Ethics briefings

End of life issues

End of life issues remain a cause for concern, debate, and Parliamentary action in several countries. In France, disagreement between doctors and nurses about the management of very ill patients led to an investigation into 18 deaths in Besancon hospital. It found that 14 patients had been illegally given euthanasia. The report, published in May 2004,1 found that deaths were caused by injections of potassium chloride, curare, painkillers, and sedatives resulting in cardiac arrest or paralysis of the respiratory muscles. In July 2004, a German nurse was charged with killing at least 12 patients and another 70 deaths were under investigation.2 He confessed to 10 killings, claiming he wished to end patients’ suffering. Suspicions were only aroused when muscle relaxant drugs were missing and only 5% of suspicious deaths were subject to post-mortem examination. An expert on health professionals who kill in such circumstances noted that such murders often pass unnoticed.2 Such reports highlight the problems of identifying illegal killings in situations where unexpected death is common.

On the other hand, some patients experience significant difficulties refusing treatment. One of the biggest end-of-life debates took place in France following the death of Vincent Humbert in 2003, which caused controversy about the right to refuse treatment.3 Humbert was left tetraplegic, dumb and blind after an accident and sent a letter to President Chirac expressing a wish to die. His mother attempted to engineer his death by injecting him with barbiturates but this only pushed Humbert into a coma. Subsequently, Dr Chaussoy, head of the intensive care unit, disconnected Humbert’s respirator causing his death, on the basis that this is what he would have wanted. In October 2003, Humbert’s mother was charged with poisoning him and Dr Chaussoy was also charged with causing his death by “premeditated poisoning”, …