Christine Malèvre was a nurse on the neurology and pulmonology unit of the hospital in Mantes-la-Jolie, a town in the Yvelines department west of Paris. In 1998 she told investigators that she had ended the lives of more than two dozen sick and dying patients in her care, describing the deaths as acts of mercy, according to United Press International. A few months later she changed her account, saying she had helped four dying patients to die, and only because they had asked her to.
In January 2003 the assize court of the Yvelines, sitting in Versailles, found her guilty of murder in the deaths of six patients who died on her ward in 1997 and 1998. The court cleared her of a seventh death, finding the evidence insufficient. She was sentenced to ten years' imprisonment and barred from working as a nurse. She appealed, and as of October 2003 she was in custody awaiting a second trial in Paris.
The case drew attention far beyond the courtroom. To campaigners for a change in the law she was, for a time, a nurse who had dared to do openly what they believed was done in secret in French hospitals. To the prosecution and the families of the patients she was something else: a woman who had decided on her own that her patients should die. That disagreement shaped the case from her arrest to her appeal.
Little is known about Christine Malèvre's early life. She was 33 when her trial opened in January 2003, according to UPI and the Czech daily Novinky. A report printed by the Southeast Missourian, a Missouri daily, said she began working at the Mantes-la-Jolie hospital in 1995.
The unit where she worked cared for people with serious diseases of the nervous system and the lungs, many of them at the end of their lives. About 80 people died on the unit each year, according to a report published by the French nursing news site infirmiers.com before her appeal.
Former colleagues described a nurse who got on well with her patients but whose attachment to them went too far. They said, as Novinky reported from the first trial, that she was drawn into ways of behaving that were highly unusual in a hospital, and that she regularly went to the funerals of patients who had died. The Southeast Missourian report said her conduct, including what it called "excessive devotion to terminally ill patients," had begun to arouse suspicion the year after she arrived.
Experts quoted by Novinky said she had gone through serious psychological difficulties as a teenager. In their view she was easily fascinated by illness and death and sought a feeling of power and superiority over her patients. Benoit Chabert, a lawyer for one patient's family, told the court she had a "perverted" relationship with her patients and a "morbid fascination" with death, UPI reported. A former nursing teacher took a different view, describing her as a gifted student who may have been overwhelmed by a situation she could not cope with.
The first questions came from inside the hospital. According to the Southeast Missourian report, an inquiry began in 1997 and eventually found that deaths on the unit increased during her shifts.
Evidence given at the first trial suggested that the hospital's doctors knew of her suspect practices as early as 1997 and did nothing about them, infirmiers.com reported. The same report said the heads of the unit, Laurence Kouyoumdjian and Olivier Ill, had denied at the first trial that they had ever deliberately caused a patient's death, and that both were expected to be questioned again on appeal.
In 1998 she was placed under formal investigation by a judge. A member of the National Assembly, Roger-Gérard Schwartzenberg, told parliament in February 1999 that Christine Malèvre, a nurse at the hospital in Mantes, had been placed under investigation ("mise en examen") the previous July and could face trial before an assize court for having helped patients to die. The Southeast Missourian report said she came under formal investigation over eleven deaths in 1998, and that the charges in four of those cases were later dropped for lack of evidence.
The figure most often attached to her name comes from her own statements. When she was first questioned in 1998, UPI reported, she said she had ended the lives of more than two dozen patients and called the deaths mercy killings. Within a few months she revised that account. She then said she had caused the deaths of four dying patients, and only at their request.
Before the trial she published a book giving her side of the story. In it, Novinky reported, she admitted causing the deaths of three patients in the final stage of life at the Mantes-la-Jolie hospital in 1997 and 1998, called a fourth death a tragic accident, and denied the other cases. Her position throughout was that the patients had asked her for help and that she had acted out of compassion.
