"Mercy killings" after Hurricane Katrina

Back in 2008, I put up an article here that combined four earlier posts I'd written following Hurricanes Katrina and Rita in 2005.  I summarized the 'lessons learned' during that crisis, for the benefit of those trying to plan and prepare for future disasters.  It remains one of my most viewed articles, and I still occasionally receive reader e-mail thanking me for putting it up.

Courtesy of a link at Commander Zero's place, I was reminded today about a 2009 article in the New York Times, describing the chaotic evacuation of patients from a New Orleans hospital during Hurricane Katrina.  There's little doubt that a number of patients were euthanized - i.e. deliberately killed - rather than evacuated, according to criteria established 'on the fly' by a few doctors who were in attendance.  Charges of murder were initiated, but never tried in court, which I think was a pity.  I have little doubt that murder was done under the guise of alleged 'medical necessity'.

It's a very sobering article to read, particularly when one remembers that none of those who died would necessarily have expected to be placed at risk under such circumstances.  Illness or injury can strike any of us at the least opportune time . . . and we, too, may find life-or-death decisions being made about (and for) us by others, without so much as a 'by your leave'.  Here's a lengthy extract from a much longer article.

It is now evident that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death when they were injected, according to medical professionals who treated them at Memorial and an internist’s review of their charts and autopsies that was commissioned by investigators but never made public.

. . .

The full details of what Pou did, and why, may never be known. But the arguments she is making about disaster preparedness — that medical workers should be virtually immune from prosecution for good-faith work during devastating events and that lifesaving interventions, including evacuation, shouldn’t necessarily go to the sickest first — deserve closer attention. This is particularly important as health officials are now weighing, with little public discussion and insufficient scientific evidence, protocols for making the kind of agonizing decisions that will, no doubt, arise again.

At a recent national conference for hospital disaster planners, Pou asked a question: “How long should health care workers have to be with patients who may not survive?” The story of Memorial Medical Center raises other questions: Which patients should get a share of limited resources, and who decides? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?

. . .

Morphine, a powerful narcotic, is frequently used to control severe pain or discomfort. But the drug can also slow breathing, and suddenly introducing much higher doses can lead to death.

Doctors, nurses and clinical researchers who specialize in treating patients near the ends of their lives say that this “double effect” poses little danger when drugs are administered properly. Cook says it’s not so simple. “If you don’t think that by giving a person a lot of morphine you’re not prematurely sending them to their grave, then you’re a very naïve doctor,” Cook told me when we spoke for the first time, in December 2007. “We kill ’em.”

In fact, the distinction between murder and medical care often comes down to the intent of the person administering the drug. Cook walked this line often as a pulmonologist, he told me, and he prided himself as the go-to man for difficult end-of-life situations. When a very sick patient or the patient’s family made the decision to disconnect a ventilator, for example, Cook would prescribe morphine to make sure the patient wasn’t gasping for breath as the machine was withdrawn.

Often Cook found that achieving this level of comfort required enough morphine that the drug markedly suppressed the patient’s breathing. The intent was to provide comfort, but the result was to hasten death, and Cook knew it. To Cook, the difference between something ethical and something illegal “is so fine as to be imperceivable.”

. . .

Records showed that more than half of the 41 bodies from Memorial that were analyzed by Middleberg’s lab tested positive for morphine or midazolam, or both. Middleberg had handled thousands of cases in his career, and the high drug concentrations found in many of the patients stuck out “like a sore thumb,” he told me.

There's much more at the link.  I strongly recommend that you click over there and read the whole thing.  It's scary in its implications of what might happen to any of us, if we're unfortunate enough to be caught up in such a mess.

Peter