Morphine, as in the case, is often prescribed in a relatively high dose to those in most severe, chronic pain, and high doses and cumulation of such opioids accelerates dying (including the stronger drug heroin, also used in the case)
R v Adams [1957] is an English case that established the principle of double effect applicable to doctors: that if a doctor "gave treatment to a seriously ill patient with the aim of relieving pain or distress, as a result of which that person's life was inadvertently shortened, the doctor was not guilty of murder" where a restoration to health is no longer possible. Such medicines are among those sometimes used in palliative care (the branch of medicine focussed on the relief of pain), most commonly for the most severe pain.
The case narrowly distinguished and approved the binding precedent R v Dyson[1] which confirms it is no defence, in itself, in offences of homicide, that the victim was already dying from an illness if the defendant's conduct has accelerated death. Doctors have an absolute defence to this where they have "properly" eased the suffering of the patient.
The defendant, John Bodkin Adams, was a doctor who was tried on one count of murder by "easing the passing" of an elderly patient, Mrs Edith Alice Morrell. The police claimed that Adams had murdered a number of elderly patients, and suggested his modus operandi was to administer heroin and morphine with the intention making his patients addicted and under his influence, then to induce them to leave him legacies in cash or kind in their wills and finally to cause their deaths by giving them sufficiently large doses of drugs. One patient's initial bequest included an elderly Rolls-Royce car, she re-decided to leave Adams nothing in her final will. The trial judge, Devlin J., suggested that Hannam had become fixated on the idea that Adams had murdered (or administered excess drugs) to many elderly patients for legacies, and had regarded Adams receiving a legacy as grounds for suspicion.[2] Hannam's team investigated the wills of 132 of Adams' former patients dating between 1946 and 1956 where he had benefited from a legacy, and prepared a short list with around a dozen names for submission to the prosecuting authorities.[3] The list included Morrell, Mrs Gertrude Hullett and two other cases in which evidence had been taken on oath,[4] Devlin considered that Morrell's death, which was chosen by the Attorney-General for prosecution, looked the strongest of Hannam's preferred cases, despite it being six years old, although he noted that some others believed that the Hullett case was stronger.[5]
Trial
The case presented by the prosecution was based on the police investigation. As outlined in the opening speech of the Attorney-General Sir Reginald Manningham-Buller, it was that Adams either administered or instructed others to administer drugs that had killed Morrell with the intention of killing her, that these drugs were unnecessary as she was not suffering pain as she had been semi-comatose for some time before her death. Manningham-Buller suggested that the motive for Adams deciding that it was time for Morrell to die was that he feared her altering her will to his disadvantage.[6] Strictly in the English law of murder, the prosecution did not need to show a motive but, if it did not, it needed to prove the offence by demonstrating precisely how the killing was carried out.[7] Throughout the trial, the prosecution maintained that the motive was a mercenary one; Manningham-Buller did not say that Adams had a primary intention to kill (to euthanise), from his phraseology of the intention of "easing the passing" – according to the trial judge.[8]
The prosecution initially argued that all of the large quantities of morphia and heroin prescribed by Adams in the months leading to Morrell's death had been injected, that this amount was sufficient to kill her, and that it could only have been intended to kill.[9] Adams was accused of murdering Morell by one of two methods, singly or in combination. The first alleged method was as the cumulative result of the amounts of opiates given in the ten months before her death,[10] the second was as the result of two large injections of an unknown, but presumed to be lethal, substance prepared by Adams and injected into Morrell shortly before her death.[11] However, on the second day of the trial, the defence produced nurses' notebooks, which showed that smaller quantities of drugs had been given to the patient than the prosecution had estimated, based on Adams' prescriptions. These notebooks also recorded that the two injections made the night before her death as consisting of paraldehyde, described as a safe soporific.[12]
In response to the defence's production of the nurses' notebooks, one of the prosecution's medical expert witnesses changed his testimony,[13] Dr Douthwaite had introduced a new theory on how Morrell had been killed, which was not accepted by his fellow sworn-in expert, nor the defence's medical expert witness.[14] The prosecution's only riposte was to argue that the nurses' records were incomplete, and the judge commented that, by this point, a conviction seemed to him unlikely because the medical evidence was inconclusive[15]
Judgment
In Devlin's summing up, was said that a doctor has no special defence, but "he is entitled to do all that is proper and necessary to relieve pain even if the measures he takes may incidentally shorten life" (i.e. as a secondary intention). He made one legal direction that established the double effect principle in respect of the mens rea of murder. Where restoring a patient to health is no longer possible, a doctor may lawfully give treatment with the aim of relieving pain and suffering which, as an unintentional result, shortens life. Liability for murder can be avoided if medicine which is beneficial to the patient is given, despite the knowledge that death will occur as a side effect. The second legal direction was that the jury should not conclude that any more drugs were administered to Morrell than shown in the nurses' notebooks.[16]
Devlin also indicated to the jury the main defence argument was that the whole case against Dr. Adams was mere suspicion and that, "...the case for the defence seems to me to be a manifestly strong one".
