Summary: A recent incident in Dutch health care that has kept the media occupied since two months involved a medical student during a family medicine rotation. Apart from the terrible happenings, it is instructive to discuss of the role of the clerk. Description: A recent incident in Dutch health care that has kept the media occupied since two months involved a medical student during a family medicine rotation. Apart from the terrible happenings, it is instructive to discuss of the role of the clerk.

So what happened?

Monday August 19, 2013, a village family doctor was called for a patient at home badly suffering of a painful terminal cancer condition and likely to die within days. The patient had previously asked for euthanasia but had afterwards recalled this request. The visit was done together with a fourth year medical student. In line with the family’s wish, the doctor decided to conduct euthanasia with an extravagant dose of morphine (a 1000 mg shot), without meeting the legally required precautionary measures of euthanasia. In fact, the only option would have been to conduct palliative sedation. The patient died within hours, while doctor and student were back in the office. The family fully supported this decision and conduct, but the student wasn’t sure. She reported this experience to her academic supervisor. Then the university department of family medicine reported the incident to the health inspectorate, which then informed the public prosecutor. The doctor was arrested and interrogated for six hours. He committed suicide six days later.

Family doctors all over the country expressed terrified feelings of anxiety, before the details of what had happened were disclosed in the media. Both the doctor's and the patient's family have been angry about the accusation of murder by this well respected village doctor. The role of the medical student was pivotal. She documented the happenings in a reflective diary report that found its way to a Dutch newspaper but that reads like it was probably meant for her portfolio. Apparently she had observed that the doctor did not adhere to rules of careful terminal care. Should she have stopped him? Reading her report I don’t think she would have succeeded.

This shows, in extreme sense, the tension between being loyal toward a medical tutor and adhering your sense of legal justice and ethical behaviour. Is reporting this incident a brave deed? Of course, from the perspective of patient safety it is. But at the same time, she must have felt that not reporting would have left the doctor alive and the family satisfied, and – who knows – even the patient. It must be a terrible dilemma. The case could serve the education about the ethics of health care and ethics of medical training.