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Katana
03-30-2012, 07:36 AM
Greetings. Though I'm a writer in Canada, the setting for my novel takes place in England. I would like to make sure everything is factual before sending out queries.

The scenario: a doctor is arrested for a suspected euthanasia in a hospital. I'm aware that physician-assisted suicide is illegal in England; can someone tell me what the procedure would be after that? For example, would there be a hearing in front of prosecutors or in front of a judge (or both) to determine if there is enough evidence to go to trial? If so, would the doctor be present for this hearing, or would the doctor only appear if it goes to trial?

This has been a tough one to research! :(

waylander
03-30-2012, 10:34 AM
I am not a lawyer - one will be along shortly - but I reckon it might play out like this.
The doctor would be arrested, statements taken etc and would go for a hearing before a magistrate at which they would be present. The main outcome of this would be either they would be bailed awaiting trial (fairly likely) or remanded in custody (unlikely unless they were considered a flight risk). While they're bailed the Crown Proseceution Service would review the file and decide whether to proceed or not. The General Medical Council would most likely suspend the doctor and initiate their own investigation.

Buffysquirrel
03-30-2012, 11:53 PM
I'm not a lawyer either but I have been researching this area recently for my own WIP.

The police may arrest the doctor on suspicion of murder but they may equally only question him. It depends on how willing he is to co-operate with their investigation. If he's 'helping with their enquiries', he can leave the police station at any time.

Once arrested, he can be detained for up to 24 hours for questioning. At the end of that time, the police must either a) release him on police bail (ie he's given a date on which he must return for further questioning) b) get an extension to question him further or c) charge him. Once he's charged, questioning must stop. Detention can be extended up to 36 hours on the authority of a police superintendent, but if they want to detain the suspect beyond that time without charging him, they'll have to take him to the magistrates' court.

Once he's charged, he'll be taken to the magistrates' court for a bail hearing. The options are to remand him on bail, possibly with conditions attached, or to remand him in custody. A murder suspect would normally be remanded in custody. Custody means prison.

Once the police have completed the process of gathering evidence, they send a file to the Crown Prosecution Service (CPS) which decides whether or not to prosecute.

There's some useful if brief info on the Home Office site: http://www.homeoffice.gov.uk/police/powers/custody/

Katana
03-31-2012, 02:54 AM
Thank you, waylander and Buffysquirrel, for your replies. Iím very grateful that you took the time to respond.




[snip]

Once arrested, he can be detained for up to 24 hours for questioning. At the end of that time, the police must either a) release him on police bail (ie he's given a date on which he must return for further questioning) b) get an extension to question him further or c) charge him. Once he's charged, questioning must stop. Detention can be extended up to 36 hours on the authority of a police superintendent, but if they want to detain the suspect beyond that time without charging him, they'll have to take him to the magistrates' court.
I think I have everything right so far. A snippet from my synopsis to give you the gist:

There he encounters a terminal cancer patient with unmanageable pain, to which he can relate. Though physician-assisted suicide is illegal, he and her family concoct a scheme, skirting the law, to grant her wish to end her life humanely. He is arrested for her Ďmurderí, but her family throws the case into disarray when they claim an ĎIím Spartacusí defence, with the prosecutors not knowing who is responsible for the deed and who is lying. Due to lack of evidence, he is releasedÖ(etc.)



Once he's charged, he'll be taken to the magistrates' court for a bail hearing. The options are to remand him on bail, possibly with conditions attached, or to remand him in custody. A murder suspect would normally be remanded in custody. Custody means prison.
Because there is some doubt as to his guilt, I donít have him remanded into custody, but would this be correct?



Once the police have completed the process of gathering evidence, they send a file to the Crown Prosecution Service (CPS) which decides whether or not to prosecute.
Again, because there is doubt as to who did it, would it likely go beyond the police and into the hands of the CPS? Would he have to appear in front of the CPS for questioning? Iím also wondering where his lawyer (solicitor?) would be in all this. I'm assuming right at his side through all questioning by police and prosecutors.


The General Medical Council would most likely suspend the doctor and initiate their own investigation.I donít have the GMC suspending him, because of the lack of evidence, and he is sent a letter of reprimand, but no further action is taken. I'm hoping that this would be likely.

Does this cover all my bases (is that a North American phrase? ;)) Again, I'm so grateful for your help. This has been the most difficult part of writing this beast, and inquiries made to British law offices have gone unanswered.

waylander
03-31-2012, 11:12 AM
The doctor would never appear in front of the CPS. They simply review the file the police have sent them and decide whether there is a case to answer.
The doctor has the right to have a lawyer present while he is questioned, up to him whether he exercises that right.

