The Times
January 6 1999

Police check hospitals over 'backdoor euthanasia'


The deaths of at least 50 hospital patients around Britain are being investigated by police and health officials amid allegations of a creeping tide of backdoor euthanasia.

Seven separate inquiries are looking into claims that doctors have withheld intravenous drips from dehydrated patients, often while they were under sedation, and left them to die from thirst. The patients involved were suffering from strokes, asthma, other common medical conditions and dementia. At least five hospitals - in Derby, Surrey, Kent and Sussex - are at the centre of police inquiries as a result of relatives' complaints or nurses' whistle-blowing, while others have been referred to the General Medical Council and health authorities.

The Crown Prosecution Service will soon decide whether to prosecute in two important cases in which doctors have been accused of manslaughter due to criminal negligence. In the most serious of these, police are investigating 40 deaths at the Kingsway Hospital in Derby, where nurses claimed that dementia sufferers on a psycho-geriatric ward were starved and dehydrated until they became so weak that they died from infections.

The inquiry was launched in November 1997 after junior nurses complained, and papers relating to patients at the hospital between 1993 and 1997 are expected to be sent to the CPS in the spring.

In general, the practice of denying nutrition and fluids to patients believed to be entering the final phase of a terminal illness is defended as "helping nature to take its course". But some doctors condemn it as involuntary euthanasia.

The cases of patients in persistent vegetative state (PVS), such as the Hillsborough disaster victim Tony Bland, must be referred to the courts. But a grey ethical area allows doctors to "exercise their clinical judgment" in other cases.

Sources in the medical profession suggest that some may be using that discretion to keep patients quiet and acquiescent on the wards. Some who have had had a momentary choking fit, for example, have then been put on a nil-by-mouth regime, sedated and left to dehydrate.

Dr Gillian Craig, a retired consultant geriatrician from Northampton, has told the Royal College of Physicians that water and food are basic human needs that should not be regarded as treatment that a doctor may give or withhold. "Sadly there are times when sedation without hydration seems tantamount to euthanasia.

"This strengthens the hand of those who are pressing to legalise physician-assisted suicide. Good palliative medicine is a major defence against euthanasia, but please heed my warning. Sedation without hydration has enormous potential for misuse. I would like to see this regime consigned to the dustbin of history.

"Attention to hydration is not merely an option, it should be a basic part of good medicine."

One case being considered by the CPS concerns the death of an 81-year-old woman who was admitted to hospital in Surrey in May 1997 for treatment for constipation and a urine infection. Her health was otherwise good. She was denied intravenous fluids, in spite of the pleading of relatives.

At one stage a hospital crash team, called at her daughter's insistence by a doctor previously unconnected with the case, carried out emergency measures that required cutting into her neck and groin arteries to insert fluid lines. But septicaemia had set in. Her daughter said: "This was not a dying patient when she was admitted. In fact she was a relatively healthy lady, full of fun, with a relatively common problem. Six days later she was on her deathbed as a direct result of dehydration. I had literally begged them with my hands pressed together in supplication to rehydrate her."

The issue of withholding or withdrawing treatment has been taken up by the British Medical Association in a huge consultation exercise which it hopes will result in practical guidelines.

The consultation paper, Withdrawing and Withholding Treatment, asks whether food and drink might be withdrawn from patients such as severely impaired stroke victims as well as those in a persistent vegetative state.

But Dr Craig said: "This is already happening without any regulation whatsoever. Moreover, the BMA are clearly aware of this. It can happen when the carers have reached the limit of their resources and are no longer able to stand patients' problems without anxiety, guilt or anger. A sedative will alter the situation and produce a patient who, if not dead, is at least quiet."

She also spoke about the dangers of grouping together patients whose condition might be misdiagnosed as terminally ill in institutions where staff are orientated towards death and non-intervention. She cited the case of a man sent to hospital for terminal cancer care. The geriatrician felt the diagnosis was not well established and found the main problem was dehydration. With intravenous rehydration and intensive nursing, he recovered and went home for 18 months. Some doctors are concerned over the distress dehydration can cause even in PVS patients. Anthony Cole, a consultant paediatrician at Worcester Royal Infirmary and chairman of a Roman Catholic ethics committee, said: "There is some scientific evidence that, if the base of the brain is intact, patients will experience thirst even if the higher functions have been lost. Death from dehydration is painful and unacceptable."