The case of Dr Munro: Are there lessons to be learnt?

Medical Law Review

Volumn 18, Issue 4, 2010, Pages 564-577

  Goodman, James ^a  

^a ST MARY S HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACTIVE EUTHANASIA; ARTICLE; HUMAN; LEGAL ASPECT; NEWBORN; PREMATURITY; TREATMENT WITHDRAWAL; UNITED KINGDOM;

ENGLAND; EUTHANASIA, ACTIVE; HUMANS; INFANT, NEWBORN; INFANT, PREMATURE; WITHHOLDING TREATMENT;

EID: 78649667138     PISSN: 09670742     EISSN: 14643790     Source Type: Journal    
DOI: 10.1093/medlaw/fwq024     Document Type: Article

References (41)

1. M Brazier and E Cave, Medicine, Patients and the Law (4th edn Lexis-Nexis and Penguin, London 2007) 490-516.
2. Withholding or Withdrawing Life Sustaining Treatment in Children: Framework for Practice (2nd edn RCPCH, London 2004) 21
3. S Wall and J Partridge, 'Death in the Intensive Care Nursery: Physician Practice of Withdrawing and Withholding Life Support' (1997) 99 Paediatrics 64
4. GMC Fitness to Practise Hearing of Dr Munro. 5th-11th July 2007. Minutes on file.
5. Described by Andrew Long of the GMC in 'Doctor "hastened babies" deaths' BBC News Report, http://news.bbc.co.uk/1/hi/scotland/north_east/6273528.stm. accessed 15 July 2009.
6. K Galloway and M Yaster, 'Pain and Symptom Control in Terminally Ill Children' (2000) 47 Pediatric Clinics of North America 711
7. Above, n 4, 3
8. According to the Munro FTP panel minutes: Dr Munro also faced charges relating to his record keeping including that the records were inadequate (admitted and proved), misleading (not proved), below the standard to be expected of a registered medical practitioner (admitted and proved except in relation to allegation 8b) and dishonest (not proved). He also faced allegations that he had mislead the investigation when asked during a telephone conversation with Dr A, clinical Governance Support Practioner on 4 January 2006 if he had ever prescribed pancuronium for the treatment of agonal gasping, prior to its use in the case of Baby X. Dr Munro replied that he had not, although a subsequent review of cases revealed the use of pancuronium by Dr Munro in the case of Baby Y. He faced charges that his conduct in this instance was inaccurate (admitted and proved), misleading (proved), below the standard to be expected of a registered medical practitioner (proved), and dishonest (not proved).
9. 'The panel accepts that in the particular circumstances in the cases of both Baby X and Baby Y you administered pancuronium believing that they were in distress that had not been, and could not be, relieved by morphine. Having regard to the lack of clear, specific, professional guidance and that it is undisputed that your intention was to relieve suffering rather than to hasten death, the panel is satisfied that at all times you sought to act in the best interest of each baby' (at 11).
10. 'In the judgment of the Panel, the concerns raised by the facts are not so serious as to raise the question whether you should continue to practice either with restrictions or at all. Accordingly, the Panel has determined that your fitness to practice is not impaired by reason of misconduct.. you have insight into the failings which have been highlighted by this case and that there are no issues of patient safety that need to be addressed. The Panel has concluded that it is neither necessary nor proportionate to issue a warning. The Panel has therefore determined to conclude your case by taking no further action'. Above, n 4, 12-3.
11. R v Cox [1992] 12 BMLR 38
12. 'A doctor who answered the prayer of a patient desperate to die' The Independent (10 April 2005), http://www.independent.co.uk/life-style/healthand-families/health-news/a-doctor-who-answered-the-prayer-of-a-patientdesperate-to-die-531412.html. accessed 1 August 2010.
