Hurricane Katrina’s Medical Ethics, Term Paper Example

Hurricane Katrina struck New Orleans on August 29, 2005. The Memorial Medical Center there became a shelter for people in the area. But it quickly became surrounded by floodwaters which entered the basement where the backup generators were located, depriving the hospital of electricity (which is exactly what happened to Japan’s Fukushima Daiichi nuclear power plant after the earthquake of 2011). The floods also disabled the sewage system. Within days, people in the hospital were increasingly leaving or desperate to do so. This included some nurses and physicians, who either left on their own or were ordered to leave by their supervisors. The remaining senior hospital staff resorted to triage, a battlefield procedure that separates wounded into three categories: those who will probably live without immediate help, those for whom immediate medical help might save, and those who will probably die regardless.

In the hospital were patients who were classified as Do Not Resuscitate (DNR), meaning that should they lose consciousness, no special effort was to be made to revive them. It was allegedly decided that the latter group would either be evacuated last or not at all, depending on their individual condition. These patients were all on the seventh floor, and normally under the care of another healthcare company, called LifeCare Hospitals. Afterwards, some Memorial and LifeCare staff personnel deposed that an informal collective decision had been made to euthanize the DNR patients by using morphine and other drugs. A staff physician, Dr. Anna Pou, was seen carrying hypodermic needles and vials, and injecting DNR patients. Afterwards, elevated levels of morphine were found in tissue samples taken from two dozen of the forty-five bodies removed from the hospital by mortuary workers after Katrina.

Dr. Pou and two nurses were charged with homicide and arrested. The two nurses agreed to testify against Pou in exchange for immunity from prosecution. Yet despite the clinical evidence of elevated morphine levels in the deceased patients and the testimony of the two nurses, the Grand Jury declined to indict. The problem was that the bodies had been dead too long in hot and humid conditions to permit a final determination. The charge was expunged from Dr. Pou’s legal record, and the state of Louisiana agreed to pay her legal costs. Several lawmakers apologized to her. In interviews and media appearances, Dr. Pou never admitted to deliberately killing her patients, saying that the drug dosages were palliative, to reduced pain. Dr. Pou has become an activist in defense of medical staff working in crisis conditions (Fink).

The main ethical issue

The lack of a final legal determination may not be important to an ethical determination. Indeed the ethical issue was never really in doubt, and this was implicit in the charges against Dr. Pou. District Attorney Charles Foti made the moral distinction himself during a widely viewed news conference in 2006: “This is not euthanasia; this is plain and simple homicide” (deBoisblanc). Yet under Louisiana law, there is no meaningful distinction between the two. Euthanasia is homicide. Morally of course there is all the distinction in the world, and Foti wanted to make sure that the public understood that. Instead, what the public ended up understanding was that there was plenty of moral justification, given the conditions at the hospital during and after the hurricane, to give every benefit of the doubt to the physicians. They stood at their posts in the presence of patients who, by every standard of medical practice, were going to die very soon anyway. The public also understood that Pou may in fact have commit euthanasia, but here is where the legal aspect returns: based on the lack of clinical findings, it could not be proven or shown beyond a reasonable doubt that Pou was not attempting to administer palliative care, which is of course a part of her duty as a physician. So two of our seemingly main ethical issues to be summarized are hypothetical ones: if Dr. Pou committed euthanasia, was it ethically right for her to do so? And if she did do so, would it have been ethically right for her to deny it later? These questions arise because Dr. Pou acted ethically within her responsibilities by remaining on staff, even as other doctors did not or legally could not, having been ordered to leave. It’s important that those two questions, presumably the most relevant, are hypothetical. It’s important because it is an ethical question in its own right as to whether we may assume that she did commit euthanasia and then lie about it. My assumption in this paper is that we do not have the right to make that assumption. There simply is no evidence to support it. In the place of evidence we have a dropped prosecution and plenty hearsay and dubious news stories.

Kantian Perspective

Kant wrote, in what he called the categorical imperative, to always act in ways that you would want everyone to always act — to follow universal laws. It is important to emphasize that Kant meant this rule to always apply. It isn’t hypothetical or conditional. The key question here is what was Dr. Pou’s categorical imperative? We can gain an insight into this by looking at what her colleague, Dr. Bryant King, did when he saw Dr. Pou with a handful of syringes: he boarded a boat and left the hospital (Johnston). One physician stayed and acted, another fled, making no attempt to learn for sure what was going on, nor making any attempt to stop what he opposed or didn’t understand. This is an excellent real-world philosophical problem because the Kantian view is called deontological ethics, which place special emphasis on the relationship between duty and the morality of human actions. It has been summed up as duty for duty’s sake. In taking negative action by leaving, did Dr. King abide by a categorical imperative?

Framing the question this way, we at least are basing it on known facts, instead of the hypothetical ones involving exactly what Dr. Pou did or didn’t do. We have no ethical right to speculate in the sense of doing so in order to draw speculative ethical conclusions regarding her.