Buffysquirrel
03-31-2012, 03:20 PM
If he's charged with murder, he'll be remanded into custody. You could have the police not charge him due to lack of evidence.

The decision to prosecute is made by the CPS, not the police, as waylander says, based on the evidence gathered by the police then passed to the CPS once the investigation is complete. The first time anyone from the CPS would see the doctor would be when they're in court opposing bail.

I don't think the defence they've concocted is going to fly. There's several ways for the CPS to get round it. Firstly, they can charge them all with conspiracy to murder. Secondly, they can use 'joint enterprise' to charge them all with the murder. Thirdly, they can do them for obstructing justice if they really can't get anything else on them.

Also, murder should not be in quotes. The act you describe is murder under English law.

The doctor has a legal right to have a solicitor present during questioning, even if he's only 'helping with enquiries'. As he's a professional, educated person, he almost certainly would have a solicitor. Probably one he's paying for. He's supposed to be given time to consult with the solicitor in private, too.

It's far more likely that the police and CPS would be sympathetic to family members who killed a terminally ill person than to a doctor who did the same thing. A doctor might do it again.

jclarkdawe
03-31-2012, 04:59 PM
You need to understand that the forensics here, regardless of whether this is England, the US, or any country, is where you run into problems with this type of case. The cases that have developed in hospital murders tend to be where the prosecutor can show a pattern of behavior. In other words, multiple dead bodies. And the probability that the prosecutor is missing a few of them.

First question is going to be why would the authorities do an autopsy on an elderly person dying in a hospital? Hospitals do not do an autopsy on every patient who dies in the hospital. Many of the deaths in a hospital are a predictable result of the patient's condition. Any patient that a doctor is likely to assist in his/her suicide is likely to be terminal regardless of the situation. And in the US at least, would likely have a DNR (do not resucitate) order. And patients are "allowed" to die all the time in hospitals.

But if you get over the hurdle of an autopsy being unlikely, what's the cause of death? Most likely would be an overdose of morphine (i.e., 'snowing'). Assuming the autopsy finds this cause, how do you prove, beyond a reasonable doubt, that it wasn't accidental? Doctor merely says the nurse gave the patient too much morphine, or the morphine pump broke or was disabled, or patient needed that much morphine for the pain level. How is the prosecutor going to prove otherwise?

Normal scenario in the US, and I'm going to guess in the England, goes something like this. Patient goes into the hospital, just about to circle the drain. Doctor tells family that "she'll do everything she can." Doctor realizes that "everything she can" has about as much chance as the snowball in Hell. Family hears that the doctor will save patient.

Patient dies, not surprising the doctor, but shocking the hell out of the family. After all, the patient had been healthy. Doctor says something along the lines of "At least the patient is no longer suffering." Family hears, "I put the poor son-of-a-gun out of his misery." Family quickly translate this into "I offed your mommy (daddy, whoever) because I thought they were suffering too much."

Family bitches to hospital. Hospital investigates, looks at record, see the drain circling, says to the family, "Sorry for your loss, but your mommy was in serious condition. Dr. Murderer did everything they could, but nothing would have saved your mommy." Family translate this to "cover-up."

Family is more ambitious then most and bitches to police/prosecutor. Police/prosecutor investigate, have medical examiner look at file. ME sees the drain circling, tells police/prosecutor and says you don't have a case.

Doctors (and nurses) are incredibly hard to convict of murder in the best of circumstances because they know what drugs are likely to be discovered in an autopsy. There's a very good reason why snowing exists.

Only way you're likely to get a case is if a decision is made (unlikely to be any sort of formal decision and the question becomes quickly whether the decision is medically reasonable) and then someone starts talking.

In the case of both of my parents, decisions were made in their last days that did not maximize their lives. I suppose a case could be made that euthanasia was practiced. But in point of fact, this is normal and depending upon the circumstances, not very unusual.

For a long-term cancer patient, who is stage 4, with "unmanageable pain," the common solution is snowing. You increase the morphine to a point where the patient can tolerate the pain. This is going to probably exceed the level recommended dose, cause the patient to become unconscious, but it doesn't matter in this circumstance, as the patient is terminal. In other words, no matter how much morphine you do or do not give the patient, the patient is going to die. The morphine is going to diminish the patient's ability to fight, speeding the process of death. In other words, the doctor is treating the patient's pain management as the primary objective, rather than the patient's maximum life. Perfectly acceptable medical practice.

