October 7th 2017


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COVER STORY Green energy push has left us blowin' in the wind

EDITORIAL Lessons for Australia in NZ election results

CANBERRA OBSERVED Assurances on religious freedom needed now

ENERGY Peak oil turns out to be another moral panic

FOREIGN AFFAIRS Timor Leste, Australia reach new border treaty

BUSHFIRES Disaster awaits as advice again goes unheeded

GENDER POLITICS Does biological sex matter?

SAME-SEX MARRIAGE Intolerance of the 'Yes' campaign for all to see

EUTHANASIA Medical murder: three historical cases

INTERNATIONAL AFFAIRS Gallant Taiwan survives alone in the bitter sea

SAME-SEX MARRIAGE Prepare for apologies in a generation's time

SAME-SEX MARRIAGE A reflection on the use and abuse of the thought of the Angelic Doctor

MUSIC Stupendous talent: What to do with all that ego?

CINEMA Trollhunters: Guillermo del Toro's TV fantasy

BOOK REVIEW Debunking the 'harmless' tag

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EUTHANASIA Victoria's death bill: questions that need answers

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EUTHANASIA
Medical murder: three historical cases


by Dr Robert M. Kaplan

News Weekly, October 7, 2017

“When the doctor turns to murder, he has the nerve and the knowledge.”

Arthur Conan Doyle, physician

 

“Anyone who paints the sky green and the plants blue is to be  sterilised.”

Adolf Hitler

Now, the topic of euthanasia has been around for many years, but the critical debate in euthanasia started in the mid-19th century, with the invention of the syringe, because with the syringe you could start to deliver high-potency drugs to the patient, and from this point on both physician and patient were aware that in intractable situations, the sudden end to pain and suffering could be delivered. The debate has taken all sorts of steps, and I don’t need to tell you of the current situation. I’m going to look at three cases that I hope illustrate very important points about the situation.

Right royal rogue

The first one starts in January 1936. Some of you will remember the movie, The King’s Speech. There’s a scene where the ailing George V is seated at the table with two future kings: Edward VIII and George VI. But there is another figure at the table who doesn’t get much attention in the movie. He is Lord Dawson of Penn, the royal physician. His presence shows that when somebody is under the power of a doctor, no matter the fact that he is the monarch of England, the emperor of India, the head of the Commonwealth: he can still be murdered by his doctor in full view of everybody. George V was dying of chronic bronchitis; the last four kings of England have died of smoking-related disease. He was ailing for some weeks.

Now on January 16, Queen Mary called for Dawson. Now Dawson was the most admired and respected figure in not just British medicine but possibly the world. He was the royal physician, he was president of the British Medical Association, and he made his name saving the King’s life in 1928. When Dawson arrived, the claim is that Queen Mary and Edward said to him: “We do not want the King’s life prolonged.”

We’ll come back to that. By January 20, it is clear to everybody that the King’s condition is failing. However, he was able to run a 10-minute meeting of the Imperial College and then retire to bed. Now, he was described as being “semi-conscious”, and at 9.30 the following morning Dawson put out possibly the most famous medical bulletin in British history: The king’s life is drawing peacefully to its close.” I wish I could get lines like that.

That evening, at about six o’clock, the Archbishop of Canterbury went up to the King’s bed and prayed, and then left. The King was then left with Sister Catherine Black, his nurse, and at about eight o’clock Dawson turned up, and he loaded a syringe with morphine and cocaine, and told her to give it. And it must have been the most difficult decision of her professional life: She refused. She knew this was a lethal dose, so she leaves the room.

Dawson then phones his wife and tells her to call the editor of The Times and tell him, “Hold the presses, I’ll have news for you soon”, or something to that effect. At 11.20pm, the King is still alive; he’s barely conscious, but he’s alive. Dawson then packs the syringe and injects him in the jugular vein. It’s interesting that, while he was euthanising someone he didn’t know the basic fact that, as any intern will tell you, the jugular vein is very difficult to inject; there are far better places. And the King expires.

The next day several things happen. The Times has been informed, so it has a piece: “King’s life ends peacefully”, and it was put out that the King’s last words were: “How is the empire?” In fact, the King’s last words were far more to the point than that. As Dawson put the needle into his jugular vein, he said: “God damn you.”

What happens after this? Dawson goes back to London and 10 months later takes part in a debate in the House of Lords on a bill to permit the legalisation of euthanasia. Dawson votes against it on the grounds that these things must be left to the doctor; we have a medical mission to relieve suffering.

