Hurricane Katrina

Perhaps a post too late to count, but I wanted to write a bit about Hurricane Katrina. During the disaster in 2005, Memorial Hospital was flooded and lost its electricity and emergency generators at a time when the temperature and humidity were nearly unbearable. When no governmental evacuation was apparent, staff and patients began evacuation but could not get everyone out. Some of the sickest patients who were unlikely to survive were left behind.

The ethical controversy occurred when a doctor was charged with second degree murder (though in 2007, a Louisiana grand jury refused to indict her). At the time of the hurricane, she went to the hospital to take care of the patients, many of whom were already abandoned by their health care teams. Some of those patients were suffering because the ventilators had failed and the pharmacy was depleted of necessary drugs; she administered pain-killers to some of those patients. She was accused of mercy killings of critically ill patients with lethal doses of narcotics with the intent of ending their life.

It's an important question to ask: what role, if any, should a physician play at the end of someone's life? If someone is terminally ill, has intractable suffering, is of sound mind and judgment, and requests an overdose of pain medication, what does one do? There are some who say physicians should have no involvement in ending a patient's life; it gives too much power to doctors who are fallible and who do not know everything. Others think that refusing to help a patient die who is in intractable pain is unethical of the doctor; as the ones who deal with dying on a regular basis, how can we abandon patients at this critical time? This is clearly a controversial issue and one I'm fascinated by but cannot resolve.

What if a patient says she is having trouble sleeping and asks for a prescription of barbiturates to help her sleep when you know her intention would be to commit suicide? Or what about the case of a person who needs escalating amounts of pain-killers to control his suffering until the point that he slips into a coma and passes away? How do we navigate responsibility and morality, life and death, when much of medicine is uncertain? In Oregon, physician aided death is allowed within strictly regulated boundaries. Is that immoral? Or should all the states follow suit?