On June 12, 2008, Roger Matern, an 84-year-old with heart disease, visited a Montreal naturopathy clinic. He was tired and frustrated with conventional medical treatment.
Mitra Javanmardi, a veteran naturopath, recommended a concoction of nutrients, which she administered intravenously.
Sixteen hours later, Mr. Matern was dead. One of the ingredients administered, L-carnitine, was contaminated with a bacterium, causing blood poisoning and fatal toxic shock.
Ms. Javanmardi was charged with criminal negligence causing death and manslaughter. She was prosecuted because she had administered the treatment intravenously. Under Quebec’s Medical Act, naturopaths are not authorized to do so. (They are allowed to do so in most other provinces.)
After a lengthy and highly publicized trial, Ms. Javanmardi was acquitted of both charges in 2015. The Crown appealed and the Quebec Court of Appeal overturned the acquittals and ordering a new trial on the charge of criminal negligence.
On Thursday, the Supreme Court of Canada, in a 5-2 decision, restored the acquittals.
That Ms. Javanmardi has walked away scot-free has outraged many.
Naturopathy is largely pseudoscientific nonsense that espouses treatment with all manner of “natural” products.
But naturopathy was not on trial.
The prosecution revolved around two fundamental legal questions: Was Ms. Javanmardi negligent? If so, did her negligence kill her patient?
Did she, through her actions or omissions, show wanton or reckless disregard for the life of Mr. Matern? Did the naturopath commit an unlawful act that caused the death of a person?
There is no question Ms. Javanmardi committed an unlawful act – administering a drug intravenously.
But, according to the majority on the court, IV injections are not inherently dangerous. Ms. Javanmardi estimated that she had treated about 10 patients a week for 25 years with intravenous potions, without incident.
Two other patients had received the same contaminated drug as Mr. Matern, without ill effects. And when he felt ill, Ms. Javanmardi had urged him to go to hospital.
Those are not the actions of a negligent person, or of a killer/manslaughterer.
So it’s hard to take issue with the legal ruling.
But the fact that the decision sticks in our collective craw is a reminder that, as Justice Horace Krever said in his landmark report on the tainted blood scandal, the courts are a terrible place to bring justice to those who have suffered medical harm.
The law is black-and-white; medicine – and even “alternative” medicine – is full of greys.
Treatments are administered even if, in many cases, we know those treatments will cause harm. The hope though is that they will prevent greater harm.
Take chemotherapy: Highly toxic poisons are used in the hope they will stop cancer from spreading. It doesn’t always work. Sometimes the treatment proves deadly.
That doesn’t make a physician negligent or a killer.
In this case, the Supreme Court ruled that Ms. Javanmardi could reasonably expect that the treatment would not cause harm. After all, she had done similar interventions thousands of times, albeit illegally.
In Quebec, naturopathy is not a regulated profession. That means anyone can hang up a shingle and consumers are free to seek their services. Other provinces recognize naturopathy as a self-regulating profession.
It’s not clear which approach is best. By licensing quackery such as naturopathy and homeopathy, governments lend them a veneer of legitimacy. Conversely, when they regulate, it can create some oversight and allow the public to seek recourse if they are harmed – if these professions take self-regulation seriously, which is not always the case.
Mercifully, most “alternative” treatments are benign, causing harm largely to the pocketbook. There are not many deaths, aside from the occasional poisoning by pathogen or broken neck during chiropractic manipulation.
Of course, there will be those screaming that mainstream medical treatment kills many more. It is true that medical care entails many risks but, as mentioned earlier, it is the potential to do good or reduce suffering, that mitigates the harm.
Did the potion that Mr. Matern received have the potential to benefit him in any way? Probably not. But, again, that was not for the court to decide. Did it hasten his death? No doubt. Was it negligent? Not really.
Being a quack does not make you a killer.
But if there is a codicil to the ruling of the learned justices, it should be this: Caveat emptor.
André Picard