rarer, he argues.
“In the case of a person under the age of 18, the decision must be made within 18 days [l’intérêt supérieur] of the minor. Conversely, an adult can make a choice that is contrary to their well-being,” explains Me Leroux.
“The best example is blood transfusions,” he adds. A 17-year-old who refuses care on religious grounds could be required to have a blood transfusion, while medical staff could give an 18-year-old autonomy if they were deemed capable. »
Mr Leroux also claims that there is plenty of case law that favors welfare over religious freedom for children. “Courts will always prefer expert evidence presented by the scientific community to decide [l’intérêt supérieur] Of the child. What are the pros and cons of treatment? What are the pros and cons of not being treated? The referee […] according to these criteria. »
Emilie Bilodeau, La Presse