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Katrina `Mercy’ Killings Cross Line, Ethicists Say

c. 2006 Religion News Service NEW ORLEANS _ Conditions were hellish: Electrical power knocked out by Hurricane Katrina. The hospital isolated; its medical staff exhausted, anxious and largely helpless. Profoundly sick patients deteriorating in unbearable heat. But if a doctor and two nurses at Memorial Medical Center purposely injected patients with a lethal dose of […]

c. 2006 Religion News Service

NEW ORLEANS _ Conditions were hellish: Electrical power knocked out by Hurricane Katrina. The hospital isolated; its medical staff exhausted, anxious and largely helpless. Profoundly sick patients deteriorating in unbearable heat.

But if a doctor and two nurses at Memorial Medical Center purposely injected patients with a lethal dose of painkillers, as Louisiana officials alleged Tuesday (July 18), even if it was to end their suffering, they crossed a legal and ethical boundary, according to several medical ethicists.

Louisiana Attorney General Charles Foti Jr.’s allegations that Dr. Anna Pou and nurses Lori Budo and Cheri Landry were principals in the second-degree murder of four unidentified patients raised Hurricane Katrina’s legacy of misery still higher.

Foti ordered the arrest of Pou, Budo and Landry on Monday and said he would turn the case over to Orleans Parish District Attorney Eddie Jordan for prosecution. In the meantime, Rick Simmons, Pou’s attorney, said the allegations are false. “There is no motivation, and there is no homicide,” he said.

After the allegations of killings at the hospital surfaced in October, and as Foti’s investigation quietly advanced, one widespread belief was that because of the unprecedented misery that engulfed Memorial, if doctors and nurses hastened patients’ deaths, they were motivated by humanitarian concerns.

If so, such humanitarianism is misplaced on several counts, several ethicists said this week.

In modern medicine, death cannot be defeated, but it has come to be managed to an extraordinary degree, said Tom Murray, president of the Hastings Center, a bioethics think tank in Garrison, N.Y.

“There are quite a number of studies that say upwards of 70 percent of deaths in hospitals involved explicit decisions to limit treatment,” he said. “And those figures are old. Most people believe it’s higher than that now.”

Doctors and patients have become familiar with managing death, he said.

Patients with advanced cancer often refuse another harsh treatment that might mean a few more weeks or months of life. Or the parents of a patient with brain damage might agree to withdraw life support.

Or a family might request higher doses of narcotic for a terminal patient suffering pain, even if the higher dose may depress breathing and hasten death by a few hours.

The key is not the outcome, but the intention, ethicists said.

“Intention is the single most important element” in judging the ethical appropriateness of such decisions, Murray said.

“In normal circumstances, we have a clear, bright line between relieving pain and hastening death,” said David Magnus, president of Stanford University’s Center for Biomedical Ethics. “You are allowed to relieve pain even if it has a foreseeable but unintended consequence of hastening death.

“If morphine will help relieve pain, even if it brings on respiratory distress and brings on death, that’s well understood in every state. It’s accepted medical practice.”

By contrast, it is clearly unethical to end a patient’s misery by intentionally killing, Magnus, Murray and other ethicists said.

In practice, however, it sometimes happens, even outside extraordinary public emergencies such as Katrina, Murray said.

“In American law, the rule in every jurisdiction is you don’t do that,” Murray said. “It’s homicide.

“Does it happen? Yeah, it probably does happen. No one knows how frequently.”

He said intentional killings usually happen only in cases in which a trusted doctor knows a family or a suffering patient well.

“It happens quietly. It’s rarely prosecuted. … But the majority of doctors who do ethics say you should never do that,” Murray said.

Some ethicists said they sympathized with the staff at the besieged hospital and were impressed by the fact that they faced almost intolerable conditions.

“I can’t even imagine what they must have gone through trying to do what was best for their patients,” Magnus said. “But we draw that bright line we don’t want doctors and nurses to cross. They had an obligation to patients to do everything possible to relieve their suffering _ but to intentionally euthanize, if that’s in fact what took place, crosses that bright line.”

Moreover, there is another complication, ethicists said: consent.

“What if all those patients didn’t want that?” Magnus said. “I doubt they knew just what each of those patients wanted, what each of their surrogates wanted. I doubt they talked to each of the surrogates.

“If it’s that they decided to intentionally euthanize patients … the lack of consent makes it worse, even under those horrible circumstances.”

(Bruce Nolan writes for The Times-Picayune in New Orleans.)

DSB/PH END NOLAN