Dr. Nancy Morrison and her dying patient: a case of medical necessity.
Bibliographic record
Abstract
1. Prologue On May 6, 1997, 60 police officers swarmed into the Queen Elizabeth II Health Sciences Centre (QEII) in Halifax, Nova Scotia, in order to effect the arrest of physician, Dr. Nancy Morrison, on charge of first-degree murder in connection with the death of patient six months earlier. They also carried out searches of 21 locations pursuant to search warrant. The patient had died in the intensive care unit (ICU) two and half hours after his removal from artificial life support, and months later physician at the hospital had informed the police that Dr. Morrison had unlawfully caused his death. A preliminary inquiry was held in Provincial Court where Randall P.C.J. discharged Dr. Morrison after ruling that a Jury properly instructed could not convict the accused of the offence charged, any included offence, or any other offence. (1) When the Crown's appeal was denied by Supreme Court judge, (2) it decided to pursue the matter no further. The case of R. v. Morrison thus never went to trial. This article has dual purpose: to present and analyze the legal repercussions of the patient's death, and then to consider the viability of defence of medical necessity if the case had gone to trial. On the day of his death the patient received massive infusions of drugs, and the precise dosages and times of administration will be duly noted. (3) A brief review of the drugs in question will assist the lay reader to appreciate the situation as it unfolded. All told, between 6:50 a.m. and 2:30 p.m. on his last day the patient received intravenously four drugs to ease his dying: Ativan, Versed, morphine, and Dilaudid. (4) Ativan (generic name lorazepam) and Versed (generic name midazolam) are sedative-hypnotic and anti-anxiety drugs. He received 10 mg of Ativan which is not an unusual amount. However, the amount of Versed was in excess of 230 rug, whereas the recommended common of Versed for the intractable distress of dying patient is 30-60 mg/24 hours. Hence the total given (mostly between 12:30 p.m. and 2:30 p.m.) was four times the highest daily dose recommended for such cases. Morphine is an opiate analgesic (in lay terms, pain-killer), whereas Dilaudid is synthetic opiate and is five to eight times more potent than morphine. The patient received 40 rug of morphine and in excess of 800 mg of Dilaudid. In effect, then, this amounted to somewhat more than 4400-6800 rug of morphine equivalents. To place this drug history in context, consider study appearing in the journal, Palliative Medicine, which reviewed 30 cases in which morphine was administered to relieve the intractable distress of dying patients. The dose range over 24 hours was between 150-600 mg for 18 patients, 600-2500 mg for nine patients, 2500-5000 rug for one patient, and in excess of 5000 mg for two patients. (5) In other words, Mr. Mills was given more opiates than 90 per cent of these patients and comparable amounts to the other 10 per cent. Beyond that, the time frame for all 30 patients was 24 hours whereas his was only seven hours and 40 minutes. A case reported in the journal, Clinical Pharmacy, provides the drug history of terminally ill cancer patient who required exceptionally high doses of narcotic analgesics to control chronic, severe pain. (6) Over the last few days of her life, her daily intravenous (IV) intake of morphine was in the range of 8100-8500 mg. (7) Again, note that in less than eight hours Mr. Mills received in excess of 4400-6800 rug of morphine equivalents. In sum, one can say that Mr. Mills received what was clearly an extraordinary (although not unheard of) amount of opiates. 2. The Day of the Patient's Death Paul Mills was 65 years old and he was very sick man; on November 9, 1996 his caregivers and family agreed that the time had come for him to die. His medical history was as follows. Mr. Mills was admitted to the Moncton (New Brunswick) General Hospital in April 1996 with cancer of the esophagus. …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".