In the Republic of Ireland, the Supreme Court has just handed down a ruling specifying the framework in which a medical team can go against the wishes of parents regarding the medical treatment of their child. A decision with serious consequences at a time when the campaign to legalize euthanasia is raging in the country.
“The fact of refusing treatment for a child does not necessarily require parental consent to be legal, if this refusal is based on a decision taken in the best medical interests of the child, and if it appears contrary to medical ethics to provide such treatment,” writes the highest court in Eire, in its judgment rendered on January 22, 2021.
To grasp the problem posed by a decision whose terms remain rather vague—one may wonder in what sense an increasingly secularized society understands the term “medical ethics”—it must be put in context.
The Supreme Court intervened to settle a dispute between the medical profession and the parents of young John J. The latter suffered an accident in June 2020, which left him with significant brain damage, in particular a dystonic disorder, which caused sometimes severe muscle contractions.
The doctors intended to prescribe for the patient a treatment based on analgesics: treatment which, if it relieves the pain, has the effect of reducing the respiratory capacity, which can pose a risk to the patient’s life.
John’s parents refused in the name of protecting their child’s life, and wanted another protocol to be put in place.
Last November, although the patient’s dystonia had progressed positively, John was placed in palliative care, against his parents’ wishes.
The case was brought before the High Court which ruled in favor of the medical profession: John’s parents then appealed to the Supreme Court, which delivered its decision on the following January 22.
The point of law here is whether John’s parents’ refusal to consent to the recommended treatment—a placement in palliative care that would be disproportionate in their view—constituted a breach of their parental obligations such that the state was required to disregard their consent, as provided for in Article 42A of the Irish Constitution.
“Notwithstanding the exemplary care and love shown by parents facing terrible suffering, their attitude in this matter can be rightly described as constituting a dereliction of duty,” said the Supreme Court.
Further, the magistrates specified the criterion applied: “the court, in its decision, relies on what one is entitled to expect from enlightened, considerate and caring parents, in the care of their child.” Some will not fail to emphasize that, through this decision, there is a risk of seeing more and more parents dispossessed of their rights, by decision of the medical profession.
While the debate on euthanasia rages in Ireland—the Dáil Éireann or Lower House of Parliament voted to legalize assisted suicide on October 8, 2020—they remain perplexed by the January 22 judgement, which could pave the way to the outright euthanasia of severely disabled children or adult patients against the consent of their parents.
The question falls under the important distinction emphasized by Pope Pius XII when it comes to care. Patients, and thus parents of a sick child, are required to receive ordinary care, but are not required to use extraordinary care, even if they can. The “extraordinary” aspect may as well arise from an objective element—hardship, cost, length of treatment, expected benefit—as well as from a subjective element: what the individual or the family can bear in a given case.
It is precisely this subjective aspect which is neglected by the court when it employs the above-mentioned criterion: “the court, in its decision, relies on what one is entitled to expect from enlightened, considerate and caring parents, in the care of their child.” Because no case is the same, and we cannot put ourselves in the shoes of others.
The tribunal may have ruled correctly in this case, but the principle on which it is based is dangerous, because it overlooks an important moral aspect that Pope Pius XII had perfectly emphasized. Thus, if an adult can refuse a treatment that the medical profession deems necessary –morality remaining safe—it seems difficult to deny this capacity to parents who show great concern for their child. To override their will, it would have to be shown that they were acting in a frankly unreasonable manner, or that this was ordinary treatment to which all are bound by natural law.
And if euthanasia was voted in Ireland, could the parents, according to this judgment, oppose it being applied to their child, if the medical profession unanimously deems it necessary?