It was warm today, perhaps for the first time this year.
In the bright evening sunshine, he walked unsteadily towards me. A man who looked as though he would once have been fit, time and substances seem to have taken their toll. His face was battered, his nose broken, his eyes puffy, his ears misshapen.
’Are we playing tonight, Bro?’ he asked, nodding at the red and white scarf I wore.
´We are,´ I said.
’Who are we playing?’
I wasn’t sure of the pronunciation of ´Drogheda’ in these parts.
´Dro-heda,’ I said, sounding three syllables, with the ´g’ soft.
ˋWho?’ he looked at me blankly.
’Ahh,’ he said. ‘I hope we win.’
’So do I.’
I walked on.
Who looks after him? I wondered. More to the point, who was there who might look after him?
It is not a moot point. This week there was a High Court battle about who had the right to care for an elderly man with dementia whose life is in danger if he does not have a leg amputated.
RTE reported on the detailed legal proceedings that ensued after a disagreement between the medical professionals charged with the man’s care:
The case came to court because the man has dementia and does not have capacity to make an informed decision. However, he had consistently expressed his wish not to have his leg amputated and earlier this week addressed the court by video link from his hospital bed, telling the judge he did not want the surgery and that he would be afraid to lose his leg even if it meant he would live longer.
The judge said it was a privilege to be able to speak directly to the man earlier this week as he was the “most important person” in the case.The judge said all of the doctors in the case had done their best and acted with the utmost propriety to the highest ethical and professional standards. They had, however, looked at the case in different ways, with one wishing to save a life and others asking what sort of life was to be saved and what would the quality of that life be if an amputation took place.The judge said a number of legal principles were involved in his decision including the right to life. While life must be preserved it must not be at any cost, he said. There were often competing Constitutional rights involved in such cases, and in this case, there were many including the right to bodily integrity, autonomy and equality and all of these must be taken into account.He had taken into account the quality of life the man would have if the surgery took place, his lack of mobility and possible catastrophic and severe mental distress as outlined by medical witnesses. He also took into account the evidence there was a 50% chance the man might die in the weeks after the amputation. Taking all factors into account including the man’s own expressed wishes, the judge ruled it was in the man’s best interest that the amputation does not take place and that a plan be put in place for him to be discharged home to be cared for by his family with the support of a palliative care team.
Undoubtedly, there were legal points of principle to be resolved, but it did seem to be more about principle than about the welfare of a person.
Doctors carried out surgery to put a graft on his leg and managed to save the limb but the court heard the man has interfered substantially with his wound, putting butter and marmalade on it due to his dementia.
There was no doubt that the medical prognosis for the man was poor, there was no doubt that his quality of life was poor, but considerable sums were spent on learned counsel to argue about questions of life in principle.
The battered man walking down the road this evening might have a transformed life if the care of people like him was addressed with the rigour that one would find in a High Court case.