We Had to Kill Our Patients.

September 13, 2005 4:03 PM

We Had to Kill Our Patients : while this may not hit the US press for some time, the UK's Mail on Sunday reports that doctors in New Orleans chose to euthanize patients who were dying in agony and had no chance of survival during the disaster of Hurricane Katrina.
posted by grapefruitmoon (180 comments total)

People are going to freak out.

In my book, absolute heroes.
posted by Kickstart70 at 4:05 PM on September 13, 2005

In my book, absolute heroes.

Agreed. And, unlike the Terry Schiavo mess, I think that people will largely be very understanding of this situation. I may be quite wrong, though.
posted by billysumday at 4:07 PM on September 13, 2005

I can only pray it's true, even if it is from the Daily Mail.
posted by NinjaPirate at 4:07 PM on September 13, 2005

I did what I thought was right. I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul.

There are situations for which there are no words.
posted by Smedleyman at 4:08 PM on September 13, 2005

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posted by furtive at 4:11 PM on September 13, 2005

But Frist said that those patients were all moments away from jumping out of their beds, swimming through the floods, and rescuing other patients! He diagnosed them from aerial pictures of their hospitals!
posted by klangklangston at 4:11 PM on September 13, 2005

But is it because they were black?
posted by tapeguy at 4:12 PM on September 13, 2005

I read this in The Times, so it isn't just the Daily Mail, FWIW. They quoted one female Doctor, who eventually fled from murderous looters, as saying that they chose patients who weren't going to last more than a few hours, injected them with morphine, and placed them in a dark room to die in peace.
posted by fire&wings at 4:13 PM on September 13, 2005

I have no idea what to say to this. It's horrific. God Bless America.
posted by OmieWise at 4:13 PM on September 13, 2005

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posted by matteo at 4:13 PM on September 13, 2005

Holy crap.

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posted by loquacious at 4:14 PM on September 13, 2005

I can't imagine how awful it must have been to have to make that kind of decision. This is just about humans trying to live in an awful world and do the right thing. This is not about politics.
posted by matildaben at 4:17 PM on September 13, 2005

Oh for chrissakes can we keep the politics out of it. I know, the other side won't, but that quote above has struck me to the core and I really don't give a shit what Frist might think about it right now.

Beneath all the legal and economic crap there is still something profoundly heroic about doctors. And fucking terrifying, like anything truly heroic.

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posted by freebird at 4:17 PM on September 13, 2005

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posted by nola at 4:19 PM on September 13, 2005

Paint me as an extremist irrationalist or whatever, but does it seem to anyone else like maybe disaster preparedness/disaster relief state, local and federal agencies were a bit more proactive about their policy-making and, well, preparedness, this kind of extreme decision-making might have been unnecessary? Or perhaps at least government-sanctioned or government-advised?

Or am I the kooky one here? I don't remember having to hear about this in other similar disaster situations in the U.S., but maybe it was just media blackout?

Or is the news source an unreliable one?

Wait, let me get my tinfoil hat.
posted by kalessin at 4:22 PM on September 13, 2005

. . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . .

And then a couple hundred more.
posted by goodnewsfortheinsane at 4:27 PM on September 13, 2005

.

...tough to imagine but someone is going to sue one of these hero's.
posted by j.p. Hung at 4:28 PM on September 13, 2005

I am really shocked that this wasnt covered earlier in the media blitz. But there is a chance that I missed it.
posted by Acuba at 4:29 PM on September 13, 2005

Now that the nursing home owners in St. Bernard's Parish have been arrested for 34 counts of negligent homicide, the Lousiana Attorney General has said they are investigating the deaths in the hospitals.
posted by Mack Twain at 4:29 PM on September 13, 2005

Too bad they weren't brain dead. Maybe then George Bush would have cut his vacation short to save them...
posted by any major dude at 4:30 PM on September 13, 2005

jesus.
posted by scody at 4:31 PM on September 13, 2005

That's the most unbearably sad story that I've heard regarding this disaster. Nobody should ever be put in the position that those doctors were forced into and no patient should ever be so abandoned by rescue that their death is imminent. The doctor's aren't the killers. Whoever failed them is responsible.

And I thought the headline in my mailbox this morning "45 Dead Found in Hospital" was horrible.

This is all so, so, so, so, so, bad.
posted by Jon-o at 4:32 PM on September 13, 2005

I had a feeling that we'd hear such stories. What a horrible choice to have to make.

Now that the nursing home owners in St. Bernard's Parish have been arrested for 34 counts of negligent homicide...

Do you know something we don't? Last I heard, it was still under investigation.
posted by mrgrimm at 4:33 PM on September 13, 2005

mrgrimm: story
posted by null terminated at 4:38 PM on September 13, 2005

while this may not hit the US press for some
time
It was on CNN's website Monday.
posted by thomcatspike at 4:41 PM on September 13, 2005

'These people were going to die anyway'

Well, aren't we all? Is that any reason to hasten the process?

MetaFilter: 'These people were going to die anyway'
posted by Doohickie at 4:45 PM on September 13, 2005

does it seem to anyone else like maybe disaster preparedness/disaster relief state, local and federal agencies were a bit more proactive about their policy-making and, well, preparedness, this kind of extreme decision-making might have been unnecessary?

Word. These doctors have a claim against their local gov, and possibly the feds.
posted by squirrel at 4:48 PM on September 13, 2005

May God have mercy on those doctors. They did nothing to deserve being put into that situation.
posted by Doohickie at 4:48 PM on September 13, 2005

This situation definitely puts Terri Schiavo in grim perspective, and demonstrates that all the outrageous theatrics that were delivered strictly to mollify constituents.


On preview: what goodnewsfortheinsane said.
posted by mullingitover at 4:49 PM on September 13, 2005

While it's mostly different, Nursing home owners face charges for "negligent homicide" in the deaths of 34 tenants...

In this case, they're being charged with homicide because they did not move the tenants somewhere safe..

On one hand - I can see why people are crying foul. On the other - how are 2 people supposed to move 34 tenants? I don't really know, and I'm not in a place to answer I guess. But does nursing home care include rescue from natural disaster? It's a cold, sick question to ask - but it must be asked in this case...

Sadly, I am sure the doctors - who probably have much better intentions than these nursing home owners - are going to suffer a worse fate than them...

I don't know what to think about the nursing home situation because I don't have much in the way of facts, nor do I know much about what the law defines as their responsibilities as caretakers... but I have a feeling it's going to make set a messed up benchmark for what's going to happen to these poor, poor doctors...
posted by twiggy at 4:50 PM on September 13, 2005

Has this story been confirmed? If it was on CNN on Mon, I'm surprised it hasn't been more widely reported.
posted by 327.ca at 4:52 PM on September 13, 2005

Metafilter: Utterly jaded

Not all tragedies can be avoided. Sometimes bad things happen, and no amount of planing and preparedness would avoid every possible outcome. I'm grateful that there are people that make the most of horrible situations, even when it isn't the easy thing to do.
posted by blue_beetle at 4:54 PM on September 13, 2005

I guess it has been widely reported after all.
posted by 327.ca at 4:55 PM on September 13, 2005

As strange as this may sound, I'm related (by marriage) to the couple who owned the nursing home and are being held for negligent homicide. This thread is the absolute first I've heard about this.

