The Court of Appeal confirmed on Tuesday that the Sainte-Justine University Hospital Center (CHU) will be able to extubate a 5-year-old boy after more than seven months in a coma. The parents opposed the decision, fearing the death of their son and wishing for a miracle to be performed to save him.
” Decision […]although difficult and heartbreaking, is nevertheless respectful of the rights and best interests of this child, ”we read in the decision rendered Tuesday by judges Geneviève Marcotte, Benoît Moore and Christine Baudouin, of the Court of Appeal.
On June 12, the child drowned in the family swimming pool. After spending approximately 20 minutes underwater, the boy went into cardiorespiratory arrest. Resuscitation maneuvers are attempted for over an hour. He was transferred to intensive care at CHU Sainte-Justine, where he is still, seven months later.
His prognosis is “very gloomy” and the accident left him with “serious after-effects from which he will never recover”, reads the judgment.
He will be force-fed for the rest of his life. He will no longer speak, will no longer see, will have no consciousness and will be dependent for all activities of daily living.
Excerpt from the judgment
Although the child is able to breathe on his own, he remains connected to a mechanical ventilation device through a tube inserted into his trachea, which causes him pain. Last summer, the Sainte-Justine medical team suggested that the parents remove the tube, without providing for reintubation in the event of failure.
The parents opposed the procedure. “They refuse that this one is fatal and demand that [leur enfant] be intubated again in the event of failure”, can we read in the judgment.
An “ethically acceptable” procedure
The intensivist doctor Baruch Toledano, involved in the care provided to the young boy, explained to the court that the presence of the tube puts the child at risk of serious complications such as muscle deconditioning, pressure sores, inflammation of the vocal cords, the development of pneumonia, in addition to causing him discomfort and pain.
Several pediatric care experts were also heard and ruled unanimously in favor of the plan proposed by the Sainte-Justine medical team.
Furthermore, the clinical ethicist Marie-Claude Levasseur judged that in the event of failure of the extubation, it would be ethically acceptable not to reintubate the child, “given the serious and irreversible damage from which he suffers, the episodes of discomfort he experiences, and the impacts on the different spheres of his quality of life”.
“Best interest of the child”
In November, Judge Bernard Jolin, of the Superior Court of Quebec, had authorized the doctors of the CHU Sainte-Justine to proceed with the treatment plan which includes extubation. The parents appealed the decision.
On Tuesday, the judges of the Court of Appeal agreed with Sainte-Justine, declaring that the parents’ refusal to consent to the extubation of their child without providing for reintubation in the event of failure of the procedure is “unjustified” and is “not in the best interests” of the child.
In response to the judgment, the CHU Sainte-Justine told The Press keep the focus on the “best interests of the child”, “with full respect for the rights of parents”. “The time to extubate the child will be determined by considering the wishes of the family. The hospital center remains sensitive to the drama that the family is going through and will continue to support it in this difficult period,” said media relations advisor Justine Mondoux-Turcotte.
At the time of this writing, the family’s attorney, Mr.e Patrick Martin-Ménard, had not responded to the request for The Press.
With the collaboration of Émilie Bilodeau, The Press