Doctors bear immense responsibility that extends far beyond the immediate treatment of patients. Medical errors can have not only health consequences but also legal repercussions. Allegations of negligent homicide or even manslaughter pose significant challenges for affected doctors, threatening their professional and personal existence. This article outlines the legal foundations of negligent homicide and manslaughter in the medical field, using examples and recent court decisions to illustrate how doctors can be held liable through both actions and omissions.
Negligent Homicide: Legal Foundations
Under Section 222 of the German Criminal Code (StGB), anyone who causes the death of a person by violating the required duty of care is guilty of negligent homicide. In the medical context, this means that a treatment error occurs when a doctor deviates from recognized medical standards, and this deviation is causally linked to the patient’s death.
Actions and Omissions
Negligent homicide by doctors can occur through both actions and omissions:
Actions: An example of negligent actions is the misconduct during surgery, as demonstrated in the case of the Higher Regional Court (OLG) Hamm (Decision of 08.06.2005). In this case, doctors performed a laparoscopic gallbladder removal and failed to recognize the anatomical situation, resulting in the severance of the main bile duct. This erroneous action ultimately led to sepsis and the patient’s death. The court identified a clear violation of medical standards, as the doctors failed to correctly identify and delineate the bile ducts.
Omissions: Omissions can also lead to negligent homicide when a guarantor’s duty to act is present. A notable example is the Federal Court of Justice (BGH) ruling (Judgment of 02.02.1979), where a doctor failed to perform necessary diagnostics on time for a patient. The patient died from an undiagnosed illness. The court ruled that the omission of necessary diagnostic measures constituted a breach of the doctor’s duty of care, rooted in the guarantor obligation, since the doctor, by undertaking treatment, was obligated to perform a diligent diagnosis.
Special Considerations and Challenges
In practice, a range of factors can contribute to a breach of duty of care. Organizational deficiencies in hospitals, fatigue, and stressful situations, especially for beginners in the profession, can play a role.
The case of the Local Court (AG) of Cologne (Judgment of 16.05.2012) illustrates how structural deficiencies and excessive working hours of a young resident led to a fatal error: The mix-up of blood transfusions resulted in the death of a patient. This error was significantly influenced by stress-related concentration lapses, exacerbated by the hospital’s organizational shortcomings.
Manslaughter in the Medical Context: BGH Decision of May 29, 2024 (Ref. 4 StR 138/22)
In addition to negligent homicide, there are cases where doctors are accused of intentional actions that can lead to a conviction for manslaughter. One such scenario was addressed in the BGH decision of May 29, 2024.
Facts and Legal Assessment
The accused, a specialist in anesthesiology, worked in an intensive care unit and was responsible for a severely COVID-19-infected patient. Despite intensive medical measures, the patient’s condition deteriorated. The accused decided to terminate life-sustaining measures and administered high doses of medications, including potassium chloride, intending to cause the patient’s death.
The Essen Regional Court initially convicted the accused of manslaughter, assuming that the administration of the medications was causally linked to the patient’s death. However, the BGH overturned this judgment due to insufficient proof of causality for the potassium chloride administration. It was unclear whether the medications actually caused the death or if other factors, such as severe pneumonia and multi-organ failure, played a decisive role.
Key Legal Aspects
The case highlights the challenges in distinguishing between permissible palliative care and criminal homicide. The focus is on the questions of causality and intent:
- Causality: The doctor’s action must be seen as a necessary condition for death based on recognized scientific principles. In cases where the patient is already in the process of dying, it must be determined whether the medical intervention actually accelerated death.
- Intent: It is crucial to assess whether the doctor acted consciously and deliberately with the intention of causing death. Intent to kill can also play a role in balancing medical necessities with ethical considerations.
Conclusion: The Importance of Adhering to Medical Standards and Legal Awareness
Doctors should be aware of the legal risks associated with their treatment decisions. Both negligent homicide and manslaughter can have severe legal consequences. Courts are required to carefully examine the individual circumstances of each case to fairly distinguish between permissible medical treatment and criminal behavior.
For doctors, it is essential to always act according to current medical standards and to identify and address organizational deficiencies early on. In defending against criminal charges, it is critical to thoroughly examine all relevant circumstances—such as stress factors, organizational shortcomings, and the medical necessity of certain actions—to achieve a nuanced and just evaluation of the individual case.
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