On January 5, 2018, the French State Council ruled in agreement with the Hospital in Nancy, France to stop artificial respiration for 14-year-old Inès, who has been surviving in a vegetative state for over 6 months.

The State Council spokesman stated: “Called to preside over this emergency case, the urgent applications judge ruled that the doctors’ decision meets the legal stipulations, therefore the parents’ appeal was rejected.  The child’s attending physician must now decide on the time lapse and whether or not to stop treatment.”

Facts

On June 22, 2017, Inès had a cardiac arrest at home, due to her rare neuromuscular disease: autoimmune myasthenia gravis. The ambulance emergency squad resuscitated her and admitted her to the regional University Hospital in Nancy, where she has remained unconscious but in stable condition since then, via artificial respiration and gastric tube feeding.

Last year, on July 21st, in the collegial procedure provided by the Claeys-Leonetti Act to stop treatment for a patient who is no longer able to speak, the doctor in charge ruled in favor of discontinuing artificial respiration for Inès, esteeming that it was currently a case which could be qualified as unreasonable obstinacy. Nevertheless, they agreed to not enforce the decision against the parents’ will.

On August 3rd, the parents were informed in writing, and they decided to file an appeal with the administrative court urgent applications judge in Nancy on September 11th. Three days later, the judge suspended the previous medical decision and requested a case evaluation, conducted by an expert panel which included two neuro-pediatricians and the department head of pediatric emergencies and resuscitation.

The expert report, submitted on November 17, concluded that Inès was “in a persistent vegetative state” and that she “does not and will never have again the capacity to communicate” with her loved ones.

On December 7th, given the conclusions of the expert report and after hearing the viewpoints from the parents and the hospital’s representative, the Nancy Administrative Court ruled that it would be legitimate to stop respiratory assistance for the young girl. The parents then appealed to the State Council, which met on December 28 for a public hearing to hear the positions of both parties.

The hospital’s viewpoint

In a letter dated August 3rd, the department head of pediatric emergency and resuscitation explains: “The patient’s history, clinical exam, imagery and electroencephalography exams concur with a near-zero possibility of improvement or healing, according to current scientific knowledge.”

During State Council hearing, this same physician expressed how difficult this task was, but also affirmed that he was acting according to his conscience: “It is terrible: I am not only a doctor but a man and a father; it is a painful situation, I see parents on a daily basis, and it’s excruciating to take such a decision. Our only objective is the best interest for the child. (…) and the experts concurred that it would be unreasonable obstinacy to persevere. I can’t foretell the future, but current scientific data do not give any hope for recovery”.

However, the hospital’s lawyer stated, in application of the June 2, 2017 ruling for a “Question of Constitutional Priority” (QCP), according to which a medical decision cannot be implemented prior to giving the family an opportunity for legal appeal: “The parents may still file an appeal with the European Court of Human Rights and the hospital must wait until all possible means of recourse have been exhausted.”

The parents’ opinion

From the beginning Inès’ parents have been opposed to any medical decision to stop the artificial respiration that is keeping their child alive. Their trust in the medical team may have been undermined, due to misunderstandings and lack of psychological support, but the hospital denies this.

When she appeared before the State Council, Inès’ mother stated: “there is no guarantee that she will never regain consciousness. Her father, sister, and brother are also against (stopping treatment), and the parents’ agreement cannot be overridden.” The parents’ lawyer considers that the fact that Inès is a minor introduces a new legal issue. “Can the law override the parents’ wishes while they are the legal representatives for their minor children? In my opinion, this is impossible, unless a judge would decide to terminate their parental rights”.

In its January 5, 2018 ruling the State Council rejected this rebuttal, declaring: “the parents’ agreement is not a prerequisite requirement“.  In investigating whether Inès’ case would qualify as unreasonable obstinacy, the judges largely relied on the same factual and legal criteria used for the basis of ruling on Vincent Lambert’s case in June 2014.