Lillian Boyes, 70, died within minutes of being injected with a fatal dose of potassium chloride at the Royal Hampshire County Hospital in Winchester on 16 August last year. Nigel Cox, 46, a consultant rheumatologist, denies attempted murder.
Neil Butterfield, QC, for the prosecution, told the court that Mrs Boyes had been suffering from acute rheumatoid arthritis for 20 years as well as serious complications including internal bleeding, which required major blood transfusions, and painful body abcesses. She received regular in-patient treatment at the hospital, where she came under Mr Cox's care in 1978.
However, she endured this 'appalling catalogue of disease, pain and disability' with great fortitude and good humour, Mr Butterfield told Mr Justice Ognall. 'She was by all accounts a courageous, determined and perhaps rather forceful lady who accepted her medical condition and was determined to make the very best of it.'
But about a fortnight before her death Mrs Boyes suffered a family bereavement, the third within months, and her condition deteriorated. Now in constant and considerable pain, she told medical staff and her two sons that she no longer wished to receive medication except for painkillers.
Mr Butterfield said: 'She told them that she had had enough. She did not want to carry on; she had no more fight left in her; she had given up.' Her sons agreed with her decision. Mrs Boyes asked Dr Cox, 'an experienced and highly-qualified doctor', to give her a fatal injection but he declined, explaining that he was not permitted. He wrote in her clinical notes two days before she died: 'She still wants out and I don't think we can reasonably disagree.' When increasingly large doses of heroin failed to alleviate her pain, he finally acceded. After she had died in the presence of her sons, Dr Cox recorded the injection of potassium chloride - normally administered only to boost potassium deficiency - in Mrs Boyes' medical notes, where it was seen by the ward sister who informed the hospital authorities.
Mr Butterfield told the jury that they were trying 'an unusual and distressing case' and warned them not to let their judgement be clouded by emotions or prejudice.
'This is not about whether active intervention by doctors to shorten life should be allowed by law. We are not here to debate the difficult philosophical questions of mercy killing and euthanasia.
'The defendant's intention was to kill Mrs Boyes and the motive was to end her suffering. But the deliberate killing of a helpless person, whatever the wishes of that person may be, is neither the right nor the duty of a doctor. What Dr Cox did, however worthwhile and understandable his motives, was a criminal act.'
Mr Butterfield said that the charge was attempted murder because Mrs Boyes had been cremated before a full inquiry was launched and the prosecution could therefore not prove that the potassium chloride killed her.
Sydney Kentridge, QC, defending, said that Dr Cox did not deny administering the injection and that the defence would hinge on his intention at the time.
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