None of what Dawson did to the King was known for 50 years. He dies in 1945, and 50 years after the King’s death, his diaries are published, and a Secret Service investigation into the King’s death is also published, and a whole new picture emerges. First, the King was marked “semi-conscious”; he wasn’t in a coma. He was certainly at a fluctuating level, he wasn’t well, but he was by no means terminal.

The second thing, and Dawson was quite clear about this, he did not want the cheap tabloids, the equivalent of the Murdoch press in those days, to announce the King’s death. So the King had to die that night so The Times could announce it. The next thing was, Dawson was very prestigious, but he was not paid for looking after the King, and he had a large and lucrative private practice. So he wanted to get back to London.

So we see the whole picture emerging. Dawson took it upon himself to decide to euthanise, or to be more blunt, to kill the King – nobody else. The King’s wife Queen Mary was a deeply religious woman. She would never have contemplated anything like that. His more feckless son, Edward VIII, didn’t even think about it. Dawson took it upon himself.

Even proponents of euthanasia would agree that it is quite untenable to kill someone when they themselves have not been asked or discussed the matter. What we know we can say about Dawson, if we look at the running practice, is it wasn’t just the King that he euthanised.

John Bodkin Adams

That’s our first case. The second should have been made into an Agatha Christie story. It involves the rich and titled, sumptuous picnics, gorgeous dinners, and a wonderful English coastal town called Eastbourne. And the protagonist, if you’ll accept that term, was a character named John Bodkin Adams. Bodkin Adams is now estimated to have a total of 134 deaths to his credit, all on the grounds of euthanasia, or in his own coined phrase, “easing the passing”.

Bodkin Adams was raised in the Plymouth Brethren in County Antrim. When he was young he lost his father and his brother, and his mother stuck to him like glue for the rest of his life. He went to Belfast University to qualify in medicine, but was a bit of a dud. He was told “don’t even think about specialising”.

So he went first to Bristol and joined a religious practice where they would have prayers every day before they started work, and then he homed in on Eastbourne. Eastbourne in the 1920s was one of those places where the wealthy retired to die. So it was full of wealthy people, particularly wealthy widows, and Adams homed in on these very quickly.

When he got there in 1922 and joined a practice, he had to ride on a bicycle to do his visits. Within 10 years, he was driving an expensive car and had a three-storey home, and a good deal of income that helped him buy all the latest cameras, the latest guns; he was very much inserted into the social life of the area. He was a champion clay-pigeon shooter. He did all these things to get himself into the upper class. But mostly what he did was make money.

And how did he make money? It was custom in those days for wealthy people to leave something for their doctor in their will, and he capitalised on that. He would badger people. He would phone the lawyers from a person’s deathbed, and he would hassle people. A very early example is of a William Mawhood, who was dying, and Adams was standing at the bedside injecting him to knock him off, and while Mawhood was still conscious was saying: “I want you to sign for my inclusion in your will.” To her eternal credit, his wife chased him out of the room with her walking stick.

What happened was he would take these people who he could get to sign over something in their will, and they would be killed. He bought several Rolls-Royces, collections of silver, furniture; he had lots of money. So his income escalated dramatically. And he had a terrible reputation: It was well known among the nurses and the undertakers, and the rumour started spreading.

We now know that he was a homosexual and was very much involved with a type of underworld with all these activities that lead to a secret life. His mother lived with him; it seems he hated her, as on his one attempt to get away, in 1933 – he got engaged to a woman called Nora – his mother broke up the relationship. She died in 1943. It gives you an idea of what kind of doctor he was that, as GPs did in those days, he was an anaesthetist and he was terrible. He was constantly plugging in the wrong tubes, he was falling asleep, and the surgeons complained that he was eating cake in the theatre. But this didn’t deter him.

The question you’ve got to ask is: Why did Adams have a practice of 2000 patients including the wealthiest citizens and most prominent people in town? His charm, and his religiosity. He would have religious icons in his surgery, he would pray beside the bed of the patient, and he was always available. So, they loved him.

The interesting part is, if you were wealthy, you had Adams’ constant attention. If you were poor he would look after you and never charge. But he was quick to dispense heavy drugs, and that is where his problems started.

