Ethical and Legal Issues in Health-Hurricane Katrina
Read: “The Deadly Choices at Memorial” by Sheri Fink
List five ethical questions and five legal questions arising from the Hurricane Katrina disaster as it impacted Memorial Hospital. Offer your proposed answer for each ethical and legal question.
Health Ethical and legal questions from Hurricane Katerina Disaster
In late August 2005, the Gulf Coast was hit by one of the biggest tropical waves named Hurricane Katrina. The hurricane was destructive causing over $125 billion in property damage and most importantly over 1,800 fatalities. Reports show that New Orleans was the most affected region. One of the most important issues that emerged from this hurricane was ethics and law legal issues in health. A reading from Sheri Fink’s “The Deadly Choices at Memorial” related to the issues surrounding this extreme disaster demonstrated that there are certain legal and ethical issues in health that are used in holding health practitioners and professionals accountable for their actions (Funk, 2009).
Five Ethical Questions
1. What is the line between comfort care and mercy killings?
Comfort care focuses on improving the quality of life and relieving the pain of patients while mercy killing implies providing an easy and painless death often to a critically ill patient at his or her request. The case of Memorial Medical Center demonstrates that there is a very thin line between comfort care and mercy killings, a line that is often not distinguishable. During her trial, Dr. Pou argued that the injections that she gave were ethically and legally justifiable and that the intention was to improve the quality of health of the patients and ensure that they were ready for the evacuation. However, witnesses argue that the injections were administered to cause murder. The truth was not determined; however, if indeed the injections were administered with the intention of comfort care then Dr.Pou acted from a professional capacity. However, if she intended to commit intentional murder and make the job of evacuation easy, then Dr.Pou broke the laws and ethics that medicine was built on thousands of years ago.
2. Can standard practices other than those legally and ethically allowed, be applicable in similar extreme circumstances?
Dr. Pou’s leadership and medical professionalism were heavily tested during this period which forced her to apply standard practices beyond the law and code of ethics in medicine. The aftermaths of the hurricane had led to a very chaotic environment, including the loss of power and a breakdown of communication systems. The government response was slow and the backup generators had failed to force the doctor to make decisions that she deemed best in such an extreme situation. In such extreme circumstances, it is allowed a physician implements the most appropriate course of action, one that has the most positive outcomes and can be considered morally right. This action has to be based on the ideology of consequentialism that is the outcomes should influence the decision taken. Dr. Pou’s defended her actions stating that under such duress she had to make the best decisions. However, her decisions led to the death of critically ill patients making it important that physicians understand that the standard practices beyond those legally and ethically allowed having to yield the maximum positive outcomes possible.
3. Is it okay for doctors to abandon the critically ill?
Noi, it is not ethically or professionally okay for a medical practitioner to abandon the critically ill. The role of a doctor is to prolong life and ensure that all resources in a facility are used in ensuring that all organs are working as expected. The only time a doctor can stop life support is if his or her prognosis shows that there is no hope for recovery and that continuing the process of treatment may be costly for the family and may draw out the process of dying. Dr. Pou had the legal and professional responsibility of ensuring that all her patients received the right medical care. However, a look at the duress circumstances, it is right to say that she had to make the quickest decision regarding those critically ill. The lack of sufficient resources mean that she had to choose those with the highest chances of surviving and prioritize their health first. Most of the critically ill patients had high chances of not surviving the evacuation efforts such as being passed through a three-by-three-foot hole to access the helipad.
4. Can Dr. Pou’s and her team’s actions be considered ethical?
Considering the circumstances, Pou made the only decisions appropriate for the situation and the greater good of everyone. As seen, she divided the patients into three categories, ranging from those who needed to be evacuated first and those who were critically ill. The excerpt shows that even as the patient awaited evacuation, they continued to receive care including having their diapers changed, being manually fanned, and being given sips of water. Other medical interventions such as oxygen and IV were limited. Looking at these circumstances, it is clear that Pou and her team did all they could to try and save everyone in the hospital.