Not to excuse their actions, but I can't imagine what set of circumstances could have led them to abandon their residents.

Like many of you, I'm eager to hear their side of the story before I pass judgment.
posted by ColdChef at 4:58 PM on September 13, 2005

ColdChef, there was a long story about the coming nursing home indictment on CNN last night. They reported that the lawyer for the owners wouldn't comment except to say that thier version of events was radically different ...
posted by R. Mutt at 5:04 PM on September 13, 2005

ColdChef: I just wanted to say that I'm truly sorry that my posting the link was how you had to hear about your family's situation. That makes me feel... weird...
posted by twiggy at 5:04 PM on September 13, 2005

This is one of my nightmares; that I'd be forced to end someone's life "for their own good" in the event of an emergency. What courage it took to face the ultimate responsibility for those people's suffering. From reading personal statements of some of the nurses who were on duty in hospitals during those days, it was obvious what had been happening.

The statement i read that made it clear to me was "the ventilators were still functioning and then the generators failed. We couldn't bag (hand-ventilate) everyone; it was impossible. We put everyone on T-Tubes (an extension to the tube that goes into the person's lungs) and some were able to breathe on their own."

Huge DOT!
posted by reflecked at 5:04 PM on September 13, 2005

Another tragedy amid the greater tragedy. What an absolutely heartbreaking decision they had to make and have to live with.

And a really strong reason why I did not ever really give real thought to going into medicine. I wouldn't want to be put in a situation where I had to make the decision this doctor did.
posted by fenriq at 5:04 PM on September 13, 2005

twiggy: if this is the nursing home I'm thinking of, I've heard many times that they were offered evacuation and declined it, only to accept it a few hours later (which was too late to get sufficient equipment in place to evacuate the home).

And

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at least 648 times (the latest death toll numbers reported here).
posted by SirOmega at 5:07 PM on September 13, 2005

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posted by sciurus at 5:12 PM on September 13, 2005

This might point out another in the myriad flaws with our current "disaster preparedness plan"...we need to have a civil coordinator of some sort for health care providers who could have connected with them early on and tried to figure out where to send those patients they could evacuate and also to help the people who are caregivers (often for a whopping $5. or so an hour...not exactly wages that offer much in the way of indication that you actually do hold someone's life in your hands). How come there wasn't a county health official calling each and every certified care facility about how they were going to get out? It's an epic tragedy but we can still glean something from it, something for the future and inevitable disasters to come.
posted by Griffins_posse at 5:14 PM on September 13, 2005

"They injected them, but nurses stayed with them until they died."

I never cease to be amazed at mankind's inherent humanity in the face of such adversity.
posted by Civil_Disobedient at 5:14 PM on September 13, 2005

Yeah, I'm watching Keith Olbermann on MSNBC, and he dittos what SirOmega said--it appears they were offered evacuation and did not accept it, which does seem to be pretty negligent.

From MSNBC:

"The owners of St. Rita's Nursing Home in the town of Chalmette "were asked if they wanted to move (the patients). They did not. They were warned repeatedly that this storm was coming. In effect, their inaction resulted in the deaths of these patients," Louisiana Attorney General Charles Foti said.

[...]

The owners had an evacuation plan as required under state law and a contract with an ambulance service to evacuate the patients, but they did not call the company, Foti said.

They also turned down an offer from St. Bernard Parish officials who asked if the nursing home wanted help evacuating, he said."
posted by nonmerci at 5:17 PM on September 13, 2005

Oh My God. That is amazing. I don't blame them at all. It's classic triage...but with humanity in it. I hope this doesn't get out much because people are going to absolutely explode when they hear this.
posted by aacheson at 5:19 PM on September 13, 2005

These physicians are true heroes. It's a traumatic experience, and I hope adequate counseling will be available to help them cope.
posted by NucleophilicAttack at 5:19 PM on September 13, 2005

nonmerci, I can't find any link between that nursing home and the patients in the article from the Mail. Is this the same place?
posted by wakko at 5:28 PM on September 13, 2005

Um, did you read the thread? It was mentioned numerous times.
posted by nonmerci at 5:29 PM on September 13, 2005

All the links in Google News reference that article in the Daily Mail -- which was published two days ago. I'm still skeptical (not that the Mail isn't a fine, upstanding tabloid or anything)...
posted by 327.ca at 5:32 PM on September 13, 2005

It seems like the nursing home owners could have paid someone to move the people before the hurricane hit, thusly avoiding negligent homicide charges.

Should it be legal to leave nursing home patents in the path of a Cat 5 hurricane and below sea level?
posted by delmoi at 5:35 PM on September 13, 2005

Lucky sons of bitches.

I wish somebody'd OD me on morphine...
posted by alumshubby at 5:48 PM on September 13, 2005

The doctors did the right thing.
posted by jeffburdges at 5:51 PM on September 13, 2005

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posted by Edible Energy at 5:59 PM on September 13, 2005

delmoi:

From my own experience with nursing homes, albeit as a "relative" and not as a practitioner, they cut corners wherever possible at the iffy ones even when it may affect the patients. They must have done the cost/benefit risk analysis and decided that the chance of catastrophe was less than the certain monetary loss they'd take evacuating. Worse than bad for them and the 34 lives they condemned, and they deserve to be nailed to the mast permanently if it will give even one future "caregiver" pause to do the smart thing instead of thinking about their pocketbooks.

Nursing homes bother the hell out of me, because they too often treat the elderly as invalid--some are actually good but this highlights the callous calculus involved in for-profit medical corporations.
posted by trigonometry at 6:07 PM on September 13, 2005

Looking forward to Bush's "culture of life" speech.
posted by dreamsign at 6:13 PM on September 13, 2005

I don't see how it's a hard decision at all. You know you're doing the right thing.

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posted by Mach3avelli at 6:15 PM on September 13, 2005

Battlefield pragmatism.

Doctors do this routinely, you know. My aunt - who has been a consultant surgeon in the UK for decades- told me all about it years ago, and it never seemed anything other than basic decency, to me. When the pain gets too bad and there's no hope of recovery, you do the decent thing: morphine OD. Except on the record you say "pain relieving dose increased to X mg."
posted by Decani at 6:35 PM on September 13, 2005

I will be truly disgusted and entirely unsurprised if the Bush people use this to distract everyone from their incompetence and culpability in this disaster.
posted by Rothko at 6:40 PM on September 13, 2005

This is one of my nightmares; that I'd be forced to end someone's life "for their own good" in the event of an emergency.

I was riding my bike yesterday past a squirrel who had broken his neck and was slowly being devoured by flies. He was still alive and slightly turned his head toward me in what I perceived to be some sort of plea for mercy. I didn't kill him but I should have. I should have found a rock and put him out of his misery but I couldn't bring myself to do it. I can only imagine what those doctors had to go through with people. It's just so sad that they had to be put in that situation. Especially in a country that will spare no expense - billions of dollars to test a quixotic "star wars missile defense shield - yet can't bring themselves to airlifting the dying out of a flood zone so they may die with a little more peace.
posted by any major dude at 6:42 PM on September 13, 2005

An awful decision, but yeah, they almost certainly did the right thing if what they determined about the various terminal illnesses was accurate.

