Share your views on this issue

Dr KK Aggarwal

You need to be not only scientifically correct in your clinical practice, but also legally, ethically and morally correct. Being scientifically correct alone may not be enough to save a doctor from an action. Always seek legal counsel from the hospital lawyer/s, when in doubt.

In an identical twin birth in Berlin, which happened in July 2010 to a 27-year-old female, two gynecologists are said to have killed the second child suffering from severe brain damage with potassium chloride, after delivery of the healthy child.

The case is now in the Berlin district court and doctors have been charged of manslaughter of the brain damaged child.

It was 5:16 pm when the patients abdominal wall was opened. Four minutes later, a 40 cm long and 1670 gm girl was born and abgenabelt (cutting the umbilical cord). Then the gynaecologists clamped the umbilical cord of the second twin so that the blood supply was interrupted. They then injected 20 ml of potassium chloride into the umbilical vein.

When the heartbeat stopped, they gave birth to the second girl dead. The complaint was made three years later – anonymously.

Three years later, the prosecutor brought charges against the doctors.

Legal question: Did they commit a feticide or manslaughter, when injecting a severely brain damaged second twin with potassium chloride before delivery, after delivering the healthy sibling by c-section? Though, the mother and family clearly gave their informed consent.

Scientific evidence: There is no literature on these kinds of situations.

Allegation: Only before onset of labour and thus before birth a “selective fetozid (feticide)”can be made. 

Legal Dilemma

What is the time when the birth starts: Is it with the beginning of the opening labor or with opening of the uterus in the case of a cesarean section? After that it is a human and not a fetus.

Questions

• Was the consent taken? Yes
• Was the brain damage confirmed? A prenatal specialist study had recently identified a high-grade brain injury in a twin.
• What were the options? The affected twin is killed by an electro- or laser coagulation of the umbilical vein and remains with the healthy twin until birth in the uterus OR delivery of the healthy child and then a feticide in the womb on the assumption that as long as the fetus is in the uterus, it is a fetus.
• Why was the legal advice not taken before deciding the action?

Kindly share your views on this, just if you had been called as an expert.

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA