"He left him to his fate" Death in an old people's home - and a caregiver is suddenly on trial

A nursing home resident dies, the caregiver hesitates with resuscitation. Now the Kulm District Court has ruled: The man acted lawfully. A ruling on a difficult case with fundamental questions.

"Today we have to judge a case that is not an everyday occurrence," said the public prosecutor at the very beginning of his plea. Later, when explaining the verdict, the court president will say: "What we have heard today is a difficult and emotional matter - a real taboo subject in society."

On Tuesday, the Kulm district court in Aargau's Wynental will be focusing on big questions. When should a life that is close to the end be saved? Who decides whether a terminally ill person without a pulse needs to be resuscitated or not?

The case in question took place almost four years ago. Shortly after Christmas 2021, a nurse starts his night shift in a retirement home in Aargau. On his second inspection round in the early hours of the morning, he finds a 74-year-old resident in his room who can only breathe in fits and starts.

Because his breathing was getting weaker and weaker and he could not detect a pulse, the caregiver called the cantonal emergency medical services.

Paramedics arrive too late

The entire trial revolves around the following minutes: "Instead of starting life-sustaining measures immediately and despite four requests from the employee of the emergency medical call center, the defendant pondered for several minutes whether he should resuscitate the man or not," the indictment states.

The nurse did not resuscitate the resident. The emergency services, who arrive on the scene seven minutes after receiving the emergency call, can only determine that the man is dead.

The public prosecutor's office pleads guilty to failing to provide emergency assistance. The sentence demanded: a conditional prison sentence of 24 months and a liaison fine of CHF 1,500. As the accused is a German citizen, a five-year ban from the country is also demanded.

The 65-year-old defendant has been excused from the trial. He is now retired and lives in Berlin to look after his elderly mother.

Resuscitation would probably not have helped

"Anyone who fails to help a person whose life is in imminent danger, even though he could reasonably be expected to do so under the circumstances, shall be punished", according to the Swiss Criminal Code. It is undisputed that the resident was in "immediate mortal danger". It is the "reasonable circumstances" that the prosecution and defense naturally assess differently.

For the prosecution, one thing is clear: as a qualified nursing professional with over thirty years of professional experience, he was easily able to start resuscitating the man before the paramedics arrived. Moreover, he had no knowledge of any living will.

In fact, there was a living will from 2019 in which the resident stated his wish to forego life-sustaining measures in the event of an emergency.

According to the public prosecutor, the fact that the man would most likely have died even if the accused had resuscitated him was irrelevant: "He left him to his fate, which was tantamount to death." The defendant's assistance was limited to making the emergency call, "which was clearly inadequate".

Sweets despite diabetes

The defense lawyer argues quite differently: for example, the defendant had never learned how to perform chest compressions, neither during his training as a nurse in Germany nor during his work in Switzerland. During his entire professional career, he had never performed or witnessed a resuscitation.

In addition, there are guidelines in the nursing home according to which residents are generally not resuscitated. The so-called position paper is handed out to all residents and their relatives before admission. According to the defense lawyer, it is therefore understandable that the defendant hesitated with resuscitation until the paramedics arrived and discussed it on the phone.

The man was already seriously ill when he moved into the nursing home. He suffered from diabetes and had a damaged heart. Despite this, he ate sweets - with the blessing of his relatives. Despite the advice of a doctor, he refused to be admitted to hospital.

"The aim of palliative care in a nursing home is not to cure, but to improve the quality of life," said the defense lawyer. With his actions and the existing living will, the man had expressly expressed his will to accept his imminent death. To put it bluntly: "You go to an old people's home to die. If you want to live, you go to hospital."

Accused is acquitted

In its verdict, the court ultimately followed the defense's arguments in full. The accused is acquitted of the charge of failing to provide emergency assistance and the costs of the proceedings are borne by the state. The verdict can still be appealed by both sides and is therefore not yet legally binding.

And if the case in Kulm has made one thing clear, it is how close responsibility, morality and legal boundaries lie to each other in the care of people at the end of their lives. Or in the words of the court president: "A difficult and emotional matter."