Not sure why this is an FPP, tho.
posted by dhoyt at 6:47 PM on September 13, 2005

They must have done the cost/benefit risk analysis and decided that the chance of catastrophe was less than the certain monetary loss they'd take evacuating.

The analysis may have included the risk to patients upon being moved versus the probability or a direct hit. Is it possible they were trying to not risk lives to a false alarm?
posted by missbossy at 6:56 PM on September 13, 2005

dhoyt, I think, as the stories come out, what happened in places like hospitals will be among the most compelling.

As for this story - jeeze. Just when I thought the SuperDome stories couldn't be "topped," along came the nursing home one. And then the story of dogs eating human remains.
And now this.


BTW do you think these are the same patients reported in earlier stories as being 40 bodies found in hospitals? Or were those people who did die of "natural" causes.
posted by NorthernLite at 6:56 PM on September 13, 2005

of a direct hit
posted by missbossy at 6:57 PM on September 13, 2005

Well, aren't we all [going to die anyway]? Is that any reason to hasten the process?

Yes, yes it is, if the only other option is still to die, just more slowly and horribly. If I had to choose between suffocated slowly after my ventilator failed, struggling against it the entire time (because the body does not go gentle into that asphyxiation), or being overdosed with a painkiller so that I simply drift off to unconsciousness without pain or anxiety... Well, I'd be begging for the needle.

On preview: It's not even relevant if their illnesses were terminal or not. These patients were going to die regardless, and the doctors had a choice: let them die horribly, or help them die peacefully. "Do no harm" is more nuanced than "preserve life at all costs."
posted by jesourie at 6:59 PM on September 13, 2005

Speaking of outrage:

The always honorable Minister Louis Farrakhan says

"I heard from a very reliable source who saw a 25 foot deep crater under the levee breach. It may have been blown up to destroy the black part of town and keep the white part dry."

posted by dhoyt at 7:02 PM on September 13, 2005

I keep trying to stay informed without getting completely overwhelmed, and so I avoided the nursing home story until now, when it makes me want to cry.
posted by OmieWise at 7:06 PM on September 13, 2005

dhoyt: A reliable source who could see through 25 feet of muddy water?
posted by furtive at 7:10 PM on September 13, 2005

The always honorable Minister Louis Farrakhan says

"I heard from a very reliable source who saw a 25 foot deep crater under the levee breach. It may have been blown up to destroy the black part of town and keep the white part dry."


posted by dhoyt at 10:02 PM EST on September 13 [!]

Yeah, that's a theory floating around the net. People claim to have heard explosions...
posted by jikel_morten at 7:10 PM on September 13, 2005

jesh!
posted by thecollegefear at 7:12 PM on September 13, 2005

I can say with absolute certainty that had any one of those who the physicians triaged and deemed unable to be moved and/or terminal had been a loved one of mine, I would personally shake the hand of the person who had to make so horrible a decision. And thank them for caring enough about the person to assist them to die without any more suffering than absolutely necessary.

I have never understood the sheer selfishness of those who put their eighty year old parent on a vent and refuse to sign off on DNR orders in spite of the fact the parent will never recover from whatever ails them. /end tangential rant
posted by sillygit at 7:14 PM on September 13, 2005

Hardly new to Metafilter.
posted by caddis at 7:33 PM on September 13, 2005

This is horrifically sad.

I expect that within the next month charges will be discussed or brought. This is just too ripe and attractive for a grandstanding DA to pass up. The odds that within this miasma there is not one orderly or nurse that got bent out of shape or had their ethics challenged by being a witness or participant in these deaths are pretty small, and they will subsequently become a witness against medical staff. Let's hope good sense prevails.
posted by docpops at 7:35 PM on September 13, 2005

Speaking of outrage:
The always honorable Minister Louis Farrakhan says
"I heard from a very reliable source who saw a 25 foot deep crater under the levee breach. It may have been blown up to destroy the black part of town and keep the white part dry."
posted by dhoyt at 10:02 PM EST on September 13 [!]

Yeah, well, he and the other three members of the Nation of Islam believe way dumber shit than that, so I'm not surprised.
posted by Optimus Chyme at 7:39 PM on September 13, 2005

I can only hope that I have such caregivers when my time comes.
posted by deborah at 7:51 PM on September 13, 2005

any major dude will tell you
posted by mr_crash_davis at 7:51 PM on September 13, 2005

"I heard from a very reliable source who saw a 25 foot deep crater under the levee breach... People claim to have heard explosions..."

Oh please. The USACE have said that the levees failed after water overtopped them, eroding the dry bank. A concrete wall breaking under water pressure because it is no longer secured to the ground would make a fairly big noise, and the rushing water would erode a fairly big hole. I can't believe the lengths people will go to confirm their terrorism paranoia.

Back on topic:
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posted by Popular Ethics at 8:08 PM on September 13, 2005

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posted by adzm at 8:10 PM on September 13, 2005

The hospital administrators and the City should be indicted; not the MDs.
posted by ParisParamus at 8:32 PM on September 13, 2005

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posted by VulcanMike at 8:40 PM on September 13, 2005

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posted by dazed_one at 8:41 PM on September 13, 2005

The hospital administrators and the City should be indicted; not the MDs.

if the mds are indicted, one can certainly imagine there will be a long, long list of witnesses called ... hospital administrators, city officials, state officials, federal ... all to establish negligence on the part of said officials

i really wonder if a da would want to open such a can of worms

all i can say is that it's a real tragedy ...
posted by pyramid termite at 8:44 PM on September 13, 2005

Interesting story, especially if it is being passed on by MSM. However, I note that William McQueen is here called "an emergency official." In a story a week earlier, in gthe Mirror I think, his British wife was looking for him and she described him as some sort of plantation worker. Probably means nothing.
posted by jakking at 8:52 PM on September 13, 2005

j.p.Hung: ...tough to imagine but someone is going to sue one of these hero's.

I agree, people will sue the hell out of them. What a difficult decision for the medical staff to make. I can't imagine how I would handle such pressure.
posted by Kloryne at 8:52 PM on September 13, 2005

Oh, and any major dude -- everytime you post, that song is suck in my head for days. Not necessarily a bad thing...
posted by Kloryne at 8:55 PM on September 13, 2005

This broke my heart when I read about it yesterday. What a horrible position to be in having to make those sorts of decisions. The nursing home story just makes me angry, but not the doctors who helped people die peacefully. The last few years of my dad's life, he was often in the hospital for extended stays, and had there been a disaster like this, he would have taken days to die on his own ... even in those instances when he was expected to get better and be able to leave again, and it would have been horrible for him. I would have faulted no one for helping him along. In fact, once my dad's DNR order went into effect on his last trip to the hospital and he was removed from the machines, I don't know that his last few shots of morphine weren't someone helping him along, and I wouldn't fault his heath care workers if that were true.
posted by Orb at 9:07 PM on September 13, 2005

The hospital administrators and the City should be indicted; not the MDs.
posted by ParisParamus at 8:32 PM PST on September 13

Federal response to Katrina Fastest of all Hurricaines Ever
posted by Optimus Chyme at 9:16 PM on September 13, 2005

He was still alive and slightly turned his head toward me in what I perceived to be some sort of plea for mercy. I didn't kill him but I should have.