On these grounds, the jury returned a Not Guilty verdict after deliberating for only forty-six minutes.[17]
Outside the courtroom he opined that the majority of those that had followed the case in The Times law reports expected an acquittal.
It is worth noting the mens rea for murder is governed by the doctrine of intent, set out in the Woollin case, where a defendant is held to have intended the outcome if it is virtually certain and the defendant has appreciated that virtual certainty.[18] Applying this test would create liability in R v Adams but it did not for the legal excuse provided for by the doctrine of double effect.
Reginald Edward Manningham-Buller, 1st Viscount Dilhorne,, known as Sir Reginald Manningham-Buller, Bt, from 1954 to 1962 and as The Lord Dilhorne from 1962 to 1964, was an English lawyer and Conservative politician. He served as Lord Chancellor from 1962 to 1964.
John Bodkin Adams was an Irish-born British general practitioner, convicted fraudster, and suspected serial killer. Between 1946 and 1956, 163 of his patients died while in comas, which was deemed to be worthy of investigation. In addition, 132 out of 310 patients had left Adams money or items in their wills.
Nolle prosequi, abbreviated nol or nolle pros, is legal Latin meaning "to be unwilling to pursue". It is a type of prosecutorial discretion in common law, used for prosecutors' declarations that they are voluntarily ending a criminal case before trial or before a verdict is rendered; it is a kind of motion to dismiss and contrasts with an involuntary dismissal.
In English criminal law, intention is one of the types of mens rea that, when accompanied by an actus reus, constitutes a crime.
Patrick Arthur Devlin, Baron Devlin, PC, FBA was a British judge and legal philosopher. The second-youngest English High Court judge in the 20th century, he served as a Lord of Appeal in Ordinary from 1960 to 1964.
In English law, the defence of necessity recognizes that there may be situations of such overwhelming urgency that a person must be allowed to respond by breaking the law. There have been very few cases in which the defence of necessity has succeeded, and in general terms there are very few situations where such a defence could even be applicable. The defining feature of such a defence is that the situation is not caused by another person and that the accused was in genuine risk of immediate harm or danger.
An error of impunity is a lapse in the justice system that results in criminals either remaining at large or receiving sanctions that are below a socially optimal level. The term is used in Brian Forst's book Errors of Justice and in Robert Bohm's introduction to a special edition of The Journal of Criminal Justice on miscarriages of justice. If convicting an innocent person, called a miscarriage of justice, is a Type I error for falsely identifying culpability, then an error of impunity would be a Type II error of failing to find a culpable person guilty.
Hugh James Delargy was a Labour Party politician and MP.
Benjamin Geen is a double murderer who killed two patients and committed grievous bodily harm against 15 others while working as a nurse at Horton General Hospital in Banbury, Oxfordshire in 2003 and 2004. Geen was believed to be motivated by his 'thrill-seeking' temperament, and injected a number of patients with dangerous drugs in order to cause respiratory arrest so he could enjoy the 'thrill' of resuscitating them. He was apprehended after staff at the hospital noticed that it was always when he treated patients, most of whom only had minor injuries such as dislocated shoulders, that they inexplicably had respiratory failures. Upon his arrest, a syringe full of some of the drugs he used to attack patients was found on his person. When he saw officers approaching, he discharged the syringe contents into his jacket pocket in an attempt to hide the fact he had removed potentially lethal drugs from the hospital without authority. He was found guilty at trial in 2006 and sentenced to a minimum of 30 years imprisonment.
The Ann Arbor Hospital murders were the murders of 10 patients by unauthorized administration in their IV of the curare drug Pavulon in an Ann Arbor, Michigan, VA hospital in 1975. After a vast FBI investigation into the deaths, the nurses Filipina Narciso and Leonora Perez were charged with murder but convicted only for the charges of poisoning and conspiracy. Public opinion was against prosecution of the nurses on the basis that they could have had only the most trivial of possible motives for conspiring to commit such extremely serious crimes, and the case was dropped after a retrial had been ordered.