13. 'Questions about the decision to prosecute Kay Gilderdale' CPS (26 January 2010), http://www.cps.gov.uk/news/press_statements/questions_about_kay_gilderdale_decision/. accessed 15 July 2010.
14. 'Mother cleared of ME daughter's attempted murder' BBC Online (25 January 2010), http://news.bbc.co.uk/1/hi/england/sussex/8479211.stm. accessed 15 July 2010.
15. 'Jury heckled over murder verdict for mother Frances Inglis who acted out of love' Times Online (21 January 2010), http://www.timesonline.co.uk/tol/news/uk/crime/article6995295.ece. accessed 15 July 2010.
16. [1981(] 12 BMLR 1
17. A Morris, 'Fitness to Practice and the Ethics of Decision-making at the End of Life: Dr Michael Munro' (2007) 23 Tottels Journal of Professional Negligence 228
18. Carried out on the Lexis-Nexis newspaper database on 25 June 2009
19. 'Concerns at deaths of babies' Aberdeen Evening Express (15 May 2006)
20. An attempt was made to contact the Procurator Fiscal, however their stance was that they do not comment upon individual cases. Contact was made with two senior legal scholars in Scotland who advised of the practices of the Fiscal and confirmed that no other information was in the public domain.
21. It is not known which journal paper Dr Munro is referring to here. It could possibly be P Perkin and D Resnik 'The Agony of Agonal Respiration: Is the Last Gasp Necessary?' (2002) 28 J. Med. Ethics 164. This paper provides a logical and ethical argument for giving muscle relaxing drugs during agonal gasping.
22. 'Doctor felt babies were suffering' BBC Online (9 July 2007), http://news.bbc.co.uk/1/hi/scotland/north_east/6276900.stm. accessed 15 July 2010.
23. 'Doctor denies misconduct for injecting dying babies' The Guardian (9 July 2007), http://www.guardian.co.uk/society/2007/jul/09/health.medicineandhealth. accessed 11 July 2009.
24. Above, n 5
25. 'Death case doctor tells of harrowing year on remand: Hospital consultant faces continuing uncertainty over professional future after judge imposes a suspended jail sentence for lethal injection' The Independent (22 September 1992), http://www.independent.co.uk/news/uk/death-case-doctor-tells-ofharrowing-year-on-remand-hospital-consultant-faces-continuing-uncertaintyover-professional-future-after-judge-imposes-a-suspended-jail-sentence-forlethal-injection-1552854.html. accessed 15 July 2010.
26. Above, n 5
27. L Koniaris and others, 'Inadequate Anaesthesia in Lethal Injection for Execution' (2005) 365 The Lancet 1412
28. P Devlin, Easing the Passing: The Trial of Dr John Bodkin Adams (Faber and Faber, London 1986) 171: 'If the first purpose of medicine, the restoration of health, can no longer be achieved, there is still much for a doctor to do, and he is entitled to do all that is proper and necessary to relieve pain and suffering, even if the measures he takes may incidentally shorten life'
29. Above, n 4, 9
30. H Kuhse, 'Response to Perkin and Resnik: The Agony of Trying to Match Sanctity of Life and Patient-centred Medical Care' (2002) 28 J. Med. Ethics 270.
31. Above, n 20
32. Above, n 20
33. See s 1 as amended by s 37 of the Human Fertilisation and Embryology Act 1990. Only s 1(1)(a) has a 24 week time limit.
34. If, for example, there is a substantial risk that if the child was born it would suffer serious mental or physical disabilities
35. For discussion see J Rachels, 'Active and Passive Euthanasia' (1975) 292 N. Engl. J. Med. 78.
36. R Gillon, 'Euthanasia, Withholding Life Prolonging Treatment and Moral Differences Between Killing and Letting Die' (1988) 14 J. Med. Ethics 115-7.
37. Above, n 2, 21
38. R Magnusson, 'Euthanasia: Above Ground, Below Ground' (2004) 30 J. Med. Ethics 441.
39. Above, n 16, 237
40. 'Decision On Prosecution-The Death by suicide of Daniel James' CPS (9 December 2008), http://www.cps.gov.uk/news/articles/death_by_suicide_of_daniel_james/. accessed 15 July 2009.
41. Above, n 5