Oh man. Yes, you should have.

Every living thing deserves mercy and to be treated with kindess and respect. Sometimes 'Kindness and Respect' means doing what these doctors did, and I salute them.
posted by anastasiav at 9:17 PM on September 13, 2005

derail-->

I can't believe the lengths people will go to confirm their terrorism paranoia.


They don't think it was terrorism. They think it was the government that left them to fend for themselves for five days. I'm not saying they're right, wrong, or credible but I'm pretty sure that's what they think.
posted by rdr at 9:49 PM on September 13, 2005

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posted by login at 10:12 PM on September 13, 2005

I can't believe the lengths people will go to confirm their terrorism paranoia.

The theories I've seen floating around aren't about terrorism, but rather about government blowing up a certain levee in order to save the better part of town, or something like that.
posted by jikel_morten at 10:28 PM on September 13, 2005

when doctors are mercy-killing patients in extensive care for the sake of what may happen next, the country has lost its moral compass.

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posted by seawallrunner at 10:40 PM on September 13, 2005

We had a case in an ICU that I worked in where life support was withdrawn to allow the patient to die (jargon update: some want to change DNR, do not resuscitate, to AND, allow natural death). The patient didn't die right away and a doctor assisted death using a non-narcotic drug whose only purpose could be to hasten death (not alieve suffering). The DA wanted to press charges but couldn't get the cooperation of the family who vowed to testify for the defense. It was the family who asked for the suffering to end and morphine wasn't doing the job.

Any malpractice trial will have to be in front of a jury. Even if the family participated, I can't imagine a jury of sane individuals, when presented with the circumstances would award damages.

With that said, this is really sad. I can imagine what they were thinking when their situation made them god. I don't envy them but I respect them for staying and doing the best job they could under dire circumstances.

I used to work at Tulane. It broke my heart to hear the stories coming out of Tulane and Charity (in fact all of New Orleans, I checked to see if my old apartment was dry). It's like hearing that an old friend died. You haven't thought about them recently and now you can't stop thinking about them.
posted by whatever at 11:34 PM on September 13, 2005

As person born in Baton Rouge, one that went to grad school there, and one that goes back almost twice I year I have two comments.

One, when I saw the weight of the problem, one of the first things I did was pull out a NO area map and circle hospitals, major gathering points, and highways. I then tried (also via Google Maps) to figure out the worse areas.

Two, if I was thinking of that Monday night, what the hell happened to our government's response?
posted by webranding at 11:56 PM on September 13, 2005

webranding: Armed mostly with info from web browsing I called my brother 24 hours before landfall and said "Looks like we're about to see destruction of apocalyptic proportions."

And I'm just some guy.
posted by StickyCarpet at 12:13 AM on September 14, 2005

"... and had no chance of survival...."

This has nothing to do with the hurricane, but earlier tonight I was watching Schindler's List for the first time, and was moved by the scene where the doctor and nurse poison their patients before Nazi soldiers can get upstairs to machine-gun them. Obviously, as Jon-o says, nobody should ever be put in the position that those doctors were forced into, but sometimes it happens.
posted by lelilo at 12:14 AM on September 14, 2005

"SticklyCarpet" that is my point and the point of many others.

Plus, I've lived there. Politicans there are more gangsters then leaders. I will admit that. I mean a five term governor (Edwards) has been in jail for years.

But several things. (1) The local officals asked for help before the storm hit. (2) If I know local officals are idiots, I would hope the federal government would as well.

BTW: You point that we could both see on our computers there would be problems, yet we have government officals from the White House talk about newspaper headline is a sad, sad thing.

There is just no excuse. None!
posted by webranding at 12:25 AM on September 14, 2005

"lelilo" I think what those doctors did, if the story is accurate, shows an amazing amount of courage. The other large death toll from a single location is 34, from a nursing home.

I don't know who said it, but I've repeated it for many years.

"The true test of a society is how they take care of those that can not take care of themseleves. Children, sick, elder, those with mental illness."

Seems we could not take care of them.
posted by webranding at 12:31 AM on September 14, 2005

It came down to giving people the basic human right to die with dignity.

Being overdosed with morphine cause they see no value in me and cant be arsed spending the money to try , oh aye , thats a lot of dignity.
What other spurious Human rights are floating about these days ?
posted by sgt.serenity at 12:37 AM on September 14, 2005

sgt, more details may come out. I hope what you suggest is not the case. I am 35. Pretty fit. A few years back I got a bizzare virius that almost killed me in three or four days. I was in the ICU with a tube helping me to breath for more then a week. Without power I would have died.

I can only assume much older and sicker people were in worse shape. And the people in the hospital after days and days of waiting for help, knew they would die a much longer and worse death. I mean the temps in the hospital in question was 106 in the afternoon.

No toliets. Almost no water. Armed people coming in looking for drugs. What would you have done?
posted by webranding at 12:49 AM on September 14, 2005

Give the drugs to the junkies as long as they carry someone out.
posted by sgt.serenity at 12:56 AM on September 14, 2005

Has this been corroborated? I cannot find the link at cnn.com that was mentioned.
posted by furvyn at 12:57 AM on September 14, 2005

Q: What's Bush's opinion on Roe v. Wade?

A: He doesn't have one. He doesn't care how people get out of New Orleans.
posted by fandango_matt at 1:01 AM on September 14, 2005

sgt, you can't mean that. Just give them the drugs to leave. Mix up the best drug you can and give it to them.

For me I knew I would live, but I had to stay in the ICU. Death was all around me. And don't think for a second I couldn't hear it. And this was in a "perfect" situation. Think about what this situation was like.

Depends what part of the debate you are asking about furvyn. The death of the people, yes. The fact people helped it along, not in a way that I would say is was fact.
posted by webranding at 1:02 AM on September 14, 2005

Orb - my father was in a similar situation. No matter, I do not begrudge the medical staff anything - my father didn't have to suffer any longer.
My mother was a nurse at the nursing home my grandmother was in. My mother knows death all too well. She knew my grandmother had little time left, and that time would be nothing but pain and agony (for my grandmother as well as my mother). Mom upped Grandma's morphine, and she slipped into a final, peaceful sleep - it's the most wonderful thing my mother has ever done. Tragic situations call for heroic compassion.

As for the nursing home situation, if things are proven true, and the owners are convicted, I truly hope it sets a legal precedent. If these people are punished for negligent homicide, so should others.

I'm not trying to politicize this, but, in light of Bush accepting responsibility for the inaction of the Fed, what are the legal implications here? In accepting responsibility, is he opening himself up to the possibility of murder charges?
posted by zerokey at 1:24 AM on September 14, 2005

Q: What's Bush's opinion on Roe v. Wade?
A: He doesn't have one. He doesn't care how people get out of New Orleans.

