Guest blog by David Holding, Author of books on Killer Doctors…
Reliance on the existence of medical privilege is attributed to Dr John Bodkin Adams who when arrested in 1956 on suspicion of murder arising from his medical practice, is said to have protested: “She wanted to die, that cannot be murder. It is impossible to accuse a doctor”. Unfortunately for him, his opinion was erroneous and he was prosecuted, albeit unsuccessfully. However, the legal importance of the case is that it endorsed the validity of the ethical doctrine of ‘Double Effect’ in English law. Dr Adams prescribed large and rapidly increasing doses of opiates to relieve disturbed sleep in a number of elderly care-home residents, many of whom had made bequests to the doctor in their will.
What was not explored at the time of the trial or since, is whether or not a GP can act with ‘Double Intent’ as distinct from ‘Double Effect’? In the general context of the administration of opiates to patients with a terminal illness, it is possible that in some instances, the GP does intend to hasten death as well as relieve symptoms.
This crucial importance of ‘intention’ was re-emphasised in the 1992 trial of R v Cox (12 BMLR 38). Consultant rheumatologist Dr Nigel Cox had managed the severe destructive arthritis of Mrs Lilian Boyes for 17 years and had an excellent relationship with both her and her family. She was in severe and constant pain which resisted even the opiates, and surrounded by her family, she begged and pleaded for assistance to die. Without discussing his decision with the nursing staff, Dr Cox administered intravenous potassium chloride to Mrs Boyes who subsequently died.
Dr Cox was charged with the attempted murder of Mrs Boyes on 16 August 1991 and stood trial in September 1992. The prosecution led evidence that, injected in that manner, and in the quantity, the drug had no therapeutic property, and that the accused intended in so administering it, to end the life of his patient. The defence argued that the primary purpose of the accused was to relieve the pain of the dying patient, and therefore, that there was no intention to kill the patient.
Mrs Boyes’s body was cremated and, therefore, it was no longer possible to prove ‘beyond reasonable doubt’ that the sick woman had died as a result of the Doctor’s actions. As a result, the lesser charge of ‘attempted murder’ was brought. This introduced the legal advantage of a sentence amenable to judicial discretion. Dr Cox was convicted but given only a one year suspended sentence. Following a disciplinary hearing by the General Medical Council, (GMC) he was allowed to continue in practice subject to some retraining.
The distinction between the cases of Dr Bodkin Adams and Dr Cox, rested on ‘intention’. Both were motivated to act by the benevolent wish to relieve symptoms, but Dr Cox intended to kill, if only to secure pain relief. Dr Bodkin Adams intended only to relieve distress. Criminal offences are defined in terms of ‘act’ and ‘intent’. Motive can be an exonerating factor, as it was for Dr Cox, but only influences the sentence handed down.