After World War II, rumours were spreading about a number of cases. In 1957 he was charged with two murders, both of wealthy women. Adams had been pushing one of them, Edith Morrell, for several years to leave him something in her will, and she cancelled it several times, and then changed her mind again. And he called in at two o’clock in the morning, gave her a huge injection of morphine and threw the nurse out of the room. Of course she was dead within the hour. A similar thing happened with another patient.

When the police interviewed him, he was aghast. He said in the end “all I was doing was easing the passing, and it’s impossible to charge a doctor with murdering a patient”. Well, he was wrong.

What followed was the longest murder trial in British history, and he was the first doctor to be charged with murder since William Palmer who was executed in 1857. The newspapers had a field day, and that cost him plenty too. But the trial was a complete mess – and there’s a story behind this. He had Frederick Geoffrey Lawrence, the best lawyer, looking after him. The prosecution’s case seemed to have been almost deliberately messed up to make sure that Lawrence could tear to pieces any possible evidence against Adams. At the end of it, the jury took barely 40 minutes to find him not guilty.

But Adams faced another trial, this one for faking signatures on prescriptions, and he was struck off the register for four years. During that time he kept himself busy suing the newspapers that had said he was a killer, and made a fortune.

Now you would think after that that he would be a dead letter when he returned to practice, but no, the young patients all adored him, and he worked until 1983, when he died. At his death, he left an estate worth £403,000, which was not insubstantial.

Every serious historical investigation is pretty certain that 134 patients died at Adams’ hands. He was completely amoral. He had no qualms. The expression, “easing the passing”, was just nonsense; he did it for his convenience, and his convenience alone. One would have very little difficulty in describing Adams as a psychopath. But you’ve also got to look at the context in which it happened.

Adams came from a humble background; he was an outsider to the establishment in that town, and on top of it he was leading a secret second life as a homosexual. As it turned out a number of the people he was closely involved with in this underworld were significant political and legal figures. It is not unlikely that the murder trial was messed up deliberately because, if Adams had gone down, he would have taken with him, once he started talking, some leading political and social figures in England.

Adams’ legacy and progeny

There’s no question that Adams was completely amoral, but his activities led to one change in law: the concept of double effect was established as a legal precedent. “Double effect” means, mainly in the eyes of the law, that if in the process of treating a terminal patient the patient dies, the doctor is not held responsible. That is John Bodkin Adams’ legacy.

Now, remember what I said about his killing? In the late 1990s, a documentary about Adams was made and it was keenly watched by a GP in the town of Hyde, Manchester. His name was Harold Shipman, and Shipman has the record as the greatest British serial killer. Shipman would say “I’m going to take some blood” or “I’m going to give you an injection”, and he would bang in a big fat wad of heroin. He is estimated to have killed 256 patients.

Shipman told a family he had watched the documentary and found it very interesting, and when he went to trial he used the same logic as Adams: “Ordinary people, police don’t understand. I’m a doctor, you can’t understand, and what I’m doing is easing the passing.” Well he was found guilty and sentenced to life.

Jack Kevorkian

Now, the last character is, I think, very important for the Australians here, and one everybody’s heard of. His name is Jack Kevorkian. Jack Kevorkian was born in 1928 in Pontiac, Michigan, and his parents were survivors of the Armenian Genocide. So Kevorkian grew up with a family image of terrible death and suffering. I’ve worked with the Armenian community; Kevorkian’s the only one I know who used to absolutely glory in the gory details when detailing them to people.

He was a strange guy; a man of many talents, but completely unfocused. He became a doctor in 1952, and spent 15 months in Korea; that was the last time he did any clinical work. When he was an intern, and this demonstrated his obsession with death, he would race around the wards to find somebody who was dying so he could take pictures of their cornea as they died.

He then became a pathologist, and continued doing things that were on the edge. He developed the unscientific idea that you could save lives by transfusing blood from dead people. So he would sit there in the pathology lab and as soon as a corpse came in he would take the blood out and transfuse it to himself or his staff. To give you an idea of how witless he was, the idea of transfusion reactions or infections never occurred to him. So he got hepatitis C.

He was getting nowhere with his pathology career. In fact in 1983 he stopped practising medicine (you may recall another person in Australia who has also given up his medical licence). But he was determined to get in on this idea of using people who are dying or have died, and to do euthanasia. So, he wrote to all the prisons. “You’ve got somebody who’s going to be executed? Why don’t you let me give them an injection; we can take the organs out and I can do experiments on them.”

