End of life care in Canada after a murder charge in an ICU

Excerpt

Mr. P.M. was 65 years old when he died of complications after surgery for esophageal cancer in an intensive care unit (ICU) in Halifax, Nova Scotia, Canada, in November 1996. He had been transferred there from an adjacent province in September 1996 after four unsuccessful surgical procedures. He subsequently underwent another six surgical procedures in Halifax, including chest wall reconstruction, and had chronic mediastinal infection. After two long months of failing to respond to treatment, consensus was reached with his family that life support should be withdrawn. He received the last rites on 10 November 1996. At 12.30 p.m. on that day he was extubated. He immediately experienced increasing respiratory distress. Escalating doses of benzodiazepines and hydromorphone did not relieve his distress. Hydromorphone was ultimately infused at 500 mg/h (equivalent to 2500 mg/h morphine). To relieve his suffering and the perceptions of an awful death the attending physician (Dr. Nancy Morrison) opted to inject intravenously nitroglycerin and then potassium chloride. Mr. P.M. died shortly after this second injection. An internal review process concluded that these actions fell outside accepted practice, although an act of compassion was recognized. In the spring of 1997, just before Dr. Morrison was to return to practice in the ICU after an initial suspension of 3 months and in the belief that hospital authorities had done nothing, another colleague from the ICU group chose to report the facts of the case (maintaining anonymity) to the local police. In May 1997 approximately 60 police officers raided the hospital, Dr. Morrison’s home and physicians’ offices and confiscated records, computers, confidential letters, and reports, removed Dr. Morrison from her office and charged her with first-degree murder. In Canada a conviction on this charge would lead to 25 years in prison with no chance for parole. …