Introduction

Mrs Rose Ann Adshead died at her home, 2 Lawton Street, Hyde on Sunday, 18^th September 1988 at the age of 80. She was registered as a patient of either Dr Bills or Dr Carroll, who both practised from the Donneybrook Surgery, from where Shipman also practised. Shipman certified that the cause of her death was carcinomatosis due to adenocarcinoma of the rectum.

Mr Joseph Brian Adshead, Mrs Adshead's son, has provided a statement relating to his mother's death. The Inquiry has had access to Shipman's visits book for 1988 and the duty doctor transfer diary recovered from the Donneybrook Surgery. Mrs Adshead's medical records have not survived.

This decision has been made following consideration of the papers and without an oral hearing.

Personal Background

Mrs Adshead had lived an active life and had not been troubled by any serious illnesses except for gallstone problems in the 1940s. At the time of her death, she was a widow and lived alone. Three months earlier, it had been found that she had cancer. The doctor treating her at Tameside General Hospital told her son that the cancer was incurable and suggested that she would be more comfortable at home. Mr Adshead inferred from this that his mother's death was imminent.

Following her discharge from hospital, Mrs Adshead spent most of her days sitting in an armchair in front of the fire at home. She became confined to bed a few days before her death.

The Day of the Death

Mr Adshead arrived at his mother's house at some time in the morning of Sunday, 18th September. A number of family members were present and he realised that they had been told that Mrs Adshead was very unwell. She was lying in bed and, although she was awake, she was not lucid. She had been in a great deal of pain and had said that it was becoming too much for her and she wanted to die. Someone at the house telephoned the Donneybrook practice and asked that a doctor should visit.

According to the duty doctor transfer diary, Shipman was the Donneybrook doctor on duty that day. Shipman arrived at the house at about midday. Mr Adshead had seen him before and recognised him. Mrs Adshead was left alone with Shipman during the consultation. Shipman then came out of her bedroom and said that she was very unwell and that Mr Adshead 'would probably be calling him within an hour'. He then left. Mr Adshead went to find a priest and returned about 15 minutes later. Mrs Adshead appeared to be sleeping. From the time that Shipman visited, she did not open her eyes or say anything. About an hour after Shipman had left, Mr Adshead's uncle, Mr Bernard Tracey, said that Mrs Adshead had died. Shipman was called back to the house and confirmed that Mrs Adshead was dead.

Mr Adshead has said that, at the time, he had no suspicions about the death of his mother because she was expected to die and had been in a lot of pain before her death.

Mrs Adshead's name appears in Shipman's visits book on Sunday, 18th September. Alongside her name appears the following: 'D/N ', which is almost certainly a reference to the district nurse.

Certification

The Medical Certificate of Cause of Death (MCCD) has not survived, but the MCCD counterfoil is in the possession of the Inquiry. Shipman wrote that he had last seen Mrs Adshead alive on the day of her death, that a post-mortem examination would not be held and that he had seen the body after death. The MCCD counterfoil is dated 19^th September 1988.

Conclusion

The circumstances of the death are clearly established. Mrs Adshead was extremely ill and was suffering a great deal of pain. She cannot have had long to live. Shipman came at the request of the family and it is clear that she needed pain relief. Although no one was present in the bedroom besides Shipman and Mrs Adshead, I infer that he must have given her a strong pain-relieving drug. That is what both she and her family wanted. After Shipman's visit, Mrs Adshead slept until she died an hour later. It is possible that her death was entirely natural and its timing was unaffected by the treatment Shipman had given.

However, it is also possible that Shipman's treatment hastened Mrs Adshead's death. It is not known what drug Shipman gave, how large a dose he gave or how he administered it. The likelihood is that he gave an intramuscular injection of an opiate, probably morphine or diamorphine. That would be an entirely proper thing to do provided that the dose was genuinely intended to relieve pain rather than shorten life. Dr John Grenville has explained that it can be very difficult for a doctor to estimate the appropriate dose of opiate so as to achieve pain relief without shortening life. This can be especially difficult if the patient has been taking increasing amounts of the drug and has become accustomed to it. It is not known whether the injection Shipman gave an hour before the death was the first injection Mrs Adshead had had or whether she had been receiving opiate injections for some time. Dr Grenville has also said that sometimes when a doctor estimates what dose to give, he or she realises that in order to control the patient's pain, it may be necessary to give a dose which has the side effect of depressing respiration and shortening the patient's life. Provided that the doctor makes a genuine attempt to estimate a therapeutic dose, his actions are not unlawful, even though the death is hastened.

That Mrs Adshead should have died about an hour after the injection was given, causes me to suspect that the dose was not intended merely to relieve pain but was, instead, intended to end Mrs Adshead's life. That may have been what she wanted, but if Shipman deliberately gave a lethal dose, it would have been unlawful. My suspicions are aroused because Professor Henry McQuay and Dr Grenville have explained to the Inquiry that an opiate given intramuscularly will reach its maximal effect within about 30 minutes to an hour after administration. If the dose is a lethal one, death will follow within about an hour of administration. The dose might not have been lethal and it might just have been coincidence that Mrs Adshead died an hour later, but the coincidence would be quite considerable. If the dose was not lethal and Mrs Adshead had died naturally, it would be unlikely that she would just happen to die an hour after the drug was given. My suspicions are heightened by the evidence that Shipman forecast that Mrs Adshead would die in about an hour. That suggests that Shipman had administered a lethal dose and knew that Mrs Adshead would be dead within the hour.

Although I recognise that Mrs Adshead might have died when she did from natural causes or as the result of a dose of opiate genuinely assessed as being that which was necessary to control her pain, I have come to the conclusion that it is likely that Shipman made a conscious decision to give her a lethal dose and ensure that life ended within the hour. If he did that, as I think he probably did, that was unlawful. It is, however, almost certain that the effect of his unlawful intervention was to hasten Mrs Adshead's death by only a very short time.