Doctor who prescribed lethal tablets allowed to practice

Dr Iain Kerr after being suspended by the General Medical Council in 2008 for prescribing lethal pills to suicidal patients is now free to work again unsupervised

This weekend sees a popular doctor return to work without restrictions. The GMC, a UK regulatory body for the medical professions, have finally removed their sanctions.

63-yr-old Dr Iain Kerr is a popular G.P. in the west of Scotland. Two years ago he openly stated that he had tried to ease the deaths of suicidal and very ill patients by prescribing them drugs with which to end their lives if they so wished. Yet his integrity has never been questioned and his patients remain loyal. Said one of them, Mr Graham Johnston, “I think it was a disgrace to start with that he was put through this process. I have found him nothing but professional. He looked after both my mother and father and he was a constant professional throughout.”

One former patient of Dr Kerr’s, an 87-yr-old osteoporosis sufferer who feared becoming a burden upon her family held Dr Kerr in high regard. He prescribed sodium amytal to her in 1988 – a powerful and tightly controlled barbiturate – with which she could end her life. He revealed his views on physician-assisted suicide during an appraisal in 2004 when he admitted prescribing patients with sodium amytal to help them kill themselves. Dr Kerr described the drugs as an “insurance policy” for those patients. “She said to me, ‘Give me something that I can take if things get too bad’, and I said yes.”

His frank confession resulted in an investigation by local health authorities and Strathclyde Police, who took no action against him after finding there was insufficient evidence. Dr Kerr told patients he had been a member of this Society (Exit had been known briefly  as the Voluntary Euthanasia Society of Scotland). Kerr branded the law “an ass” during his hearing with the GMC. Of five patients he gave lethal medication to, four were women, aged 75, 76, 72 and 61, and one was 73-yr-old man. One of the women suffered from depression, another was terminally ill, another had heart problems and the man had a drink problem.

Last January Dr Kerr had been allowed to return to work, but only with several conditions.These included a ban on prescribing certain medicines and the imposition of a supervisor to regularly review his work. He has now had all the conditions lifted and can practice again unrestricted.

Death from barbiturate poisoning in England and Wales during the 60′s used to account
for 30 per cent of suicides and 65 per cent of all suicide deaths due to drugs. Concern about the number of accidental and deliberate overdoses from prescribed barbiturates led to a campaign by doctors in 1975 to warn people of their dangers. The campaigning group estimated 27,000 people had died using barbiturates between 1959 and 1974. Medical prescribing fell to 5.1 million prescriptions in 1978 and continued downwards in 1996. Doctors switched to prescribing minor tranquillisers instead.

Since then, barbiturates have become tightly controlled in the UK and people have turned to other methods of self-deliverance. Doctors can still prescribe them and patients take them, but unauthorised possession or supply is an offence. The maximum penalty is 5 years imprisonment and a fine for possession and 14 years imprisonment and a fine for supply. If prepared for injection, barbiturates are regarded as class A drugs with more severe penalties. They still account for a number of suicides in America and are the principal drug of choice in Dutch voluntary euthanasia or assisted suicide. A few people try to flout the law by journeying to Mexico in search of veterinary liquid barbiturates to end their life.

A number of worrying facts still emerge. Suicide among doctors often means use of effective drugs – due to their availability. This puts doctors in a privileged position in controlling their own time of death – one which the law still denies to their patients.

A second concern – especially in absence of the full facts – is whether any persons such as the patients of Dr Kerr ended their lives unnecessarily. Given the high regard in which he is held by all who know and knew him (patients and professionals), and the advanced years of the patients in question to whom he prescribed lethal drugs, any moral inappropriateness seems unlikely, even if he broke the law. But the very illegality of such doctor-assisted suicide makes transparency impossible.

A third worry is the conflict between the law and ethics. Not only his patients, but the GMC praises him. He told the GMC: “I think when dealing with someone holding a rational view of the circumstances in which they want to end their life, it was my duty to at least consider whether he or she had a reasonable opinion and that it was my duty to assist if I thought I agreed with that patient’s assessment.” The panel hearing his case last week told him, “You have always been a good and conscientious doctor.” In the absence of decisive action by politicians, the law frequently tries to fudge things when written law conflicts with moral duty. In England & Wales, we have seen how the Director of Public Prosecutions has said he will not prosecute some persons for assisted suicide even when there is enough evidence to secure a conviction. But a law that cannot be clearly implemented is a bad law. Judges, campaigners and the general public continue by an overwhelming majority to call on parliament for change. Parliament, however, does not feel overwhelmed.

The use of drugs for self-deliverance, barbiturates, drugs from Mexico, as well as safer and less troubling methods of ending one’s life in the face of unbearable and unrelievable suffering, are all dealt with in the forthcoming publication, Five Last Acts, 2nd edition. This book also includes a fairly comprehensive guide to the law in the UK on such matters.

References
Doctor who assisted in suicide is deemed fit to practise again (Herald)
Doctor Allowed to Practice Again, Even after Prescribing Sleeping Pills (Top News)
GP banned over ‘suicide’ pills allowed to return (Scotsman)
Scots doctor faces ruin over suicide pills (Herald)
Sleeping pill GP Iain Kerr guilty of misconduct (Telegraph)
GP suspended for six months after prescribing sleeping pills to suicidal patients (Daily Mail)
Patient death GP action ‘illegal’ (BBC)
GP gave sleeping pills to suicidal patient (Independent)
Doctors who kill themselves: a study of the methods used for suicide (Q J Med 2000; 93: 351-357)
Barbiturates (Drugscope)
Suicide and barbiturate prescribing (Barraclough, Nelson et al)
Barbiturates Still Drugs of Choice in Geriatric Suicide (American Association for Geriatric Psychiatry)

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