Gertrude "Bobby" Hullett, a resident of Eastbourne, East Sussex, England, was a patient of Dr John Bodkin Adams, who was indicted for her murder but not brought to trial for it. Adams was tried in 1957 for the murder of Edith Alice Morrell, and the prosecution intended to proceed with the Hullett indictment as a second prosecution that could follow the Morrell case in certain circumstances, although it did not bring the case to trial following the verdict in the Morrell trial.
Edith Alice Morrell was a resident of Eastbourne, East Sussex, England, and patient of Dr John Bodkin Adams. Although Adams was acquitted in 1957 of her murder, the question of Adams' role in Morrell's death excited considerable interest at the time and continues to do so. This is partly because of negative pre-trial publicity which remains in the public record, partly because of the several dramatic incidents in the trial and partly as Adams declined to give evidence in his own defence. The trial featured in headlines around the world and was described at the time as "one of the greatest murder trials of all time" and "murder trial of the century". It was also described by the trial judge as unique because "the act of murder" had "to be proved by expert evidence." The trial also established the legal doctrine of double effect, where a doctor giving treatment with the aim of relieving pain may, as an unintentional result, shorten life.
Herbert Wheeler Walter Hannam was a British policeman within the Metropolitan Police Service. He was based at Scotland Yard where he held the rank of Detective Superintendent.
Michael George Corbett Ashby, MRCP, FRCP was a consultant neurologist at the Whittington Hospital, London and an expert witness for the prosecution in the failed trial of suspected serial killer John Bodkin Adams.
Malcolm John Morris QC was an English lawyer. He was involved in many high-profile cases, such as the prosecutions of suspected serial killer John Bodkin Adams and pop star Mick Jagger, and the defence of Timothy Evans.
John Bishop Harman, FRCS, FRCP was a British physician, president of the Medical Defence Union and chairman of the British National Formulary. He was also notable as a medical expert witness for the defence in the trial of suspected serial killer John Bodkin Adams. His daughter, Harriet Harman, is a senior Labour Party politician.
Colin Campbell Norris is a serial killer nurse from Milton in Glasgow, Scotland, who murdered four "difficult" elderly patients and attempted to murder another in two hospitals in Leeds, England in 2002. Norris, who self-admittedly disliked elderly patients and had previously stolen hospital drugs, was the only person on duty when all the five patients inexplicably fell into sudden hypoglycaemic comas, despite the non-diabetic women only being in minor injury wards with merely broken hips. Suspicions were raised when Norris predicted that healthy Ethel Hall would die at 5:15 am one night, which is when she fell into a catastrophic arrest, and tests revealed that she had been injected with an extremely high level of man-made insulin. Insulin was missing from the hospital fridge and Norris had last accessed it, only half an hour before Hall fell unconscious. Subsequent investigations would find that the unnatural hypoglycaemic attacks followed him when he was transferred to a second hospital, and hospital records revealed that only he could not be eliminated as a suspect. Detectives believed that Norris was responsible for up to six other suspicious deaths where only he was always present, but a lack of post mortem evidence and other factors meant that investigators and the Crown Prosecution Service could not pursue convictions for these deaths. The murder inquiry was led by Chris Gregg and the investigation was praised for its thoroughness.
Arthur Henry Douthwaite was a British medical doctor, Vice President of the Royal College of Physicians and a prolific medical textbook writer. He was described as the foremost expert on heroin in Britain in the 1950s, or as a leading authority on opiates and he was called as an expert witness for the prosecution in the trial of Dr John Bodkin Adams for the murder of Mrs Edith Morrell.
Sir Frederick Geoffrey Lawrence QC was a British lawyer, High Court Judge, Chairman of the Bar Council and Chairman of the National Incomes Commission. He first came to prominence when he defended Dr John Bodkin Adams in 1957 on a charge of the murder of Mrs Edith Alice Morrell, the first murder case he handled. Prejudicial press coverage of the case prior to the trial suggested Adams was guilty and that the verdict would be a foregone conclusion, but Lawrence successfully secured an acquittal. Adams, if convicted, night have been hanged, had he also been found guilty on a second murder indictment that had been brought. Devlin at the time and later investigation suggested Adams was acquitted in part due to inadequate prosecution preparations and also due to the lack of strong and credible evidence.
Thomas Lodwig was an English doctor, accused of murdering a patient with terminal cancer in 1990. He was acquitted after the prosecution offered no evidence at his trial.
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