Tragic and beautiful.
posted by Rothko at 1:39 AM on September 14, 2005

It's funny cause it's true.
posted by sacrilicious at 1:50 AM on September 14, 2005

Families are often asked to make this decision more times than's been reported. My mother died from multiple myeloma. The last few days in hospital (nothing but heavy/light labored breathing), the nurses kept stressing over and over again that if in our opinion mother was in pain, the morphine in the IV could be turned up. They showed us wiich dials on the IV machine to use, and turned off the alarms and the safety that wouldn't allow the dosage over a certain amount. However, the more morphine we gave her, the more depressed would her respiration be; too much morphine and she would probably stop breathing. For some reason, I remember the number "40" as being important. Again and again, the nurses told us and asked us, again and again, "Do you understand what we're saying to you? Are you sure you want us to unlock the machine?"
In the end, we didn't have to do anything--but I can imagine other families being told the same thing in similar situations. Is it our own fear of death and dying? Or the last good thing you can do for someone you love? Nineteen years plus, and I still don't know. People don't die like they do in the movies, with soft lighting, a great score, and good make-up. It can take a long time and look and smell like nothing you've ever expected. I wouldn't want to wish the decision on anyone else, and I wouldn't fault anyone for making a decision either way.
posted by paddbear at 3:31 AM on September 14, 2005

Of all the nightmare scenarios that played out in NOLA the past few weeks, the one that I could barely bring myself to face was the fates of the very old and infirm. Drowning while waiting and praying for help, slowing and painfully dying because there is no power to run the machines that keep them alive. How afraid they must have been, how agonized they must have been wondering why this was the way they had to go. No one deserves to go through such a horror! If it were me, or a family member I would hope the attending physician or nurse would have the mercy & the courage, and that they didn't believe in a god who's a monster.
posted by zarah at 6:02 AM on September 14, 2005

Give the drugs to the junkies as long as they carry someone out.
posted by sgt.serenity at 12:56 AM PST on September 14

Pray tell, will the junkies also be carrying the beds, oxygen tanks, IVs, and diesel generators? You know, the equipment terminal patients need to stay alive?
posted by Optimus Chyme at 9:21 AM on September 14, 2005

I did this for my dad. It was the hardest but most righteous thing I've ever done. They get a big DOT from me.
posted by dness2 at 9:29 AM on September 14, 2005

Give the drugs to the junkies as long as they carry someone out.

Geez, sgt, that was surprisingly fatuous coming from you. If you're going to criticize what these people reportedly did, either offer a viable alternative or admit that however awful it is, you would've done the same.

Yo, thomcatspike, it's time to step up. Unless that was a feeble attempt at a joke, you need to back up the "CNN on Monday" claim. I've been watching for any corroboration of this since it broke and have yet to see anything that's not pointing back to the Mail article.
posted by soyjoy at 9:34 AM on September 14, 2005

It came down to giving people the basic human right to die with dignity.

Is the basic right here the right to die with dignity, or is it the right to die as one chooses? If I decided I want to die in a horrific, "undignified" manner, can I be killed instead in a method society considers "dignified?"
posted by DevilsAdvocate at 9:36 AM on September 14, 2005

There are more medical stories coming out now.

Autopsies planned for New Orleans hospital bodies

A Doctor's Message from Katrina's Front Lines

Agonizing Days of Heat and Death on a Medical Island

I imagine we will see these discussions continue, as doctors and nurses finally get patients triaged and to better facilities and have their first opportunities to take stock and compare notes. In fact, I think they may be doing quite a bit of legal and political organizing and critiquing of the disaster response. After all, they know how the plans were supposed to be carried out, they've followed the changes at FEMA, and...you know... even those who are deaf to the accusations of the poor might have a much harder time discrediting the statements of doctors and nurses.

posted by Miko at 9:39 AM on September 14, 2005

I understand the positions the doctors were in... :(
but I can't find it within myself to think them heroes. Sorry. No matter how justifiable, it was still a culling.
posted by slf at 9:47 AM on September 14, 2005

No matter how justifiable, it was still a culling.

Triage is always a culling. Triage is a humane and utilitarian method of doing the greatest good by applying limited resources where they can make a difference. If heroic treatment cannot make a difference in the outcome, it is never justified. Triage identifies patients who cannot be saved. They are going to die no matter what resources are spent on them. So to allow an inevitable death to proceed humanely is going above and beyond the demands of triage; it is a humane act and is fully justified. Had the doctors chosen to let them die alone on the floor, thristing, starving, and enduring pain alone for days, they would have been within the standard of triage. However, they took the time and resources to devote to providing patients with a less agonizing death. This was the right thing to do.

I can't believe anyone would stoop low enough to accuse these doctors of murder. To do so is to apply the reasoning of the safe and privileged to people in a life-and-death situation analogous to a battlefield. They suffered the same privations and stresses as other victims, all the while exposing themselves to the worst infectious agents and working around the clock without the basic necessities of proper medicine. The idea that somehow what they, in their professional wisdom and desire to do good, chose to do could be construed as wrong is inadmissible to me.
posted by Miko at 9:58 AM on September 14, 2005

No matter how justifiable, it was still a culling.

Really? How? Do you think the doctors, in their nefarious ways decided "what an opportunity! We get to kill our patients and thus keep the rest of us strong and healthy!"

Or is it better, in your eyes, to die alone and uncared for in an abandoned hospital, in the dark, than to go peacefully with a morphine sleep coming over you, your hand grasped in another's?
posted by Optimus Chyme at 9:58 AM on September 14, 2005

I've been watching for any corroboration of this since it broke and have yet to see anything that's not pointing back to the Mail article.

It's been three days without independent confirmation from sources other than the Daily Mail that this actually happened.

I think (and hope) this is a taboid fantasy.
posted by 327.ca at 10:02 AM on September 14, 2005

The "doctor's message" NPR link I gave above has a doctor describing culling patients, black-tagging the sickest and moving them to where they could die in peace, and delivering morphine to the dying.
posted by Miko at 10:10 AM on September 14, 2005

That would be "tabloid fantasy", of course.
posted by 327.ca at 10:10 AM on September 14, 2005

Just so we're all clear on one thing:

The Hippocratic Oath
(Modern Version)
I swear in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

To reckon all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

With purity, holiness and beneficence I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

Whatever in connection with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.
posted by swift at 10:13 AM on September 14, 2005

Thanks for the link, Miko. The doctor says, "We did everything from delivering babies to simply providing morphine and a blanket to septic and critical patients, and allowing them to die." That's not quite "we had to kill our patients", but when he says, "I cannot even begin to describe the transformation in my own sensibilities, from my normal practice of medicine to the reality of the operation here," you can see how helpless he must have felt.
posted by 327.ca at 10:17 AM on September 14, 2005

Almighty? fertilization? reject abortion? That seems like a religious conservative's version of the Hippocratic Oath, but I don't know enough about things to know if there's another one.
posted by dness2 at 10:18 AM on September 14, 2005

Exactly how is the oath relevant when a great many physicians don't believe in an imaginary daddy in the sky?
posted by zarah at 10:22 AM on September 14, 2005

Just so we're all clear that Swift has posted a single specific version of the Hippocratic oath, and that there are many other versions and modernizations of the ideals it is meant to express, and that it is an ethical guide but in no way legally binding:

Another modern version, and aWikipedia breakdown on the history and use of this widely misunderstood idea.
posted by Miko at 10:24 AM on September 14, 2005

Okay.

Here's the original:

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
posted by swift at 10:24 AM on September 14, 2005

What are you swift, some sort of fundamentalist?

