Abstract
In June of 2009, Michael Jackson died following a cardiac arrest. Jackson suffered from severe insomnia and anxiety, and Dr. Conrad Murray, a physician hired to look after Jackson’s medical needs during preparations for a major world tour, had apparently undertaken to treat Jackson’s insomnia in his home using a drug with known deadly potential: propofol. This is not a pediatric case, nor is it even typical in cases of medical negligence. But the Michael Jackson case illustrates many issues concerning legal standards with regard to negligence when it results in a patient death and practice standards with regard to sedation, professionalism, and the ethical obligations of physicians. In this chapter, we will undertake to discuss the Jackson case from both legal and professional perspectives, and then to compare elements of the Jackson case with that of another case of sedation that also ended in patient death, but not in criminal charges of homicide.
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Notes
- 1.
Please refer to glossary for definition.
- 2.
Please refer to glossary for definition.
- 3.
Please refer to glossary for definition.
- 4.
Please refer to glossary for definition.
- 5.
Please refer to glossary for definition.
- 6.
Opening statements of David Walgren and Ed Chernoff from trial.
- 7.
County of Los Angeles Autopsy Report 2009-04415.
- 8.
Opening statements of David Walgren and Ed Chernoff from trial.
- 9.
Transcript of Recorded Interview of Conrad Murray.
- 10.
California Penal Code, Section 187(a).
- 11.
California Penal Code, Section 188.
- 12.
Please refer to glossary for definition.
- 13.
California Penal Code, Section 192.
- 14.
Pennsylvania—Commonwealth v. Yuknovich, 295 A.2d 290 (1972); Virginia—Moxley v. Commonwealth, 77 S.E.2d 389, 393 (Va. 1953) (stating that “malice is the essence of murder”); Georgia Code Sec. 16-5-1, defining murder as a killing committed with malice aforethought.
- 15.
Pennsylvania—18Pa.C.S. Sec. 2504, requiring an act committed in a grossly negligent or reckless manner, Commonwealth v. Agnew, 398 A.2d 209 (Pa.Super.Ct. 1979), defining criminal negligence as a great departure from the standard of ordinary care evidencing disregard for human life; Texas Penal Sec. 19.04, defining manslaughter as occurring when the actor causes a death through reckless acts, with recklessness defined as being aware of but consciously disregarding a substantial risk that death will occur. Sec. 19.05, defining criminally negligent homicide as occurring when the actor causes a death through criminal negligence, further defined as occurring through an act that one ought to be aware creates a substantial risk death; Virginia—Gallimore v. Commonwealth, 436 S.E.2d 421, 445 (Va. 1993), stating that gross negligence, required for involuntary manslaughter, is a reckless or indifferent disregard of the rights of others, under circumstances reasonably calculated to produce injury; Georgia Code Sec. 16-5-3, defining involuntary manslaughter as causing the death of another in the commission of an unlawful act, other than a felony, or in the commission of a lawful act in an unlawful manner likely to cause death or great bodily harm; Illinois—720 ILCS 5/9-3, defining involuntary manslaughter as killing an individual by an act that is likely to cause death or serious bodily injury, when that act is performed recklessly.
- 16.
Please refer to glossary for definition.
- 17.
The People v. Stanley Burroughs, 35 Cal. 3d 824 (1984).
- 18.
The People v. Stanley Burroughs, supra at 833.
- 19.
Ibid.
- 20.
Conrad Murray Trial—Judge’s Instructions to Jury.
- 21.
Please refer to glossary for definition.
- 22.
Conrad Murray Trial—Opening and Closing Arguments of Ed Chernoff.
- 23.
For further reading on basic principles in medical ethics, see Beachamp T, Childress JF. Principles of Biomedical Ethics, 7th Ed. Oxford University Press, Oxford, UK. 2012.
- 24.
Some details in this case have been altered from the actual case to protect patient privacy. The analyses provided here are based only on the facts presented in this text, and do not represent actual legal rulings.
- 25.
A more difficult analysis could exist in cases when there is a legal requirement that a licensed physician be present during the procedure, that requirement is violated and a patient dies due to administration of anesthesia that is below the standard of care. In the context of criminal charges, difficult questions would arise concerning the quality of the care, the extent to which the administration of anesthesia violated the standard of care, and whether there is evidence that the absence of a licensed physician was a contributing cause of the death.
- 26.
The following are general lay definitions of terms common to the practice of criminal and civil law. Some of the precise definitions vary from state to state according to that state’s laws and practice.
References
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http://www.drugs.com/monograph/propofol.html. Accessed 13 May 2013.
American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology. 2014;120(2):268–86. Also available at http://www.asahq.org/For-Members/Practice-Management/Practice-Parameters.aspx.
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Statement on granting privileges to nonanesthesiologist physicians for personally administering or supervising deep sedation. American Society of Anesthesiologists, Park Ridge, IL. 2012. https://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx
Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. American Society of Anesthesiologists, Park Ridge, IL. https://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx. Amended Oct 2009.
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Glossary
The following are general lay definitions of terms common to the practice of criminal and civil law. Some of the precise definitions vary from state to state according to that state’s laws and practice.
- Civil lawsuit
-
 A legal case brought on behalf of an individual (plaintiff) against another individual or entity (defendant) who acted negligently (below some standard of care) and thereby caused them harm. This case is brought for a monetary recovery for damages sustained by the plaintiff. The plaintiff’s burden of proof in a civil lawsuit is typically by a preponderance of the evidence, a lesser burden of proof than in a criminal prosecution. A successful civil lawsuit usually results in the payment of money for the losses sustained by the plaintiff.
- Criminal negligence
-
 Acting in a grossly negligent manner. Typically, this involves the conscious disregard of a known risk of death or serious injury.
- Defense
-
 Those responsible for representing a defendant in a criminal case or a civil lawsuit. The defense does not have the burden of proving innocence or lack of fault.
- Homicide
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 The unlawful taking of another’s life. Homicide ranges from first-degree murder (the taking of a life with specific intent to kill and with malice) to involuntary manslaughter (an accidental killing where the defendant acts unintentionally and without malice but with criminal negligence).
- Informed consent
-
 The consent given by a patient to a doctor that allows the doctor to perform a certain procedure or render particular treatment. The consent is “informed” because the doctor has explained the specifics of the procedure or treatment to the patient, including the risks and alternatives, who has then made a knowing, informed decision about whether they want to proceed.
- Involuntary manslaughter
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 The unlawful taking of another’s life without intent to kill or to harm and without malice, but the act is committed with criminal negligence.
- Malpractice
-
 Professional negligence. This is an act of negligence committed by a professional such as a doctor, a lawyer, and an engineer while acting within their profession. The negligent conduct is measured by the standard of care in that profession and in that specialty in which the professional practices. A doctor who commits malpractice is said to have breached the standard of care in their area of specialty.
- Negligence
-
 Failing to act in a reasonably prudent manner.
- Prosecution
-
 Charging an individual (defendant) with a violation of criminal law, marshaling the evidence against that individual, presenting the evidence to a court or jury and, if a conviction is obtained, proceeding to sentencing against the individual. The prosecutor represents the people of the state where the crime occurred and technically not the victim of the crime, although the prosecutor often speaks on behalf of the victim. The prosecutor bears the burden of proving guilt beyond a reasonable doubt. If a conviction is obtained, the defendant faces incarceration.
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Van Norman, G.A., Rosen, J.S. (2015). Michael Jackson: Medical Ethics and What Went Wrong. In: Mason, K. (eds) Pediatric Sedation Outside of the Operating Room. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1390-9_36
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