The prosecution rejected that version. Prosecutors called her a serial killer, Novinky reported, and the families of the patients said she had acted on her own, without any request. Before the appeal, infirmiers.com summed up their view: to prosecutors and families, her account was false, and she was "an unbalanced woman with morbid urges."
None of the deaths beyond those in the indictment was tried. Her early statement about more than two dozen patients is her own account, which she withdrew, and it was never tested in court.
Her trial opened on Monday, January 20, 2003, before the criminal court sitting at Versailles, according to Novinky's report from that day. She was charged with the murder of seven patients and faced a possible life sentence. Novinky said she was the first health worker in France to be tried for helping someone to die. The press had given her two nicknames, "angel of death" and "black widow."
The courtroom was full of reporters and photographers. On the first day she stayed silent and struggled to hold back tears, Novinky reported. The families of the patients were represented by Olivier Morice, who said that a person like her should never have entered the health professions. The Southeast Missourian report said Morice acted for the families of three of the patients.
The hearing lasted about two weeks. Over that time, as UPI put it, she was described both as a serial killer and as a nurse with a gift for compassionate care. Former colleagues spoke of her closeness to patients; experts spoke of her personality; and the families spoke of relatives who, they said, had never asked anyone to end their lives. The son of one of the patients was quoted by Novinky, as the trial opened, as saying that anything less than a life sentence would be "another heavy blow" for the families.
The trial also went beyond her own conduct. Doctors and nurses testified, probably for the first time before a French assize court, that the lives of incurable and dying patients were sometimes cut short in hospitals, infirmiers.com reported. Some witnesses said patients had been given overdoses of drugs that were first prescribed to ease pain. Dr. Denis Labayle, a head of department at the hospital in Evry, told the court that French society would not be able to avoid thinking about the question, and warned that leaving people without help or support carried a risk of abuse. The practice described by these witnesses was never set down in any formal way, according to the same report, and it was far removed from the open assisted death that some campaigners were asking for.
Her lawyers built their case on that gap. They described her as a young woman with an unstable personality who had lost her bearings in the hard conditions of her unit and in what they called the hospital's general culture of silence. In their view her case was a product of that "hypocrisy."
The day before the verdict, the prosecution asked for a sentence of at least ten years. The families thought that too lenient, the Southeast Missourian report said, since French law allowed a life term. Morice said that if she had been tried for killing seven people in good health, "we'd be far from 10 years and closer to life in prison."
At the end of January 2003 the court gave its verdict. It found her guilty of murder in the deaths of six patients on her ward in 1997 and 1998, and acquitted her in the death of a seventh because the evidence was insufficient. The judges imposed the ten years that the prosecutor, Alain Junillon, had asked for, and barred her from working as a nurse, according to UPI. The infirmiers.com report gave the date of the verdict as January 30 and named the offense as "assassinat," the charge on which the Cour d'assises des Yvelines convicted her.
She showed no emotion as the verdict was read and wept afterward, UPI reported. Neither her lawyer nor the families, who had brought the original complaint, commented at once.
She was taken into custody after the verdict and stayed there. Her requests to be released while she waited for the appeal were refused, infirmiers.com reported.
From the moment the case became public, it was argued over in terms much larger than one nurse and one ward. Novinky described how the press first presented her as a pioneer of the right to a merciful death, and how the case set off a wave of public and parliamentary debate.
That debate reached the National Assembly early. In a question to the government published in February 1999, Roger-Gérard Schwartzenberg, a deputy for Val-de-Marne, cited her case and a second case involving a nurse in Nice, both of whom could face trial for helping patients to die. He argued that palliative care should come first and said France was clearly behind: 41 departments, he said, had no specialized palliative beds or mobile teams. Even the best palliative care, he went on, would leave some patients in pain that could not be relieved and who asked to die. He called euthanasia "always a failure and a tragedy," and suggested that euthanasia, especially in its passive form, might already take place quietly on some hospital wards, so that the law amounted to silence. He asked whether the government would hold an open debate in parliament.