You lost me at "in the presence of the Almighty."
posted by mrgrimm at 10:26 AM on September 14, 2005

Okay.

Here's the original

Really? I figured the original would be in Greek.
posted by mrgrimm at 10:30 AM on September 14, 2005

Don't miss "The Hippocratic Oath Today: Meaningless Rhetoric or Invaluable Moral Guide?" from the NOVA link above.

Fundamentalists don't get to have too much of a field day with this, because it dates from a time when Zeus and Athena were the Almighties being referenced, women were not recognized as citizens (let alone able to make reproductive decsions), and the need for euthanasia was hardly dreamed of, as most people died from acute traumas and infections rather than long chronic illnesses.

From the linked article: "According to a 1993 survey of 150 U.S. and Canadian medical schools... only 14 percent of modern oaths prohibit euthanasia, 11 percent hold convenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients -- all maxims held sacred in the classical version. The original calls for free tuition for medical students and for doctors never to "use the knife" (that is, conduct surgical procedures) -- both obviously out of step with modern-day practice."

The Oath is largely ceremonial. Debates on medical ethics usually refer to its spirit, but find its specificity is all but useless as regards the ethical challenges posed by modern medicine.
posted by Miko at 10:31 AM on September 14, 2005

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are [skilled] in this work.

I don't get that one. Does it not apply to surgeons? TAKE OUT MY STONE!

I didn't realize the original oath was so backwards. Thanks, swifty.
posted by mrgrimm at 10:34 AM on September 14, 2005

What are you swift, some sort of fundamentalist?

No, I'm not a fundamentalist, nor religious. That's beside the point, anyway.

I think the doctors probably did a good thing. However, it's also true that doctors take an oath (which may be as meaningless as the U.S. President's oath of office; that's up for debate) in which, in all the translations I've seen (yeah, yeah, they're not the original Greek, but please...), they promise not to kill a patient with drugs, and, provocatively, to administer abortions. Why isn't this a part of the debate?
posted by swift at 10:34 AM on September 14, 2005

Thanks, Miko. Still interested in the knife clause. I'm not sure why it was prohibited (other than that they were ass-backwards about many things).
posted by mrgrimm at 10:35 AM on September 14, 2005

Triage is always a culling.

Yes, but this wasn't triage -- the analogy is strained, at best. Triage is deciding which patients you're going to expend scarce care-giving resources on, so that you make sure at least some people survive. This wasn't that -- it was playing god.

Which is not to say it was wrong.

Yes, this must have been a very, very hard decision to make. I might well have made the same decision -- I can't know. I'm here; they were there. That said, I will go to the wall saying that when you make such a decision, you should make it prepared to be charged with murder. You should make it without needing forgiveness, without expecting absolution, legal or otherwise.

If you make the decision expecting that you will be absolved, it's not a courageous decision, by definition.

This is a hard, hard scenario. Absolutely. I, personally, think it was the right thing to do, based on what I know here and now. Sometimes the right thing to do is illegal; more troubling, sometimes the right thing to do is "merely" the less-wrong thing to do.

I'm also as sure as I can be that there will be huge numbers of people who don't agree with that, and will want to nail these people to the wall with splintery wooden pegs. As much as it pains me to say this, we'll have to let that fight happen. My personal opinion is that when things like this happen, you should put it before a jury and let them decide. That's what they're for.
posted by lodurr at 10:36 AM on September 14, 2005

Louisiana Attorney General Charles Foti told NBC's "Today" show that "We're going to investigate every death" at nursing homes and hospitals that were not from natural causes following the charges made on husband and wife owners of a nursing home.

...I wonder if the doctors/nurses mentioned above will be found and charged...and if such is the case, it's going to be a very controversial case.
posted by grafholic at 10:36 AM on September 14, 2005

"Controversial" is putting it mildly. My stomach knots just thinking about it.
posted by lodurr at 10:47 AM on September 14, 2005

Don't for a minute assume any hospital or nursing home is really ready to move large number of critically ill or elderly patients. One or two, perhaps, but a complete evacuation is going to be extremely difficult to pull off even with planning ahead. The nursing home in my fire district has no EMTs on staff and has to call the fire department for CPR and first aid if an ambulance is delayed. I'm ashamed to admit that our evacuation plan in case of a fire in the facility is to move patients across the street to the community college even though the overwhelming majority are not ambulatory. How we're going to move that many beds quickly is something no one has really considered.

That doesn't excuse the nursing home owners from blame, however. A fire is one kind of emergency, the predicted strike of a hurricane is completely different kind. Yes, it would have been slow and difficult to move those people, but given the amount of warning they had, it was certainly manageable. So I'm glad they're charged with homicide and I hope they're convicted, even though I fear there will be some legal dealings that mitigate the charges.

The doctors, on the other hand, might well have been dealing with patients who couldn't be moved given our current technology. We won't know for sure until more investigation occurs. Until we know better, I'm willing to give them the benefit of the doubt.
posted by tommasz at 10:50 AM on September 14, 2005

As a follow-on to my post, if you have friends or relatives in a nursing facility, you should ask the management what their emergency plans are. You might also ask the chief of the fire district that same question. If they don't at least somewhat line up, you know something's wrong.
posted by tommasz at 10:54 AM on September 14, 2005

A modern version according to PBS, Wikipedia'a commentary on today's Hippocratic oaths, a note regarding the AMA, the BMA, and the Oath. swift is being rather disingenuous by presenting a version of the Oath that is very conservative compared to the versions administered by most schools today. Look at the numbers on the third link: the vast majority of oaths administered prohibit neither abortion nor euthanasia, and a similarly vast majority do not invoke a deity. Most of these are also not just "translations" of the original Oath, although they generally carry some of the same ideas. Furthermore, it seems to me that leaving patients to die slowly and in pain in a dank unlit incredibly hot hospital without any resources is more harmful to the patient than a quick and peaceful morphine death. Maybe you think that choosing to let a patient die a slow and painful death is justified because a doctor spoke a few [overly conservative] words decades ago, but to me that seems to fly in the face of both human decency and the spirit behind the Hippocratic Oath and all of its successors.

On preview, I guess a few people already said what needed saying. What a hellish situation, for both doctors and patients. I think Civil_Disobedient has it right.
posted by ubersturm at 11:08 AM on September 14, 2005

lodurr: Triage is deciding which patients you're going to expend scarce care-giving resources on, so that you make sure at least some people survive.

How was that not the situation. They decided who to spend time, energy, water, medicine, oxygen, and all their limited resources on based on who was most likely to survive, and isn't that the very definition of triage?

Triage: A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. Triage is used in hospital emergency rooms, on battlefields, and at disaster sites when limited medical resources must be allocated.

The only difference is they didn't just push them off to one side and ignore them while they died slowly and painfully for as many hours as they had left.

And to those commenting here saying they did the wrong thing, I guess you think they should have just let these people die slowly on their own, and I am left wondering if you have ever watched someone slowly die.
posted by Orb at 11:10 AM on September 14, 2005

lodurr: it was playing god.

Really? 'cause that's not how I play god. I like to sit in a dark room and then, all of the sudden, speak out loud "Let there be taffeta." Sometimes I pour a pitcher of water on my ant farm and see how that sand ark is coming along.

