American housewife Nancy Kissel, dubbed the "milkshake murderer", has lost her final bid to appeal against her conviction in Hong Kong for the 2003 murder of her banker husband.
The 49-year-old expatriate, serving a life sentence since 2005, was found guilty of drugging her husband - a senior executive at US bank Merrill Lynch - with a sedative-laced strawberry drink before clubbing him to death with a lead ornament in their luxury home.
She has maintained she acted in self-defence against an abusive spouse.
"We dismiss this application," presiding judge Robert Ribeiro said on Thursday at the Court of Final Appeal as a frail-looking Kissel sat quietly in the dock behind bars.
She was then taken out of the court room on a stretcher.
Her defence team had told the court that Kissel suffered from depression and "had only killed the deceased in a frenzied attack provoked by threats and the deceased's physical assault on her".
Kissel's trial gripped the former British colony, shining a spotlight on Hong Kong's elite expatriate community, and featuring sensational allegations of a heady mix of adultery, violence, spying, greed and enormous wealth.
The Michigan-born mother-of-three was first convicted of murder and handed a life sentence in 2005, but the Court of Final Appeal overturned the conviction in February 2010, citing legal errors, and ordered a fresh hearing. She was convicted again in 2011.
An appeal against the second conviction was rejected in December last year, and her bid to overthrow that ruling went to the city's highest court after an application was rebuffed in a lower court in January.
Kissel had admitted to killing her husband and offered to plead guilty to manslaughter.
After killing her husband in their Tai Tam home, prosecutors accused Kissel of rolling up his body in a carpet and covering his head with plastic, leaving it in the bedroom for days before hiring workmen to carry it to a storeroom.
Prosecutors also argued that Kissel stood to gain up to $US18 million from the death of her wealthy husband, saying she planned to run away with a TV repairman with whom she admitted having an affair in the US.
