Judgment of the Court of Appeal |  Sainte-Justine can extubate a child in a coma

Judgment of the Court of Appeal | Sainte-Justine can extubate a child in a coma

The Court of Appeal confirmed Tuesday that Sainte-Justine University Hospital Center (CHU) can extubate a 5-year-old boy after more than seven months in a coma. The parents opposed the decision as they feared their son’s death and wished that a miracle would be performed to save him.

Posted at 11:17pm

Split

” Decision […]although difficult and heartbreaking, nonetheless respects the rights and best interests of this child,” we read in the decision of Justices 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 about 20 minutes underwater, the boy went into cardiac arrest. CPR maneuvers are attempted for over an hour. He was transferred to the intensive care unit at CHU Sainte-Justine, where he is still seven months later.

His prognosis is “very bleak” and the accident “leaved serious after-effects from which he will never recover,” according to the verdict.

He will be force-fed for the rest of his life. He will lose speech, sight, consciousness and be dependent for all activities of daily living.

Extract from the judgment

Although the child can breathe on his own, he remains connected to a mechanical ventilator through a tube inserted into his windpipe, causing him pain. Last summer, Sainte-Justine’s medical team suggested that parents remove the tube without providing for reintubation in case of failure.

The parents opposed the procedure. “They deny that this one is deadly and demand that [leur enfant] be intubated again if unsuccessful,” reads the verdict.

An “ethical” practice

Intensive care doctor Baruch Toledano, who was involved in caring for the boy, told 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 and the development of pneumonia, in addition to discomfort and pain.

Several pediatric experts were also consulted and unanimously approved the plan proposed by the Sainte-Justine medical team.

Furthermore, clinical ethicist Marie-Claude Levasseur judged that if extubation fails, it would be ethical not to re-intubate the child “given the serious and irreversible damage it is suffering, the episodes of discomfort it suffers and the impact on the various aspects of his quality of life”.

“Child’s welfare”

In November, Judge Bernard Jolin of the Quebec Superior Court authorized doctors at CHU Sainte-Justine to proceed with the treatment plan, which includes extubation. The parents have appealed the decision.

On Tuesday, judges at the Sainte-Justine Court of Appeal echoed this, saying that parents’ refusal to consent to their child’s extubation without providing for reintubation if the procedure failed was “unjustified” and “not in the best interest” of the child child.

In response to the verdict, the CHU urged Sainte-Justine La Presse to maintain the course of “the best interest of the child, with all due respect for the rights of the parents”. “The timing of the child’s extubation will be determined taking into account the wishes of the family. The Hospital Center remains sensitive to the drama the family is going through and will continue to support them during this difficult time,” said Media Relations Advisor Justine Mondoux-Turcotte.

At the time of writing, family attorney Me Patrick Martin-Ménard had not responded to La Presse’s request.

With the collaboration of Émilie Bilodeau, La Presse