Those doctors weren't doing any of that. They were in a horrible, painful, and tragic situation and proved themselves to be humanity at its finest by not putting ideology above compassion and having the courage to make very difficult decisions. That's very serious, very human, work.
posted by cytherea at 11:35 AM on September 14, 2005

Yes, but this wasn't triage -- the analogy is strained, at best. Triage is deciding which patients you're going to expend scarce care-giving resources on, so that you make sure at least some people survive. This wasn't that -- it was playing god.

That IS triage, and that's exactly what they did. Triage demands that you do not treat people who cannot be saved no matter what you do. Those resources are best reserved for those for whom treatment will make a difference. Triage aims to divide patients into 3 broad categories: those who are as good as dead, and nothing you can do will make them stay alive; those who are going to make it without your help (however maimed, scarred, or painful that may be); and those for whom treatment will make a difference. All resources of time and equipment are to go to that last group. This is standard treatment on any emergency scene; in fact, if you take Red Cross training, this is what will be taught to you. For those who still doubt that triage means deciding whom to treat, leaving others to die and leaving still others untreated, read this Wikipedia entry. Make sure you scroll down to "Advanced Triage" which by the descriptions was the system medical personnel in NO had to resort to. It is the one used in battle situations and mass emergencies.

So, I fail to understand the point of view that accuses doctors of killing people here. It is not applicable; this is not Kevorkianism. The people were going to die, and soon. They were given morphine to reduce their experience of pain as they died. That treatment was extremely humane because it devoted two important resources (time, and medication) to the palliative care of the dying, though triage did not demand it. It does not fit the definition of murder.
posted by Miko at 11:58 AM on September 14, 2005

And to those commenting here saying they did the wrong thing, I guess you think they should have just let these people die slowly on their own, and I am left wondering if you have ever watched someone slowly die.

I have actually , happy now ?
and let me tell you something else , if you'd drop the smart ass semantics about pretty obvious things like - people who are ill are actually f**ing worth something - maybe george w. bush wouldnt be sitting in the F**king white house right now.
Right to die ? aye - half of you should be beaten to death with a copy of the road to wigan pier.
I'll share how i really feel about this issue later.
posted by sgt.serenity at 12:00 PM on September 14, 2005

So one can already see the shift in reactions toward second guessing and criticism. There won't be any shortge of persons willing to destroy the lives of the doctors caught in this morass because their nosebleed perspective has been challenged. This is how compassionate doctors learn to fear a vindictive system and cast common sense and compassion out the window for fear of a relative or staff lurking out of sight waiting to sue or press charges.
posted by docpops at 12:02 PM on September 14, 2005

In the midst of it all, I seem to remember hearing about a makeshift morgue at the airport in New Orleans. The doctors and nurses were putting those who were still in the midst of dying in the morgue so they could have peace and quiet in their final moments. I think the coverage was first on Oprah but was picked up by the news stations. What a horrible situation, with the workers on the ground trying to do their very best to give their explosion of patients a few moments of dignity and calmness before passing away.

This is why doctors are now reluctant to give help on airplanes in an emergency. I recently sat next to a doctor who was in the midst of being sued for trying to save a guy who had a heart attack on the plane. He said it has become an ethical dilemna at its best: almost all doctors still respond in a case like that, but the implications are becoming so serious that they're thinking twice, not performing anything beyond basic help, and try to get the explicit consent of family members travelling with the person. What a disaster.
posted by fionab at 12:14 PM on September 14, 2005

I only hope that if I am in a similar situation, my doctors will be so compassionate.

And sgt, there is a difference between "ill" and "definitely going to die."
posted by dame at 12:15 PM on September 14, 2005

if you'd drop the smart ass semantics about pretty obvious things like - people who are ill are actually f**ing worth something

What would you have done, dr.serenity? What would you have done?
posted by Optimus Chyme at 12:17 PM on September 14, 2005

Well, I don't know if I would call giving someone enough drugs to kill pain a killing even if the result was a quickened death. Might be hairsplitting, but as prolife as I am I don't see letting someone be in pain if I had a means to relieve it. Now if a drug was given simply to "put someone to sleep" I would have a problem with that...perhaps it is simply all in the intent.
posted by konolia at 12:18 PM on September 14, 2005

Horrifying choices to make. I wouldn't be surprised if these doctors lost their licenses, and THAT would be a crime in my eyes.
posted by agregoli at 12:38 PM on September 14, 2005

What would you have done, dr.serenity? What would you have done?

Lets just say theres a few of you i wouldnt want round my grannies house for tea shall we ?
Hows Harold Shipman doing these days ?
posted by sgt.serenity at 12:50 PM on September 14, 2005

If that's the best you got, sarge, you're an effing c*nt.
posted by docpops at 12:51 PM on September 14, 2005

mrgrimm - it refers to that when a doctor (a generalist) recognizes that they may not have the skill to perform a task, that they should seek out the help of a specialist. Bladder/kidney stones are difficult to operate, especially if you want the patient to recover (loss of blood and infection/sepsis would be the biggest hurdles).
posted by PurplePorpoise at 12:53 PM on September 14, 2005

Lets just say theres a few of you i wouldnt want round my grannies house for tea shall we ?
Hows Harold Shipman doing these days ?
posted by sgt.serenity at 12:50 PM PST on September 14

You are a coward. Answer the question. What would you have done?
posted by Optimus Chyme at 12:58 PM on September 14, 2005

PurplePorpoise: good clarification. It also helps to point out that, until the 19th century, what we now call 'physicians' and 'surgeons' were in different fields and didn't have the same training. Surgeons actually had less education and book-learnin' than physicians, but more practical skill with the bloody arts. They were crude, last-resort procedure-doers. Also, the risk of infection from surgery was incredibly high, and painkillers all but nonexistant. Physicians would not have stooped to use of 'the knife'.
posted by Miko at 12:59 PM on September 14, 2005

Im here saying that killing people is wrong and i'm an effing c*nt ?
Let me enlighten you here pal , caring by definition , isnt about allowing vulnerable people to die , i've worked in plenty nursing homes and hospitals where the doctor descended from his heavenly cloud once in a blue moon to decide what people he couldnt be arsed treating.
And let me tell ya , it wasn't because f**king Gangs of werewolves were prowling the streets , or because godzilla and mothira were havin it out by the way , it was because they didnt want to 'waste' money and money is an interesting word optimus , how many poor people have you defended lately mate ? conscience bothering you ?
posted by sgt.serenity at 1:19 PM on September 14, 2005

No, you're a cunt because you just compared a physician trying to care for patients in a disaster area to a convicted murderer.

Is it more clear to you now?
posted by docpops at 1:25 PM on September 14, 2005

Let me enlighten you yet again my dear friend , caring doesnt involve giving your patients lethal injections , it really doesnt.
When it comes to things like that , You'll find me extemely c*ntish indeed.
Good to hear you're comfy with it though.
posted by sgt.serenity at 1:35 PM on September 14, 2005

What would you have done? Because I see a whole lot of words and no answers. What would you have done?
posted by Optimus Chyme at 1:36 PM on September 14, 2005

Wow, this kind of flameout usually only happens in the grey.
posted by soyjoy at 1:38 PM on September 14, 2005

"caring by definition , isnt about allowing vulnerable people to die "

Well, that's actually exactly what caring for people is all about in many cases. And relieving suffering. And having enough experience with the process of dying and with dying persons themselves to be the one person in the room that might have the best ability to make the advocacy decision for that patient when they cannot and their POA isn't available.

