Fourteen cases of euthanasia to be referred to French police
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《英国医生杂志》
Fourteen of eighteen suspected cases of euthanasia at the University Hospital in Besan鏾n, in eastern France, are euthanasia in the eyes of the law, according to a medical expert抯 report delivered to the city抯 prosecutor in January and made public last week.
After a local health authority in April 2002 found evidence of possible euthanasia in the deaths of the patients in the intensive care unit between 1998 and 2001 the case was handed over to the Besan鏾n prosecutor for a preliminary analysis by a medical expert.
"Of the 18 cases examined by the expert—all of which were hopeless cases, where it was decided to abandon treatment—fourteen were, in the eyes of the law, euthanasia," Jean-Yves Coquillat, the prosecutor, told L扙xpress magazine, which, along with the newspaper La Croix, broke the story on 10 May (www.lexpress.com). "Four were 慸irect?euthanasia—to use the doctors?term—caused by injecting either curare or potassium," he said. The injections of cisatracurium caused paralysis of the respiratory muscles, while the potassium chloride resulted in immediate cardiac arrest.
Death was more or less immediate in those four cases but slower in the other 10 cases.
The 10 other patients were injected with a strong mixture of midazolam, a sedative, and fentanyl, a painkiller, which causes respiratory depression, which can lead to death.
However, French law does not distinguish between what doctors in France sometimes call "direct" or "active" euthanasia (taking action to end the patient抯 life) and "indirect" or "passive" euthanasia (allowing a patient to die through inaction), both of which are punishable by a life sentence.
But the case comes at a time when France is debating whether the medical code should allow doctors to "accompany" incurable patients to death. That was spurred on by the case of Vincent Humbert, a 22 year old man injured in a car crash, who died after his life support was turned off by his doctor at his own request last September (BMJ 2003;327:1068).
Mr Coquillat sent the Besan鏾n case to the police in Dijon for further investigation, and a decision whether to pursue it or not will be made this autumn.
The case came to light as the result of a dispute between the hospital抯 medical staff and its nurses and paramedics after the intensive care unit was restructured in 1998. The nurses and paramedics complained several times to the hospital directors about bad organisation and unacceptable treatment of patients, including suspicions of euthanasia.
Among the complaints—which they eventually took to the local health authorities in late 2001—were that decisions leading to patients?deaths were not made collectively but sometimes by one doctor against the opinion of another doctor.
"In one case a nurse refused to inject potassium, so the doctor did it himself," according to the prosecutor. "Sometimes nurses would return to a patient抯 bedside to reduce the dose after the doctor had increased it."
Medical records written by the nurses and those written by the doctors also differed, with the doctors?records not mentioning the injections, while the nurses did.
The patients included an elderly person in a coma, a man with a self inflicted gunshot wound to the face, and a victim of a car crash. Although the patients?families were usually consulted beforehand, the report concluded that they were not fully informed. None of the families took legal action.
Mr Coquillat said that more families have now come forward with suspicions of euthanasia at the hospital in the same period, and they and the doctors and nurses will be questioned during the investigation.(Paris Brad Spurgeon)
After a local health authority in April 2002 found evidence of possible euthanasia in the deaths of the patients in the intensive care unit between 1998 and 2001 the case was handed over to the Besan鏾n prosecutor for a preliminary analysis by a medical expert.
"Of the 18 cases examined by the expert—all of which were hopeless cases, where it was decided to abandon treatment—fourteen were, in the eyes of the law, euthanasia," Jean-Yves Coquillat, the prosecutor, told L扙xpress magazine, which, along with the newspaper La Croix, broke the story on 10 May (www.lexpress.com). "Four were 慸irect?euthanasia—to use the doctors?term—caused by injecting either curare or potassium," he said. The injections of cisatracurium caused paralysis of the respiratory muscles, while the potassium chloride resulted in immediate cardiac arrest.
Death was more or less immediate in those four cases but slower in the other 10 cases.
The 10 other patients were injected with a strong mixture of midazolam, a sedative, and fentanyl, a painkiller, which causes respiratory depression, which can lead to death.
However, French law does not distinguish between what doctors in France sometimes call "direct" or "active" euthanasia (taking action to end the patient抯 life) and "indirect" or "passive" euthanasia (allowing a patient to die through inaction), both of which are punishable by a life sentence.
But the case comes at a time when France is debating whether the medical code should allow doctors to "accompany" incurable patients to death. That was spurred on by the case of Vincent Humbert, a 22 year old man injured in a car crash, who died after his life support was turned off by his doctor at his own request last September (BMJ 2003;327:1068).
Mr Coquillat sent the Besan鏾n case to the police in Dijon for further investigation, and a decision whether to pursue it or not will be made this autumn.
The case came to light as the result of a dispute between the hospital抯 medical staff and its nurses and paramedics after the intensive care unit was restructured in 1998. The nurses and paramedics complained several times to the hospital directors about bad organisation and unacceptable treatment of patients, including suspicions of euthanasia.
Among the complaints—which they eventually took to the local health authorities in late 2001—were that decisions leading to patients?deaths were not made collectively but sometimes by one doctor against the opinion of another doctor.
"In one case a nurse refused to inject potassium, so the doctor did it himself," according to the prosecutor. "Sometimes nurses would return to a patient抯 bedside to reduce the dose after the doctor had increased it."
Medical records written by the nurses and those written by the doctors also differed, with the doctors?records not mentioning the injections, while the nurses did.
The patients included an elderly person in a coma, a man with a self inflicted gunshot wound to the face, and a victim of a car crash. Although the patients?families were usually consulted beforehand, the report concluded that they were not fully informed. None of the families took legal action.
Mr Coquillat said that more families have now come forward with suspicions of euthanasia at the hospital in the same period, and they and the doctors and nurses will be questioned during the investigation.(Paris Brad Spurgeon)