He started writing, and he started in the Journal of Medicine and Law. He wrote about obitoria. And what are obitoria? They are centres where people with terminal illnesses can go to be killed. But he didn’t stop there: his orbitoria would “help” people who were disgruntled with life, people who had psychological problems, in fact anybody who wanted to be killed.

In 1990 he wrote his book, Prescription Medicide. He wrote: “We’ve got to look for some good in what the Nazis did in the concentration camps. They did merciless killing; what we want to do is merciful killing.”

He continued: “you can kill someone by injecting them with a syringe, but that’s a very subjective thing. There are two better ways of killing people.” (I want to point out that this book was published and had good sales.) He wrote: “The first way is, of course, to guillotine them. The second way,” displaying a degree of creative thinking that I must admit I don’t have, “is you put somebody’s head under the foot of an elephant and get them to squash it.”

Remember, this is somebody who’s putting himself out as an authority, as a person who can lead in taking people’s lives.

By the end of the 1980s, he was in business. He brought out a machine called a “Thanatron”; and again you’ve heard of people inventing machines to kill. The Thanatron was a machine that the patient operated. He would first administer Nembutal, and then potassium chloride, and kill himself. Kevorkian was getting huge publicity, and he thrived on it; he was an absolute media hound.

If I had time, I’d take you through the cases but, in short, he killed 130 people. How did he kill most of them, and where? In the back of a van that he had set up using carbon monoxide. What do we know of the people who were killed? If you just take a random sample, 70 per cent of the 130 people were not terminal; they did not have serious illnesses. They had neurological disorders, they were alcoholics, they were depressives, just disgruntled with life, or they had been sent by their families.

One of the cases, for example, had chronic fatigue syndrome. Now chronic fatigue syndrome is not pleasant, it’s debilitating, but it is not a lethal illness. And the other thing is, some of them turned up in a dreadful clinical state where it wasn’t clear at all what was going on. Kevorkian had no interest in their clinical state and, as I pointed out, he had virtually no clinical experience anyway. He just leapt onto this.

Now he had become the sensation, and you see the classic path of the charismatic doctor: somebody who supposedly has special qualities to solve people’s problems. Now the problem with being charismatic as a doctor is you’ve got to deliver, and if you don’t deliver, you lose your audience. That’s why he kept getting more extreme.

By the end of his career of killing he had been charged four times, and every time the charges were dropped. So he began to think that he was immune; he challenged the authorities to charge him.

Finally came the case of Thomas Duke, who had motor-neurone disease. What got Kevorkian charged? 60 Minutes filmed the whole process and afterwards he did an autopsy and he hauled out a bunch of organs like a brace of dead pheasants, waved it in front of the camera, and said: “Organs here! First come, first served!”

So, he was charged with manslaughter, and he still had a chance of getting off. But by this stage he was so far up his own path of vanity, he insisted on defending himself. And he went down.

He was given a lengthy sentence in 1999, and was in jail until 2007. They let him out because it looked like he was going to die from hepatitis – which we remember he caught from his self-infusions of blood from corpses – and the authorities didn’t want him to die in prison.

He died some years after that. But, unlike those 130 people who had disgrace­ful, undignified, humiliating deaths, he died in a nice hospital, with all the care in the world. In the end we can see, despite everything he had done, that he was a hypocrite and his main agenda was for himself.

What can we say about Kevorkian? You see certain things there that are deeply troubling when doctors get into the euthanasia business. First, the further away they are from the actual clinical treatment of patients, the more excited and enthusiastic they get about it. Second, they are marginal. Kevorkian was really a professional failure; he couldn’t stay as a pathologist, he certainly had no clinical skill. His personal life, he played the harpsichord, he got engaged once but he dropped his end of the relationship because he said his fiancée wasn’t “disciplined enough for being his partner”. He tried to sell a movie of Händel’s Messiah to Hollywood; they knocked it back, so he set up a business making baseball caps. He was a completely marginal character.

The other issue is that Kevorkian had an obsession with death; an absolute preoccupation with it, which easily bordered on necrophilia. And for Kevorkian, there was only one interest: his role in death; in facilitating it, superseded by this pretence of helping people, easing suffering, none of which he did.

Dr Robert M. Kaplan is a forensic psychiatrist at the Graduate School of Medicine, University of Wollongong. He has written on the history of medicine and psychiatry, prehistory and archaeology, crime, serial killing and genocide, Jewish history and the Litvak mentality, and moral panic. This article is adapted and slightly shortened from Dr Kaplan’s presentation at the 2017 Life Dinner on July 29.




























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