I think before you worry about the legal end, you're going to need to do a lot of research on the medical end. You'd need to go back 40 or more years medically to find what you're proposing to be an issue. The cases that are presently out there are all non-terminal patients with the doctor/nurse showing a course of conduct over several patients.

Best of luck,

Jim Clark-Dawe

Buffysquirrel
03-31-2012, 06:30 PM
Doctor tells family that "she'll do everything she can." Doctor realizes that "everything she can" has about as much chance as the snowball in Hell. Family hears that the doctor will save patient.

Not in my experience. In my experience, a junior doctor who's never done this before comes up to you and asks if you want extreme measures to be used, and starts to lay out how unlikely it is they'll succeed, and you cut him short because you know that as well as he does and you don't want to embarrass either of you.

But that's only one experience.

ETA: although, given how easily Harold Shipman was able to get away with murdering patients who weren't even terminally ill, Jim is pretty much right, I'm thinking.

jclarkdawe
03-31-2012, 07:35 PM
Originally Posted by jclarkdawe http://www.absolutewrite.com/forums/images/buttons/viewpost.gif (http://www.absolutewrite.com/forums/showthread.php?p=7149766#post7149766)
Doctor tells family that "she'll do everything she can." Doctor realizes that "everything she can" has about as much chance as the snowball in Hell. Family hears that the doctor will save patient.Not in my experience. In my experience, a junior doctor who's never done this before comes up to you and asks if you want extreme measures to be used, and starts to lay out how unlikely it is they'll succeed, and you cut him short because you know that as well as he does and you don't want to embarrass either of you.

But that's only one experience.

ETA: although, given how easily Harold Shipman was able to get away with murdering patients who weren't even terminally ill, Jim is pretty much right, I'm thinking.

I'm sorry I wasn't a bit clearer. Your description is the more rational one and frequently happens.

My description is the one where someone complains about someone being murdered by a doctor or a nurse. The patient or the family or both vehemently believe that modern medicine can save anyone, it's not their time, et cetera. The doctor will either slide over the seriousness, realizing that shoveling crap against the tide is a waste of time, or will explain it but not be heard. Then when the result everyone but the family sees coming, comes, the family is in shock. They're wondering why no one told them this, and deny the existence of any possible telling. In the US, they're ready to sue, sue, and sue some more.

These are the people that doctors, hospital administrators, and the authorities see typically in the doctor/nurse accused of murder case. I don't know the rate at which this happens, but I'm guessing it's unusual to find anyone in the system for more then five years who hasn't seen or heard one of these cases. So the bias is to not believe the person when they show up.

Reading through the information on the Shipman case, it's clear that bias was going on. It took a case involving a financial motive on Shipman's part for authorities to really start investigating. Shipman's case is typical of the genre.

Even with all the ducks lined up, this is going to be a case where it's going to be hard to believe, and even if you believe it, even harder to get a jury convinced of. And if you're not likely to convince a jury, the prosecutor should not be advancing the case.

Best of luck,

Jim Clark-Dawe

Buffysquirrel
03-31-2012, 11:28 PM
Certainly the CPS won't pursue a case that has no realistic prospect of conviction.

ETA: I think the phrase I was actually thinking of is 'heroic measures'. I've tried so hard to blur those memories *eyeroll*.

Katana
04-01-2012, 02:14 AM
Thank you, Jim Clark-Dawe, Buffysquirrel and waylander, for the very helpful, in-depth information. It will be invaluable.

"Snowing" is the method that would be used. So if I'm reading this right, it's unlikely to be a criminal case, and unlikely the doctor would even be questioned by the police, so nothing would come of if, especially if the family isn't going to make an issue out of it.

That will certainly simplify matters. I just have to make sure all 'i's are dotted and 't's are crossed to make things believeable, and I'm well on my way there. :)

Kenn
04-01-2012, 05:54 PM
It is worth looking at the current guidelines.

http://www.cps.gov.uk/news/press_releases/109_10/ (http://www.cps.gov.uk/news/press_releases/109_10/)

They say the focus would be on the motive of the doctor. I doubt whether anybody would bother him, unless the coroner became suspicious over the number of patients dying under his care. According to some, this sort of thing is very common practice.

Katana
04-02-2012, 12:30 AM
It is worth looking at the current guidelines.

http://www.cps.gov.uk/news/press_releases/109_10/ (http://www.cps.gov.uk/news/press_releases/109_10/)

They say the focus would be on the motive of the doctor. I doubt whether anybody would bother him, unless the coroner became suspicious over the number of patients dying under his care. According to some, this sort of thing is very common practice.
This is very helpful. Thank you for the link! :)