October 26, 2012
Kill or care: The mercy killing debate
We should look carefully at the case in Halifax where Dr. Nancy Morrison killed a terminally ill patient, Paul Mills, with an injection of potassium chloride. Dr. Morrison is a specialist in Respirology (lung diseases), who also worked in Intensive Care where Mr. Mills was transferred due to complications from his cancer and surgery. Potassium chloride in large doses has no place in the management of symptoms in patients, including those who are terminally ill. Dr. Morrison did this to end Mr. Mills “suffering” and, at first, denied doing “anything wrong”. Apparently, Mr. Mills had been given “massive” doses of painkillers which apparently did not relieve his pain.
I could find no mention in the articles I read of a palliative care consultation and it is very likely that the so-called “massive” doses of narcotics simply weren’t adequate. Also, since Mr. Mills could only communicate by blinking his eyes, we wonder who assessed his pain and how.
Another disturbing feature of the case includes the fact that his wife was not notified of the decision to end his life and, in fact, she said her husband did not believe in mercy killing. Thus, it appears that this was a case of active involuntary euthanasia/mercy killing.
Perhaps the most disturbing feature of this case is the lack of prosecution of Dr. Morrison with the Nova Scotia Supreme Court refusing to hear an appeal by the Crown Prosecutor to allow prosecution to proceed. The Provincial Court judge had previously refused to allow prosecution on the grounds that a jury would never convict her. Apparently, one reason for this decision was that the intravenous line in Mr. Mills may not have been functioning. However, he died within minutes of the fatal injection which means the intravenous line was almost certainly working.
Dr. Morrison was supported by the Provincial Medical Association, although the College of Physicians issued a written reprimand to her for acting “outside the bounds of currently acceptable practice” for using a drug with no pain killing properties to hasten death. She has resigned from the Intensive Care unit where Mr. Mills died but continues to practice and teach at the medical school where she is (or was) “highly respected”. She now admits she made a mistake and should have consulted other physicians before her fatal action.
Of course this is not the first time a physician has killed a patient and not received significant punishment. In 1993, Dr. De La Rocha killed a cancer patient in Timmins, Ontario with potassium chloride, pleaded guilty to a charge of second degree murder, received a suspended sentence and had his medical license suspended for 90 days.
Robert Latimer was convicted of murdering his daughter, Tracy, who he said was suffering terribly from her cerebral palsy. From what I can recall the medical/nursing staff looking after her disagreed. He received a very light jail sentence of 2 years which has been appealed by the Crown and is currently waiting to be heard by the Supreme Court of Canada – possibly in the fall, so we will be watching that case carefully.
Thus, it appears that mercy killing by doctors, whether with the patient’s consent or without, is being tolerated in Canada without changing the law.
Mercy killing in Holland started with terminal cancer cases who had severe pain and were offered mercy killing as an option. These were reported to the Public Prosecutor but not prosecuted. It is not coincidence that at the time Holland was well known to be far behind other Western countries in the development of hospice or palliative care programmes and Dutch doctors knew little about modern pain control. At some hospitals as many as 50% of cancer patients died from mercy killing. Following the acceptance of this practice by the authorities, mercy killing was offered to other patients with other diseases, such as anorexia nervosa, senility and finally depression and other psychological problems. Increasing numbers of these were involuntary, without the patient’s permission. In some parts of Holland senior citizens in institutions were afraid when the doctor came in case they were to be killed. Some senior citizens carried cards saying they did not want to be killed and certain hospitals (usually Christian) were agreed to be “safe”. Apparently, doctors were increasingly failing to report cases of euthanasia. And all this in a country where many Dutch doctors died during World War II rather than comply with the Nazi Euthanasia programmes! No wonder that when prestigious groups representing the British House of Lords, the Canadian Senate, the New York State Legislature and the editorial board of the Journal of the American Medical Association returned from a visit to Holland, they all recommended that mercy killing not be legalized. These groups could hardly be called Pro-life! The State of Oregon became the first legislature in the Western world to legalize assisted suicide but now is considering revisiting the subject with the urging of the Oregon State Medical Association.
Euthanasia/mercy killing is a complex subject, difficult to study compared to abortion, since cases of mercy killing differ from one another. There is a connection of course between the two, as abortion has been called Antenatal Euthanasia and this applies especially to babies diagnosed before birth with modern techniques such as amniocentesis (which ironically was originally used to save babies with Rh disease). Newborn babies with serious mental defects such as Down’s Syndrome or physical defects such as Meningomyelocele have been left to die without necessary surgery and in some cases killed directly. Fortunately, legal decisions in these cases have almost always favored saving the baby and this practice has decreased.
So, what can we do? I believe what is needed is a coalition of Pro-life groups, disabled groups, palliative care associations and churches who can educate the public and politicians and convince them that proper palliative care will practically eliminate severe pain and that patients asking for assisted suicide or mercy killing are really calling out for help. (Patients who have survived attempted suicide generally say they do not want to die – 80% in one study).
One such effort is the Euthanasia Prevention Coalition of Ontario which has a highly respected palliative care nurse and physician as well as myself on the executive.
Edmund Burke once said that all that is required for evil to flourish is for good men (and women!) to remain silent. I hope this article will help readers to understand the issues and take some action.
L.L. deVeber MD FRCP (C)
Professor Emeritus, University of Western Ontario
Dr. deVeber was a Pediatric Oncologist.
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