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
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."