Dutch murder case leads to talks with attorney general

BMJ 2005; 331 doi: (Published 01 September 2005) Cite this as: BMJ 2005;331:473
  1. Tony Sheldon
  1. Utrecht

    Talks have begun this week between the Dutch Medical Association and the country's attorney general after the collapse in July of a murder case against a Dutch hospital doctor who gave palliative care to a dying patient.

    Doctors reacted with alarm after it emerged that the doctor, Peter Vencken, had spent nine days in custody before being charged with murder after prescribing morphine and the sedative midazolam to a terminally ill patient.

    Dr Vencken, a trainee anaesthetist, was on duty as casualty doctor when he treated a 77 year old man who had had a large cerebral stroke. In agreement with the family he gave only palliative care.

    The man was given 5 mg of morphine an hour, but after he had serious breathing difficulties the dose was increased to 20 mg. Later, as his condition worsened, he was given 5 mg of midazolam. He died soon afterwards.

    Both the ministers of health and justice had previously defined “terminal sedation,” in which pain relief may be used to induce a coma in a dying patient, as “normal medical treatment.” Such sedation is estimated to be involved in about 10 000 deaths in the Netherlands each year (BMJ 2003;327: 465).

    However, the public prosecution service took the Vencken case to appeal “to be clear where the border lies in the grey area between euthanasia and palliative pain relief.”

    Last November a court in Breda acquitted the 32 year old doctor. It accepted expert evidence that the nature, quantities, and combination of morphine and sedative were not excessive, complied with policy on palliative pain relief, and constituted normal medical treatment. It rejected the prosecution's claim that Dr Vencken intended to accelerate the patient's death, arguing that although the drugs could shorten the patient's life, this had not been the intention (BMJ 2004;329: 1206).

    The public prosecution service then appealed, but on 29 July the appeal court in Den Bosch returned a verdict in two hours instead of the usual 14 days, dismissing the charges and adding that the prosecution had failed to prove that the drugs caused the death.

    The coordinator of legal policy at the Dutch Medical Association, Johan Legemaate, said the decision indicated that the judges considered the case pointless and could be seen as a reprimand. Dr Vencken's lawyer, Kees Korvinus, has described the prosecution as “absurd” and intends to claim damages in the region of €100 000 (£68 000; $123 000). Throughout the case Dr Vencken has continued working.

    No further appeal has been made. The association has invited the chairman of the board of public prosecutors, Harm Brouwer, to discuss the decision to prosecute. Professor Legemaate said many doctors were concerned that patients could suffer if doctors were reluctant to use morphine for palliative care. The association felt that a criminal prosecution hadn't been exercised carefully and hoped for “some statement to repair the trust between the legal and medical professions.”

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