High Court rules man, 21, with no brain function after cardiac arrest can be declared dead

A 21-year-old man whose brain stopped functioning after cardiac arrest can be declared dead, a High Court judge in Belfast ruled.

Mr Justice McFarland granted permission to withdraw the patient's mechanical ventilation after rejecting counter-arguments by a self-styled medical physiotherapist who claims to have “awakened” 1,000 patients from cerebral comas.

The man at the centre of the case, who cannot be identified, was a foreign national who lived in Northern Ireland for an undisclosed period.

Referred to as 'RL', he suffered a cardiac arrest linked to a severe allergic reaction in March this year.

Ambulance staff administered emergency CPR treatment before he was mechanically ventilated and transferred to a hospital intensive care unit.

With MRI scans showing no signs of any neurological improvement, further tests carried out on April 20 confirmed that RL’s brain-stem functioning had ceased.

A Health and Social Care Trust sought a court declaration that he was determined to have died on that date, and to be allowed to end medical intervention.

Doctors in the man’s native country accepted the test results and decided it would be neither humane nor dignified to transfer him there for medical treatment which would serve no purpose.

But RL’s distraught parents, who still live overseas, sought out several foreign institutions, including a hospice facility and a private clinic run by a Professor EF, who does not accept the concept of brain-stem death.

Based on the diagnosis of life being extinct without any prospect of recovering consciousness, it was considered that exposing him to further invasive treatments at the hospice would be unethical.

However, Professor EF told the court that using neuro-physiotherapy methods, he has “awakened about 1,000 patients from cerebral coma, including patients considered to be dead.”

He indicated that his clinic would accept RL, but required a surgical intervention necessary for breathing and feeding purposes.

In a published ruling setting out the legal position in determining death, Mr Justice McFarland stressed the court cannot find someone is probably dead.

Citing separate investigative tests carried out by two medical experts, the judge said: “Both doctors… were of the opinion that death could be confirmed following irreversible cessation of brain-stem function.”

Dealing with the Professor’s evidence, he held: “Being in a coma, i.e. a state of prolonged unconsciousness, is significantly different from having no brain-stem function.

“Professor EF offers one example of a named individual ‘restored to life’ after being considered dead in 1999 and refers to ‘many such patients’ but offers no evidence for the court to consider.”

Reference was also made to professional misconduct proceedings he faced in 2015.

“It is perfectly understandable why the parents, in their desperate state of mind, should seek out any solution to their predicament, but Professor EF has only added to their grief by potentially raising a totally unrealistic and false hope,” the judge added.

Formally declaring that RL died on April 20, Mr Justice McFarland further stated: “I also grant permission to the Trust to cease mechanical ventilation, to extubate RL, to cease the administration of medication and not to attempt any CPR.”

With no appeal against his order, the judge confirmed in a postscript: “I have been advised that with the agreement of RL’s parents, and in their presence, RL was removed from the ventilator at 18:00 on April 27, 2022.”

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