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A consultant neonatologist who gave lethal doses of the muscle relaxant pancuronium to hasten the deaths of two premature babies from whom treatment had been withdrawn was this week cleared of an act “tantamount to euthanasia” by the UK General Medical Council.
Michael Munro was found to have misled a hospital colleague investigating the deaths, and to have kept inadequate notes of the cases. But Dr Jacqueline Mitton, chairwoman of the GMC's fitness to practise panel, said these findings were not serious enough to suggest that Dr Munro's fitness to practise was impaired.
“I am satisfied that you have insight into the failings highlighted by this case,” she told Dr Munro. “It is neither necessary nor proportionate to issue a warning to you.” While hastening death had been an “anticipated consequence” of giving such a dose of pancuronium, the panel found, Dr Munro's primary purpose had been to relieve suffering.
Dr Munro was working at Aberdeen Maternity Hospital when the two cases occurred, in June and December 2005. In both cases, the hearing was told, Dr Munro and the infants' parents had agreed to withdraw treatment, giving only morphine as a palliative agent.
Baby X, born two weeks premature in December 2005, had a serious brain haemorrhage with considerable injury. Baby Y, born three months premature in June 2005, had pulmonary hypoplasia and pulmonary hypertension.
When the decisions were made to cease care in both cases, the babies were removed from ventilation, infused with morphine, and given to their parents to nurse. But Dr Munro told the hearing that both infants had started agonal gasping. This, he said, was “horrendous to witness.”
In the case of Baby X, he told the hearing that he had returned to certify death after the child had apparently stopped breathing. But the infant still had a heartbeat and began agonal gasping. “I felt the baby looked distressed because the baby's whole body was being wracked by these movements,” he told the hearing in Manchester. “There was movement of the limbs and chest . . . I couldn't see how this could not be distressing.”
Baby Y also went into agonal gasping soon after he returned to certify death. The parents, he said “were utterly distraught. If you put yourself in their shoes, they have already said their last goodbyes to their baby, then suddenly there are these massive, racking agonal gasps that appeared to build up—they were utterly, utterly distraught. The parents were in tears, saying things like ‘I can't take any more.'
I took the decision then to administer pancuronium.”
He added, “I explained to the parents that this drug was to be used to ease the suffering but that one of the consequences of its use may be to hasten death. They were happy with that.”
Andrew Long, counsel for the GMC, acknowledged that the parents of both infants had no complaints about the care provided by Dr Munro.
A number of charges were dropped during the course of the hearing. Among them was the charge that Dr Munro failed to record giving pancuronium to baby X, and the charge that he failed to warn the parents of baby Y about agonal gasping.
The GMC also dropped a charge that his conduct breached the guidelines of the Royal College of Paediatrics and Child Health on withholding or withdrawing life sustaining treatment in children.
Dr Roelf Dijkhuizen, medical director of Dr Munro's employer NHS Grampian, said in a statement: “The treatment given to both babies was not part of accepted practice and therefore following a thorough investigation the decision was taken to refer Dr Munro to the GMC. We note the findings of the panel and agree with their view that Dr Munro's actions were taken with the best interests of the babies and their families in mind.”
He added: “Since the incidents came to light, a protocol for all end of life decisions has been put in place.”
Speaking outside the hearing, Dr Munro expressed relief and thanked his supporters, adding: “I very much regret any distress that has been caused to the parents of both babies by these proceedings before the GMC. I hope that today's decision will promote further consideration of the treatment of neonates and end of life decision making and that this, in turn, will lead to clearer professional guidance for doctors, better patient care and greater support for parents.”