Ethics of killing debated

What's allowed during a disaster

July 19, 2006|By RONALD KOTULAK | RONALD KOTULAK,CHICAGO TRIBUNE

The arrest of a doctor and two nurses yesterday on charges that they administered lethal drug doses to severely ill New Orleans hospital patients during the desperately worsening conditions after Hurricane Katrina raises ethical questions about what medical personnel can do in life-threatening emergencies.

Would doctors, who take a professional pledge to "first, do no harm," break their oath when they thought the only merciful thing to do was to help end the life of a patient?

The charges also put a spotlight on the use of morphine, commonly prescribed for patients in severe pain, but which can cause death when in an overdose.

And in this age of weapons of mass destruction and an increase in the severity of natural disasters such as hurricanes, society needs to rethink how it will respond to mass casualties when medical care is limited, according to medical ethicists.

"These are situations we better start discussing way in advance if such an event would ever happen in a nation where our social welfare net can fray under extreme conditions," said Laurie Zoloth, director of the center for bioethics, science and society at the Northwestern University Feinberg School of Medicine.

Louisiana State Attorney General Charles Foti filed second-degree murder charges against Dr. Anna Pou and the nurses, Cheri Landry and Lori Budo, accusing them of giving lethal doses of morphine and a sedative, midazolam, to four patients.

"We're not calling this euthanasia. We're not calling this mercy killings. This is second-degree murder," said Foti spokeswoman Kris Wartelle, according to an Associated Press report.

Rick Simmons, an attorney for Pou, said she was innocent. It was not immediately clear whether the two nurses had attorneys who could comment.

The attorney general's investigation began last fall after rumors that medical personnel at Memorial Medical Center had euthanized patients who were in pain as they waited four days in miserable conditions for rescue.

Flooding after the Aug. 29 hurricane inundated New Orleans had cut off the hospital. Power was out in the 317-bed facility, supplies were running out and the temperature rose past 100 degrees while the staff and patients waited to be evacuated.

Pou's mother, Jeanette Pou, said she was stunned by the charges against her daughter, according to the wire service. "Medicine was the most important thing in her life and I know she never ever did anything deliberately to hurt anyone."

"What do you do if you had no way to treat people and they were ill and there was no power and the ventilation had gone down and the machines that had kept them alive were failing?" asked Zoloth. "That is an astonishingly important ethical problem, given the realties we face with disaster planning."

Society might have to face ethical quandaries like this in the event of massive casualties from a terrorist attack with nuclear or biological weapons, or from a flu epidemic like the one in 1912 that killed millions of people worldwide, she said.

In such cases, as in war on the battlefield, doctors might be forced to triage patients when resources are limited, selecting for treatment those most likely to survive and leaving the most seriously injured to die, she said.

Pou had told Baton Rouge television station WBRZ in December: "There were some patients there who were critically ill who, regardless of the storm, had the orders of do not resuscitate. In other words, if they died to allow them to die naturally, and to not use heroic methods to resuscitate them."

"We all did everything in our power to give the best treatment that we could to the patients in the hospital to make them comfortable," Pou said then.

Zoloth said it's hard to second-guess what went on in the hospital without more information, but the fact that the medical staff stayed on the job indicates they were concerned about their patients.

"They all probably could have left their patients," she said. "The fact that they stayed by the bedside of the most vulnerable patients, and in many cases hand-bagged them [supplied oxygen with a manual ventilator] for hours and hours, these were acts of remarkable courage."

An even broader ethical question arises over why it took so long to rescue the public hospital patients, Zoloth said. "The patients in the poor, public hospital faced a far worse fate than the private hospital, and that was not only unethical, it was unconscionable," she said.

At least 34 patients died in the aftermath of the hurricane. Orleans Parish coroner Frank Ninyard said their bodies were so decomposed the deaths could only be listed as "Katrina-related."

Ronald Kotulak writes for the Chicago Tribune.

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