A doctor accused of homicide after sedation, what does the medical procedure say?

in collaboration with

Dr Gérald Kierzek (Medical Director)

At the Angoulême hospital center, a doctor did the unthinkable. He is accused of having killed a sixty-year-old suffering from Down syndrome. How can we explain such an incident? And what are the key elements to take into account when deciding on deep sedation? Responses from Dr Gérald Kierzek, medical director of Doctissimo.

A powerful sedative was administered

The facts date back to January 6, 2023. According to information from South Westa 66-year-old patient with Down syndrome is admitted to the emergency room.for simple examinations due to respiratory distress“.

The patient is agitated – “he was afraid of white coats and screamed” specifies a caregiver interviewed – but is nevertheless in good health. He is conscious and his blood is perfectly oxygenated. According to the family’s lawyer, the sixty-year-old’s medical file “even plans a quick return home“.

However, a few hours later, the man died. The doctor who took care of him allegedly administered morphine and a powerful sedative – the use of which is strictly regulated.

Another point of negligence on the part of the doctor in question: he did not convene a group of caregivers before administering this sedative, nor warned his relatives of this sedation (his sister and guardian was nevertheless present on site).

In fact, this sedation is never a matter of “individual decision.”

Deep sedation: what key elements should be considered when making the decision?

According to the French Society of Emergency Medicine (SFMU)the implementation of deep sedation follows a strict process.

Here are the key steps that must be followed.

• First of all, it is essential to seek the patient’s wishes, “either by his direct expression if he is able to formulate it, or through his advance directives, or, failing that, through the testimony of his trusted person or those close to him“.
• When this will is not known, “age should not be the only criterion taken into account when making a decision.”
• Every effort must be made to retrieve the patient’s complete medical file, as well as information concerning previous autonomy, cognitive state and previous quality of life. “The notions of very altered general condition, cachexia, loss of autonomy, disabling cognitive disorders, but also the possibilities of curative treatments, will help in deciding the level of care, particularly in a patient suffering from ‘an advanced chronic pathology, with an unfavorable vital prognosis.”
• We must compare the expected benefit”with the severity of the therapies envisaged and the possible impact of the treatments or a stay in intensive care.”
• Systematic admission to intensive caredoes not contribute to improving the prognosis and quality of life of very elderly patients. Autonomy is a key element of decision-making and the GIR classification can constitute a decision-making tool. GIR1 patients (people confined to bed or chair, whose mental functions are seriously impaired and who require the essential and continuous presence of caregivers) should a priori not receive treatment aimed at prolonging life, but only those aimed at improve their comfort.”
• In acute pathologies with a poor vital and functional prognosis potentially requiring exceptional treatment, such as craniectomy during malignant strokes, it is legal to initiate wait-and-see resuscitation before collecting the necessary information. “Thus, the level of therapeutic commitment must be discussed on a case-by-case basis with the patient, or failing that, their loved ones, and the resuscitator.”