Children's Rights and End of Life Decision-Making: In the Matter of JJ

AuthorFinn Keyes
PositionLL.B (Dubl), LL.M (UCL)
[2021] Irish Judicial Studies Journal Vol 5(1)
Abstract: This article analyses the decision of the Supreme Court in In the Matter of JJ [2021] IESC 1.
The article observes that this case differs from previous end-of-life cases in that it countenances a mixture of
acts and omissions leading to the death of the patient. It outlines the legal and ethical issues with respect to
acts and omissions in end-of-life decision-making and analyses how the Court engaged with those issues. The
article also observ es that the decision provides the most authoritativ e guidance yet as to the effect of the
Children's Rights Referend um on children' s rights and the thres hold f or State intervention for failure of
parenta l duty. It notes tha t while previo us commentary had suggested that Art. 42A of the Constitution
would not have a significant impact on the threshold for State intervention, the decision in Re JJ clearly signals
that the Referendum has effected a significant change in the law in this regard .
Finn Keyes LL.B (Dubl), LL.M (UCL), Barrister-at-Law.
Re JJ is a profoundly sad case that has required the Supreme Court (‘the Court’) to engage
with some of the most weighty constitutional issues in our jurisprudence. The judgment is
an intricate and measured examination of the rights of the family, the rights of the child,
medical ethics, and the role of the State in providing for the welfare of incapacitated persons.
This article will outline and analyse the findings of the Court relating to end of life care, the
boundary betw een euthanasia and lawful palliative care, and the threshold for State
intervention in the heal thcare of children in the aftermath of the Children’s Rights
Referendum. The article will confine itself primarily to the joint judgment of O’Donnell,
Dunne, O’Malley, and Baker JJ (‘the Principal Judgment), but will not address in detail the
discussion of the wards of court system in the concurring judgments of Baker J and
McKechnie J.
In June 2020 , a young boy (referred to as John in the judgment) suffered catastrophic
injuries in an accident, including a devastating brai n injury. His tragic condition was
summarised by the Court:
As a result of his i njuries, John is currently fed by a nasogastric tube, has a
long-term cat heter to facilitate the delivery of medications… It is not
expected that John will ever walk, talk , develop any meaningful awareness of
his surroundings, be able to communicate or process information, nor will
he ever be capable of performing any voluntary movements.
As a result of his neurological injuries, John developed a condition known as dystonia.
Dystonia is a hyperkinetic movement disorder that someti mes arises out of brain injuries.
The condition causes abnormal electrical signals to be sent to the muscles, which ca n result
in painful and prolonged involuntary contractions of the muscles. The medical consensus
In th e Matte r of JJ [2021] IESC 1.
Re JJ (n 1) [4].

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