Sheri Fink’s thoughtful and masterfully composed “Deadly Choices” report discusses the death of patients at New Orleans’ Memorial Medical Center (MMC) in the days after Hurricane Katrina in 2005 (additional material is at ProPublica).
“Deadly Choices” is heartbreaking. It recounts a situation that was miserable, terrifying, and in some cases, fatal. Fink reports that, among 45 Memorial Medical Center patients who died in the days during and immediately following the storm, 17 were deliberately administered lethal doses of morphine, sometimes along with a sedative, by physicians who apparently intended to hasten the patients’ deaths. (Many of these 17 were patients at a hospital-within-the-hospital, a long-term care hospital under separate ownership that shared some staff with MMC. At Slate today, Josh Levin discusses some of the troubling truths about the financing of long-term care hospitals, and Fink fills in some more of the blanks with a response at ProPublica.)
As Fink explained to Amy Goodman in an interview with Democracy Now earlier this week, at least one of the patients who were killed was not in extremis; he had not given up. He was
“Ready to rock and roll, wanted to get out. And apparently, according to several people who later spoke with investigators, a discussion was had in which they talked about how they might get him out, and they decided that because he was so heavy and it was so hot and people had—I mean, just imagine….They had been going on no sleep for days, the medical workers. They were tired. They were terribly disturbed by all the suffering that they felt that they saw around them. And so, in this sort of moment, they apparently decided that [the patient] could not be brought down, could not be evacuated, that there was no way to get him out.”
The story of what happened at MMC is also profoundly disturbing. It moves us to ask what sort of moral world physicians are expected, and allowed, to operate in. And to wonder why moral boundaries should be so elusive to exactly the people who, with access to the means to both prolong life and hasten death, walk on morally fraught territory more often than anyone.
The horrifying events at MMC are especially germane today — because they highlight a vexing question about health care reform that is very hard to answer: Is our doctors’ job to alleviate suffering, or is it to improve health?
A favored guru on health care ethics, Ezekiel Emanuel, is explicitly in favor of the latter. In “Justice and Managed Care” (subscription) in Hastings Center Report in 2000, he writes
“The allocation of health care resources should aim at and be justified by the improvement in people’s health…. The special aim or purpose of health care is curing disease, relieving pain and suffering, promoting public health, pursuing research to improve health, and so on.”
The “and so on” means that improving health — the obligation of a health care system, Emanuel asserts — amounts not just to the relief of pain and suffering but also to research and public health, and other tasks as well. The relief of suffering might not be a priority, that is. Or it might be a contingent priority, of importance for a limited time, or in certain circumstances — but not the only thing to worry about.
The point is not to vilify Emanuel. He has opposed euthanasia and physician-assisted suicide, so we should assume that he was as appalled by the actions of the chief physicians at MMC as others were.
But the Emanuelian sensibility is that the system in which physicians work is not meant to be dedicated to the relief of suffering alone. Rather, it bears other duties as well: a broad obligation to the public to promote health, and another obligation to contribute (through research) to the future of health care.
In this narrative, the physician is marshal of a campaign — not merely joined in a series of caring relationships with each of a number of patients, but commander of troops who have a long-term goal and territory to win. By implication, the rights of patients might take second seat to the needs of the public, or to the desire to learn more about how to improve health in the future. Patients shouldn’t be killed, this thinking goes, but they will have to understand that the prolongation of life is a luxury commodity to which physicians have the keys — and not everyone can have access.
The sense of the physician as a responsible manager, not merely a giver of care, connects with the utilitarian credo, “the greatest good for the greatest number” — a phrase that occurs three times in Fink’s piece as she strives to characterize the sensibility of MMC providers.
But the killings at MMC should, at the very least, make us ask whether it’s a good idea to have doctors making decisions about the greater good — or whether we want them to recognize individual persons above all.
This entry was posted on Friday, September 4th, 2009 at 9:20 pm and is filed under Ethics, Health Professions, Narratives, News, Physicians, public health, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.