Utilitarian Perspective

There are said to be many different interpretations of philosophical utilitarianism. But it is generally agreed to mean that the ethically right action to take in a given situation is the action (or non-actions) that produces the most good or happiness (such good or happiness being the “utility” in “utilitarianism”) as an outcome to that action . So how is that different from Kant’s categorical imperative? Kant believed that certain actions or (or non-actions) must be taken even if the immediate results are not beneficial. The idea is that the categorical imperative itself contains the greatest good regardless of any practical consequences.

I can’t see how Dr. King’s actions were correct from a utilitarian perspective, either for himself or society. Although he escaped prosecution and the expense of attorney fees, and avoided the professional taint of being suspected of murder (or euthanasia), we can see that there can be no personal or general increase in “the good” (as philosophers say) by abandoning one’s post in the face of a crisis-induced moral dilemma. At first, one may take Dr. King’s comment that “I`d rather be considered a person who abandoned patients than someone who aided in eliminating patients” as an honest ethical choice that he was entitled to make (Grace). That is, until you realize that, in all probability, by abandoning them he was in fact aiding in eliminating them, albeit at a literal distance. Dr. King’s rationale seems, years later, to be at best an example of honest but confused self-deception. At worst it seems (from the same safe distance) to be dishonest self-justification. Dr. Pou, by contrast, stayed at her post and took actions that, rightly or wrongly (from any kind of philosophical perspective) exposed her to legal consequences and some initial loss of personal and professional reputation. But did her decision to stay result in greater good, either for herself, her patients, the hospital, or society, or all?

I think that her decision to stay did increase the greater good. Imagine what it would mean for us as a culture if all the doctors had abandoned their posts, or simply let their DNY patients die without any attempt at extraordinary care, merely because morphine wasn’t on their pre-Karina pharmaceutical menu. That, thinking like lawyers and not doctors, they anticipated a possible perception of wrongdoing on their part and the subsequent possibility of being indicted for an openly discussed action taken in the heat of a disaster. Neither I nor anyone else can say for certain whether the actions Dr. Pou then took were good from the utilitarian viewpoint, or for any other viewpoint, because we don’t know what they were. We can only judge her decision.

Virtue Ethics

Continuing with the almost binary difference between Dr. Pou and Dr. King — one stayed and the other didn’t — which one (if not both of them) live lives of eudaimonia? That is the last of the three qualities that are said to define virtue ethics, the other two being “virtue” and “practical wisdom”. In the interest of space, I leave those latter two alone on the grounds that most readers have an intuitive understanding of them. But not so with eudaimonia, which has various definitions and qualifications, but in general can be thought of as happiness, or a flourishing life, in the sense of acting naturally with charity and benevolence, because doing so is an integral part of who and what you are. Those qualities must be there inside you, not something forced.

Did Dr. Pou stay in the hospital while Dr. King didn’t because it was an expression of herself to do so? In other words, would she have done so had she been a clerk or a nurse and not a senior staff member with professional responsibilities? Once again, we are, I think, limited in the conclusions we can draw here. My own impression is that she probably would have, because those qualities that drove her to the medical profession in the first place would have been present had she chosen another path in life. But that impression is informed by her decision to stay and act. Dr. King had qualities that led him to become a physician too. And those same qualities permitted him to abandon the hospital when the opportunity came along to do so.

My Judgment

If I am to come to a judgment about Drs. Pou and King, how can I prevent it from being just an act of kibitzing? I can offer up what I like to think I would have done: I like to think I would have stayed and either helped Dr. Pou with the injections or come up with a reason not to help her, and, if so doing, stop her. Here I think I am in the majority. I find it hard to believe that many readers of this paper would disagree and side with Dr. King. But in speculating further I am on no firmer ground than I would be if I were to try to judge Dr. Pou on what I think she did that day even though the law decided that no determination could be made.

To summarize then, I think the Kantian categorical imperative would have been to fulfill my professional responsibilities and stay at the hospital unless (like most of the LifeCare staff), I was point-blank ordered to leave. So I side with Dr. Pou there. And I think that there was an increase in the utilitarian level of personal and general benefit when Dr. Pou stayed, and I think there was less around Dr. King when he left. As for their respective levels of eudaimonia, it may be that both Dr. Pou and King are comfortable in their own skins with their outcomes. We should hope that they are, because they had philosophically difficult choices to make, and have to live with them. As for us, we are left only with what we know. One chose to stay and act, and the other chose to protest and leave. I judge Dr. Pou to have been correct, by Kant and Utility.

Works Cited

deBoisblanc, Ben. It was Heroism, Not Homicide, During Katrina. Time.com. 2006. Web. 1 May 2012.

Fink, Sherri. The Deadly Choices at Memorial. New York Times Magazine. 2009. Web. 1 May 2012.

Grace, Nancy. Transcripts. CNN.com. 2005. Web. 1 May 2012.

Johnston, Kathleen. Staff at New Orleans Hospital Debated Euthanizing Patients. CNN.com. 2005. Web. 1 May 2012.