Clarification

A FAMILY who claimed their elderly mother endured a terrifying death after being deliberately starved by a hospital doctor put their case before a coroner yesterday.

Norfolk and Norwich University Hospital allegedly decided that Olive Knockels, a former school matron who had suffered a stroke, would have no quality of life if she recovered. The case, in 2003, prompted renewed debate about guidelines giving doctors the power to let elderly patients starve.

An inquest was told that Mrs Knockels, 91, died despite a court injunction forcing doctors to reinstate nutrition and hydration as well as antibiotics. They were also told to stop prescribing the powerful painkiller diamorphine without the written consent of the patient’s daughter, Ivy West.

The order was made by Mr Justice Forbes in the High Court on October 6, 2003, after an application by Mrs Knockels’ grandson, Christopher West. Four days earlier all food and fluid had been withdrawn. The next day, however, the order was varied by the judge when David Maisey, a consultant, telephoned him. In the amended order, of October 7, nutrition and hydration were to be reinstated only “so far as is medically possible”.

On October 8, Mrs Knockels, from Holt, Norfolk, died.

In a statement to William Armstrong, the coroner, Mrs West said her mother had begged her for something to eat and drink, or a cup of tea, but the request was refused by a nurse, on the doctor’s orders. Her last days were spent with her false teeth and hearing aid removed from her bedside, in a cold hospital room.

She was admitted on September 14, 2003, after a suspected stroke.After two weeks Dr Maisey allegedly told Mrs West that he was surprised her mother was still alive and said that if the family intervened, he would have them arrested.

Mrs West said that on another visit her mother had looked terrified and had tried, unsuccessfully, to tell her something. Three days later she pleaded with her daughter: “Help. Help me please.”

The family contacted SOS-NHS Patients in Danger, which has criticised deliberate dehydration and starvation and the inappropriate use of sedatives and diamorphine. Julia Quenzler, the founder of the organisation, advised the family of their legal rights and the High Court injunction followed.

In a statement, Christopher West said: “I told Dr Maisey: ‘I wouldn’t treat my dog like that’, and he said it was easier for vets because they . . . can put animals to sleep.”

When Mrs Knockels was admitted, she was given intravenous fluids but, ten days later, nurses found they could not gain access to a vein so it was decided fluids would be given by subcutaneous infusion. But, the inquest was told, on October 2, medical staff found fluid leaking and the removal of the equipment was ordered. Two attempts were said to have been made to insert a naso-gastric tube, but without success.

Dr Maisey told the coroner: “The prognosis was very poor. Mrs Knockels was almost certain to die . . . within the next few weeks. She was lying flat. To have put any food or liquid in her mouth would have led possibly to asphyxiation.”

The cause of death had been recorded as cerebral infarction, but Michael Jarmulowicz, a consultant histopathologist, told the coroner that death was due to a lack of food and fluid and that the cerebral infarction was the secondary cause of death.

The inquest was adjourned to a date to be announced.