2016-45, medical specialist, cancer, not acted in accordance with the due care criteria

KEY POINT: no consultation with an independent physician, relationship of authority and therefore of dependence between the two physicians

In this case a specialist consulted a colleague who worked in the same hospital department. The committee asked the notifying physician to further explain in a meeting the way in which the consultation with an independent physician had been dealt with. In an earlier written response the physician had already explained that he had asked a colleague from his department, who was a member of the hospital’s palliative team, who he could approach for an independent consultation.

The notifying physician had never performed euthanasia in this hospital before. None of the people suggested by the colleague were available. Given the urgent wish of the patient in question that there be no delay in the procedure on account of logistical issues, the colleague had offered to act as independent physician.

The committee remarked at the meeting that SCEN physicians can also respond very quickly, so there would not necessarily have been a delay.

The physician and his colleague had considered the issue of whether their both working in the same department would prevent the colleague from acting as the independent physician. They assumed, however, that the colleague would only be unable to be the independent physician if he had been treating the patient, which was not the case.
As regards the relationship between the physician and the colleague who was consulted as the independent physician, the physician explained that although he was head of the department and therefore formally in a hierarchical relationship with his colleague, the department was a very ‘flat’ organisation. Everyone managed and was responsible forntheir own patient group. For that reason the physician was of the opinion that this colleague would be able to give an independent assessment.

The committee considered that the independent physician must be able to give an independent and autonomous assessment. The purpose of the independent consultation is to ensure that the physician’s decision is reached as carefully as possible. Any suggestion that he is not independent must be avoided. There can in principle be no question of independence in relation to the physician if the independent physician is from the same medical practice or partnership, if there is a relationship of dependence with the physician, or if there is a family relationship between them.

The committee is of the opinion that in this case there was a relationship of authority, and therefore a relationship of dependence, between the physician and the independent physician. This was not changed by the fact that the department was a ‘flat’ organisation in which everyone was responsible for their own patient group, according to the committee.

The committee found that, although the physician consulted one other physician, who saw the patient and gave a written opinion on compliance with the statutory due care criteria, the due care criterion of consulting an independent physician was not complied with.