German doctor is investigated for killing 76 patients with morphineBMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7419.830-e (Published 09 October 2003) Cite this as: BMJ 2003;327:830
A 53 year old doctor who treated her patients at the private Paracelsus Hospital Silbersee in Langenhagen, near Hanover, is being investigated for the possible murder of 76 cancer patients with morphine since 2001.
Suspicions were raised when health insurance companies monitoring patients' files for the past two years found extremely high costs and dosages of morphine without evidence of severe pain and suffering among the patients.
It is not clear whether the patients had wished to die—nor whether the doctor had explained the adverse effects and risks of their treatment to them.
A court has withdrawn the doctor's licence to practice. She denies carrying out euthanasia, claiming instead that she had understated the severity of the malignant diseases in her records.
Meanwhile her lawyer has made an official protest at the withdrawal of her licence. The district attorney has asked an expert on pain relief, Michael Zens, of Bochum University, North Rhine-Westphalia, to give an independent expert opinion on the case.
A spokesperson for the Paracelsus hospital chain said that earlier evidence it had requested from an expert in palliative medicine, Lucas Radbruch, from Aachen, showed no evidence of illegal euthanasia.
The hospital chain also pointed out that responsibility lay solely with the accused doctor, as she was not employed by the hospital but had a contract to use hospital beds for treating her patients. This contract was dissolved when suspicions were raised.
The case has prompted considerable discussion about palliative care and euthanasia in Germany. Unlike in other European countries, treatment to relieve pain in terminally ill patients is not widely practised in Germany. Doctors in Germany are hesitant about the use of morphine and other painkillers, because of the strict legal precautions devised by the state to avoid abuse. Many doctors are also frightened of being associated with euthanasia. Hospices are rare in Germany, as are special hospital units for palliative medicine.
Frank Ulrich Montgomery, head of the German Hospital Doctors' Association, and spokespeople for the hospice movement said that doctors who practised palliative medicine should not be subject to a witch hunt.