Nick Cartwright's Blog

I recently wrote an article for Eulogy magazine in which I discuss the forthcoming appeal of Frances Inglis against her conviction for murdering her son and contrasted it with the case of Kay Gilderdale who was treated more compassionately by the courts after assisting her daughter to die.  Space prohibited me from also discussing the issues raised by recent admissions of Dr Howard Martin – not the hemophobic rural GP portrayed by Martin Clunes or the inventor of the Air Ware sole but the disgraced GP described in The Torygraph as a “second Harold Shipman”.  The comparison with Shipman may make good copy but it is far from accurate, Dr Martin administered fatal doses of painkillers to approximately a dozen patients he believed were suffering intolerably, unlike Shipman he was not a serial killer who murdered for personal gain.  To their credit the Torygraph did employ the journalistic device of putting the phrase “second Harold Shipman” in quotation marks, although this is more likely to have been employed to avoid the libel courts than my scorn.   The only real connection between the two doctors is that Shipman was once employed, briefly, as a locum at Dr Martin’s practice.

The difficulty with the case of Dr Martin is that he was acting on the boundaries of the law in an area of medical practice which is opaque.  What Dr Martin did in some cases was clearly wrong, in others it was morally and legally permissible.  Until these areas of medical practice are openly discussed, assisted dying legalised and appropriate safeguards but in place disquieting practices will continue.  When interviewed for Radio5Live I surprised listeners when I explained it was not only legal but also common practice to administer fatal doses of painkillers such as morphine  to terminally ill patients in the certain knowledge that this will hasten their deaths.  The law utilises the ill-founded ethical doctrine of double-effect which distinguishes between primary intention and foreseeable consequences.  The law will regard the physician who administers  a fatal dose of morphine as acting with the primary intention of relieving pain even though hastening the patient’s death is a foreseen and virtually certain consequence.  It was this doctrine on which Dr Martin relied, saying “I don’t believe I’ve killed any patients.  I believe I’ve made them comfortable in their hour of need.”  What was wrong about Dr Martin’s actions was that he adopted a ‘doctor knows best’ attitude and in at least two cases did not seek the consent of his patients.

The practice of medicine needs to shed its historical connection with paternalism and respect the wishes of competent adult patients.  Dr Martin should be heavily criticised for his doctor knows best approach.  We should also be sympathetic to Dr Martin and all those who practice medicine within a legal framework which lacks clarity and consistency and who feel forced to operate behind closed doors if they are to respect the dignity of their patients and treat them with compassion.