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New euthanasia precedent?

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  • New euthanasia precedent?

    Ohio ICU physician acquitted of 14 murder counts for fentanyl dosing after a week of deliberation.

    Some patients received up to 2000 mcg.

    Initially charged with 25 counts, had 11 dropped. Wide age range.

    Hospital CEO resigned. Over 20 nurses, pharmacists, and managers fired.

    $16M paid out so far in civil cases for at least 17 patients, more pending.

    Very interesting.

  • #2
    “Prosecutors said ordering such dosages for a nonsurgical situation indicated an intent to end lives. Husel’s attorneys argued he was providing comfort care for dying patients, not trying to kill them.”
    ”"It's very important for the physician to give an accurate and honest update of the clinical situation so the family is well informed of how sick this patient really is,"

    With the lawsuits, he probably was not communicating what exactly he was prescribing. Not exactly “informed consent”.
    The is a difference between euthanasia and his actions. This seems to be he alone decided on fatal doses (intended or not). Euthanasia would mean no civil lawsuits. There is a pattern here and it is not a good one.


    • #3
      If you are going to prescribe fentanyl , you better have a good signed and written plan with the patients , POA and loved ones involved. The outcome of death by disease and or death by fentanyl with the disease as the underlying factor is predictable. I dont prescribe fentanyl but I would assume with the dose listed, an unintentional error or misjudgment can likely be fatal as well, or at least be misconstrued as being intentional.


      • #4
        Doses were not mistakes. Mostly in the setting of palliative extubation, often with family at bedside.

        True informed consent in that setting is of course a concern.

        Euthanasia--whether or not that's what this is--would not necessarily mean no lawsuits. Families bring wrongful death lawsuits all the time.

        Additional Medscape article (which of course has multiple pages for click generation):


        • #5
          Hard case and impossible to judge without knowing the medical records. Opiate tolerance often leads to escalating doses while in the ICU and palliative doses tend to be higher than those used for pain/sedation. Just listing a high fentanyl dose means very little without clinical context.

          I also found listing the names and credentials of some of the prosecution witnesses interesting while referring to the defense witness as an anesthesiologist from Georgia. Why not give Dr. Zivot’s name and explain that he is also an intensivist, ethicist who writes and speaks about end of life care and an opponent of euthanasia.


          • #6
            Complex case. I am not sure it benefits society keeping him locked up. His career is over.


            • #7
              Love that the prosecution doctor was from Vanderbilt. They just love criminalizing people.

              Dont know details of case, but have seen plenty of palliative care in ICU, etc...This was always communicated to family and they were usually at bedside.

              Could easily see it spun as the above case, and you could argue those docs were too aggressive, and maybe to avoid this we need a whole lot better algorithms and definitely more communication about reality with family and futility of care.


              • #8
                “definitely more communication about reality with family and futility of care.”
                This. Much is litigated when the family is not accepting end of life. Messy and complex.
                Gets a lot of local coverage.


                • #9
                  The guy is ahead of his time.
                  Medical-assisted end of life is a lot like porn... everyone shames it, but almost everyone secretly supports it or uses it.

                  I would hope he's acquitted. Our pets die with more dignity than our great uncle does.
                  It seems that in sexual harassment or homophobia, we like to judge acts done decades ago by today's standards. For the medical euthanasia, we judge today's actions by old standards. The laws will continue to change state-by-state, just like for homosexual or religion in schools or marij and other things, but as a "pioneer," he and the facility are up a creek for sure - just like Kevorkian.


                  • #10
                    These were all terminal extubations for patients dying despite ICU care. The doses of narcotics/sedatives were definitely a "heavy hand," but as the defense successfully argued, the highest doses were given to those with high opiate tolerance who were in respiratory distress following terminal extubation, not in some sort of pattern to dispatch patients quickly. The doses were definitely higher than I typically use in these scenarios, but I am relieved he was acquitted because a guilty verdict would throw the entire practice of compassionate terminal extubation into jeopardy. Patients do suffer anxiety and air hunger when removed from the ventilator, and if giving narcotics or anxiolytics (at any dose) runs the risk of lost license/murder charges/life ruined, most docs aren't going to do it and would rather let them sit on the ventilator instead.