5. What is the meaning of doing the greatest good for the majority, and does that end justify all means?
Dr. Pou under these circumstances had to what was best for the majority of the patients. The government had failed her and her team and had to devise the best strategy that would ensure that the majority of the patients were saved. According to Fink’s excerpt, most patients who were critically ill could not have survived the evacuation efforts. Leaving them behind was also not the best call, as there were no life machines to keep them alive or personnel to serve them. Therefore, she had to make the right decision for the greatest good of everyone in the facility including mercy killings of critically ill patients.
Legal Questions
1. What does the triage system dictate and how could it have helped the situation?
The triage system argues that those with relatively minor injuries be evacuated last while those that are in the worst shape be evacuated or treated first. The system calls for doctors to allocate the available resources to those who are seen to have very little chance of survival. However, Pou and her team had very little knowledge of the triage system and were not guided by any government protocol about the triage protocol. Pou stated that her decision was influenced by the desire to do the best with limited resources. However, this is a risky decision since predicting how a patient’s health will fare is inaccurate and may be subject to bias. This demonstrates the need to provide physicians with education such as the application of the triage systems during disasters.
2. Did Pou intentionally administer euthanasia and is it allowed by the law?
According to the recounted experiences, Dr. Pou administered lethal doses of morphine to critically ill patients intending to give them “comfort care”. It is a known medical fact that while morphine helps in reducing pain, administering it in lethal doses leads to a slow death and eventual death. If she provided these morphine injections intending to cause death, then she could be charged for causing homicide. The law does not allow nor recognize euthanasia as a way of relieving suffering through death. Moreover, in this case, the alleged acts would amount to involuntary euthanasia as the patients did not give consent to slow death making Pou guilty of homicide.
3. Should medical practitioners be granted legal immunity for their work during extreme circumstances such as hurricane Katrina?
Granting doctors such legal immunity would be unwise and unnecessary. In certain instances such as that of the Memorial Park Center, legal immunity would be more appropriate considering that Pou and her team had no resources no help, or guidance from the government and were forced to make decisions that were best for them and their patients (Funk, 2009). However, granting legal immunity in such events provides practitioners with a leeway to act as they want without caring about the law or the code of ethics. For instance, if legal immunity was granted, Pou and her team would have euthanized more patients to avoid the hectic evacuation efforts under the pretense that the patients could not be saved in such duress circumstances. The lack of legal immunity is critical in protecting the lives of patients.
4. What is legally required for doctors during such disasters?
Doctors are bound by legal and ethical standards to cling to the norms of medicine even when it feels unreasonable to do so. They should converse with patients and respect their decisions even under duress and under awful circumstances. This also means making every effort to ensure that each patient despite their condition is evacuated from situations such as those of the Memorial Park Center.
5. In line with the question above, should Dr. Pou be considered guilty of homicide?
The triage system requires that Pou evacuate the infants, I.CU. Patients and other critically ill patients first. The young babies arguably have more life ahead of them and therefore should have been evacuated before the elderly and critically ill patients. Those in better health conditions should have been the last to evacuate. However, while this is applicable theoretically, it might have been inapplicable in the actual Memorial Park situation. Pou and her team had to share the limited resources among the patients who were critically ill. The reports also show that most of these patients could not have survived the evacuation efforts as some of them were diagnosed to be in very critical conditions. Therefore, the situation at Memorial Center raises a lot of dilemmas; on one side, it is ethically and legally wrong to administer euthanasia, particularly without informed consent as it is considered to be a homicide. On the other hand, if the patients could not have survived the evacuation efforts it is only morally right for the physicians to ensure that they lead peaceful and comfortable deaths with dignity. Therefore, it is difficult to charge Pou with homicide as the incident makes it difficult to determine whether her case was that of comfort care or mercy killings.
Reference
Funk, S. (2009, August 27). The Deadly Choices at Memorial. ProPublica. Retrieved from https://www.propublica.org/article/the-deadly-choices-at-memorial-826
