Quebec's Court of Appeal has ruled that a Montreal hospital can permanently remove a breathing tube from a child who has been in a coma since he fell into the family pool in June.
In the decision dated Tuesday, the province's high court affirmed a November Superior Court ruling that permitted the Sainte-Justine hospital to go ahead with the procedure despite the parents' objections. The boy's parents appealed the Superior Court ruling.
The three-judge appeal court panel unanimously ruled that the lower-court decision — while "difficult and heartbreaking" — respected the rights and best interests of the child and that the parents' refusal was unjustified.
“The principle of preserving life at all costs is not absolute when the conditions for maintaining life are unacceptable," the high court wrote.
Montreal's Sainte-Justine hospital went to court after the parents of the five-year-old boy refused to consent to the extubation unless the hospital was willing to restore the breathing tube should things go wrong. The parents said they recognize that removing the tube is necessary, but they said they didn't want the procedure to be fatal.
The boy has been in intensive care since he was submerged in a pool for between 15 and 20 minutes on June 12. Evidence presented in court showed he suffered serious and irreversible brain damage.
Doctors have said since June 16 that the boy is breathing on his own and that the tube is doing more harm than good. The child, doctors have said, should receive end-of-life care if the extubation is not successful.
Patrick Martin-Ménard, the lawyer representing the family, says his clients are disappointed with the high court ruling but have also shown a great deference to the judicial process.
"Now the family is studying its options as to what comes next," Martin-Ménard said in an interview Wednesday, adding that his clients could let the decision stand or seek leave to appeal the case to the Supreme Court of Canada.
Quebec Superior Court Justice Bernard Jolin wrote in his Nov. 1 ruling that the parents' objections were not in the child's best interest and were based on the hope that God would miraculously return the boy to the way he was before he fell into the pool.
The appeal court ruling said the boy's prognosis is "grim" and that he suffered "serious consequences from which he will never recover." His life expectancy is estimated to be at most five years, the court added.
The hospital argued that removing the tube would allow the child to return home and receive physical therapy; delaying the extubation, doctors said, would limit the chances of that happening.
The appeal court decision cited testimony before the Superior Court from experts who said it would be the child's severe neurological damage and not the extubation process that would end his life. "Unfortunately, when it occurs, death will be the inevitable consequence of severe irreversible neurological damage to the child and not the removal of the mechanical ventilation device," the high court wrote.
"Extubation being only the manoeuvre which will confirm whether his condition is compatible or not with life."
The boy is still connected to the breathing device, seven months after the accident.
In a statement, the Sainte-Justine hospital welcomed the ruling, which affirmed that its health plan for the child is in his best interest.
"The time to extubate the child will be determined by considering the wishes of the family," hospital spokesperson Justine Mondoux-Turcotte said in an email.
"The hospital centre remains sensitive to the tragedy that the family is going through and will continue to support it during this difficult time."
This report by The Canadian Press was first published Jan. 18, 2023.