Bernard Kouchner, the junior minister for health, answered that palliative care did not fully cover the situations Schwartzenberg had described. He said the number of mobile palliative care teams would be doubled that year with 150 million francs approved by parliament, plus 50 million francs for teams working outside hospitals. The government had never opposed a debate, he said, and wanted it held calmly; he cited a Dutch ethics journal to argue that the Netherlands, which had decriminalized euthanasia, had not found a satisfactory answer either. He proposed to write to the leaders of the parliamentary groups in both chambers to set up a working meeting. Care at the end of life, he added, should not be confined to dedicated beds but should involve all medical staff.
By the time of the first trial, the context had shifted again. UPI noted that the Netherlands and Belgium had legalized euthanasia under strict conditions in the previous two years, that Switzerland allowed assisted suicide, and that both practices remained illegal in France. A poll in December 2002 found that 88 percent of French people supported legalizing euthanasia under certain conditions, UPI reported. The health minister, Dr. Jean-François Mattéi, was firmly opposed, calling euthanasia "the wrong answer to questions of suffering, solitude and abandonment." Novinky also reported that the government of the day appeared united against it.
The campaigners themselves did not adopt her case. Edith Deyris, secretary general of the Association for the Right to Die in Dignity (ADMD), told UPI that what Malèvre had done was "exactly this type of action we are fighting against." Her group wanted transparency and coordinated decisions in hospitals based on patients' written requests, she said, "the complete opposite of the shadows and impreciseness" of the Malèvre trial. Other campaigners argued that the trial had shown that secret mercy killings took place regularly in French hospitals.
Other events kept the question in the news. In January 2003, UPI reported, another French court gave Elie Bendayan, a former police officer who had shot dead his wife, who had Alzheimer's disease, a two-year suspended sentence; he had called the killing an act of love. In September 2003, shortly before her appeal, Vincent Humbert, a young man left quadriplegic, died in Berck-sur-Mer after his mother, Marie Humbert, helped him to die. Several scientists and politicians then called for a euthanasia law, and Prime Minister Jean-Pierre Raffarin ruled out changing it, infirmiers.com reported. The same report drew the line between the two cases: the Humbert family had sought an open, assisted death, while the practices described at the Malèvre trial were hidden and never formalized.
She appealed the verdict, and the second trial was set to open in Paris in early October 2003, before the assize court sitting on appeal. A report published on October 1, 2003, said the hearing was due to run until October 15. Her lawyers planned to call new witnesses on the wider question of end-of-life practice in hospitals, and the heads of the Mantes-la-Jolie unit were expected to be questioned again.
As of October 1, 2003, she had been in custody since the first verdict, her conviction was under appeal, and her requests for release had been refused.
1995: Christine Malèvre begins work at the hospital in Mantes-la-Jolie, according to a report in the Southeast Missourian.
1996: Her conduct with terminally ill patients begins to arouse suspicion, according to the same report.
1997: An internal inquiry begins; it later finds that deaths on the unit rose during her shifts. Doctors at the hospital are said to have known of her suspect practices that year.
1997 to 1998: Deaths of patients on the neurology and pulmonology unit, six of which the Versailles court later found to be murder.
1998: Under questioning she says she ended the lives of more than two dozen patients; months later she reduces this to four, at their request.
July 1998: Placed under formal investigation ("mise en examen").
February 1999: Her case is raised in a question to the government in the National Assembly; the health minister answers on palliative care and a possible debate.
Before 2003: Publishes a book in which she admits causing three deaths, calls a fourth an accident and denies the rest.
January 20, 2003: Trial opens before the assize court at Versailles on seven counts of murder.
January 30, 2003 (UPI placed the verdict on Friday, January 31): Convicted of the murder of six patients, acquitted of a seventh, sentenced to ten years and barred from nursing.
September 2003: Death of Vincent Humbert revives the national debate on euthanasia.
October 2003: Appeal trial set to open in Paris, scheduled to run until October 15.