Intended for healthcare professionals

Rapid response to:


GMC to push for erasure of paediatrician convicted of manslaughter

BMJ 2017; 359 doi: (Published 09 November 2017) Cite this as: BMJ 2017;359:j5223

Rapid Response:

Re: GMC to push for erasure of paediatrician convicted of manslaughter

I thank Dr Ilangaratne for commenting on my views. (1) (2).

Before I respond, I wish to state that I do not condone the poor clinical care provided by the team. I am commenting purely from a legal standpoint pertaining to 'criminal standard of proof' required for conviction of an individual in a clinical team .

As regards causation, if a 'medical treatment ' is (potentially) ineffective then it follows that withholding the said ' medical treatment' could NOT have hastened the death. I wonder whether the lay jury has been made aware of this critical information.

If clinical inactions could be legally deemed to have hastened death even when death is imminent and inevitable, then it has serious implications for routine care of patients where there is a high risk of mortality. For instance, most cancer deaths in hospice could be deemed to have been hastened either by medications ( e.g. sedatives ) or by withdrawal of food nutrition. (even if Doctrine of Double Effect with opiates is accepted).

As regards, 'the point of no return' there is no such clinically defined endpoint in management of septic shock and it is concerning to see legal discussions on this hypothetical clinical state.


1. S Sundar. .

2. Jay Ilangaratne.

Competing interests: No competing interests

18 November 2017
Santhanam Sundar
Consultant Oncologist
Nottingham City Hospital