It's pointless even to have this argument, because like anything in life, the uninformed will always have an opinion and aren't wise enough to shut it even when they are weighing in on matters that deeply and irrevocably affect others. Worse yet is that other people will actually pay attention to them.
posted by docpops at 1:41 PM on September 14, 2005

What would you have done?

I would have bumped them off and then blamed it on the blacks.
posted by sgt.serenity at 1:44 PM on September 14, 2005

the uninformed will always have an opinion

and you express it very well.
posted by sgt.serenity at 1:45 PM on September 14, 2005

I would have bumped them off and then blamed it on the blacks.
posted by sgt.serenity at 1:44 PM PST on September 14

Classy. I'll keep that in mind the next time you have a holier-than-thou meltdown.

You clearly have no idea what you would have done, yet you are very eager to judge others who were in a far more difficult situation. Why?
posted by Optimus Chyme at 1:54 PM on September 14, 2005

MeTa
posted by Irontom at 2:03 PM on September 14, 2005

You are a coward. Answer the question. What would you have done?

According to some people it's good and holy to allow unneccesary suffering; mother Theresa for example. So these poor souls were lucky to have been faced with a physically and emotionally catastrophic event such as being ill in the middle of a hurricane: more suffering, more holiness, god is well pleased, yay! How dare the medical professionals get in the way of that?

The answer to your question is nothing, absolutely nothing, because praying doesn't count as constructive.
posted by zarah at 2:06 PM on September 14, 2005

Please read George Washington's Rules of Civility
posted by caddis at 2:09 PM on September 14, 2005

it was because they didnt want to 'waste' money

Are you in America? I think not, because here, keeping patients well beyond the reach of any hope alive for as long as possible is an enriching decision. That is, the Medicaid checks keep coming to the facility as long as you can keep them going.

I worked in a nursing home, and cared for two women, both so addled with alzheimer's that neither ever opened her eyes, showed a facial expression other than sadness and pain, recognized a relative, communicated, nothing. One was actually still mobile, but the other one was bedridden. These women experienced nothing but discomfort and pain and slightly less discomfort and pain, and we keep them alive because the checks keep coming in.

I don't think it's humane, personally. But I'll tell you one thing, if I notice early signs of alzheimer's, I'll be sure to take myself out before things get out of my control. I figure I'll check out the second time I lose my way to the grocery store, or something. There's no way I could put my daughter through the hell of watching me turn into something akin to either of those women I mentioned above. Imho, they weren't really even people anymore, just people-shaped hunks of meat that happened to be alive. All the trappings of personhood were completely gone.
posted by beth at 2:51 PM on September 14, 2005

That doesn't excuse the nursing home owners from blame, however. A fire is one kind of emergency, the predicted strike of a hurricane is completely different kind. Yes, it would have been slow and difficult to move those people, but given the amount of warning they had, it was certainly manageable.

I don't know if this situation is as straightforward as it appears. I read this morning that the nursing home manager estimated before the hurricane that several of the patients would likely die during an evacuation. If that's accurate, you have to ask whether you'd have made the same gamble.
posted by me & my monkey at 3:47 PM on September 14, 2005

me & my monkey: Why not just evacuate the ones who wouldn't be risking death to leave?
posted by beth at 3:55 PM on September 14, 2005

The home was required by statute to have a contract for evacuation with an ambulance service. Their service of record says that the home told them not to bother.

So they gambled. Now it's up to a jury of their peers to decide if it was the right gamble. That part -- they probably didn't gamble on.
posted by lodurr at 4:28 PM on September 14, 2005

It's the choice between doing something with known risks (moving patients) that will at least allow some to survive versus doing nothing and essentially letting them all die. If you start early enough, you can reduce the risk (though it will never be zero). Personally, I would definitely have chosen to do something. Even saving one person would have been more than was saved by doing nothing at all.
posted by tommasz at 4:29 PM on September 14, 2005

The above discussion illustrates perfectly why we can't have nice things euthanasia. I used to think it was because the Republicans didn't want anybody getting the good drugs, but now I see it is because some people haven't an ounce of imagination or an empathetic bone in their bodies.
posted by Secret Life of Gravy at 4:49 PM on September 14, 2005

Why not just evacuate the ones who wouldn't be risking death to leave?

Do we know if there were any? For all I know, they were all in about the same condition.

So they gambled. Now it's up to a jury of their peers to decide if it was the right gamble. That part -- they probably didn't gamble on.

I wouldn't be surprised if they thought they were less likely to get sued for not evacuating. After all, if they did evacuate, and a few people died as a result, and the storm turned out to be harmless, do you think they would have been immune to lawsuits? If they thought that it was more likely for their charges to die if they left than if they stayed, they would probably think they're less likely to be sued for negligence - if no one dies, no one gets sued.

It's the choice between doing something with known risks (moving patients) that will at least allow some to survive versus doing nothing and essentially letting them all die.

It's very easy for us all to pass judgment in hindsight. Had things been a little different - had the levee not broken - it's very likely that they would have all survived. If you were pretty certain that evacuating these people would cause a few of them to die, but that there was a good chance that the storm and its aftermath wouldn't be as bad as the worst predictions, you might make the same decision. I'm not saying they were right or wrong, just that it's not as clear as we might think.
posted by me & my monkey at 5:18 PM on September 14, 2005

Secret Life of Gravy : Word.

Also, I don't know if it's lack of empathy so much as extreme fear of their own mortality keeps a lot of people from understanding that you will, eventually, lose the fight against death. It's not a question of if, it's a question of when. I think a lot of people consider living to always be the best option, and there I would have to disagree with them. A life that is only full of pain and suffering which is ending second by second in agony is not a life that I would want to live - were I a patient in that circumstance, I would rather die.
posted by grapefruitmoon at 5:25 PM on September 14, 2005

The reality of triage is jarring to anyone who hasn't really thought through a scenerio in which the critically ill/injured vastly outnumber the caregivers/resources available.

I took an EMT training class taught by a fireman/paramedic who did an in-class demonstration of the standard (and standardized) criteria for who gets treatment versus who gets a "black tag" (and yes, they're just as morbid-looking as you're imagining, appropriately enough) during the chapter on "Multiple Casualty Incidents" : your airway is propped open. If you don't immediately start breathing on your own (without the aid of CPR, etc.), you're as good as dead, at least until more resources arrive on the scene. The time spent assessing each victim is not to exceed 30 seconds, according to most guides.
posted by availablelight at 6:08 PM on September 14, 2005

I like cheese. And pies. I like pie too.
posted by kalessin at 6:22 PM on September 14, 2005

.
posted by ikkyu2 at 7:46 PM on September 14, 2005

.
posted by onalark at 8:33 PM on September 14, 2005

One thing I find disturbing about the account (although maybe it was addressed by the hospital staff, but not reported in the article): did the staff ask the patients if they wanted a lethal dose of morphine?

Now if the patients mere in a condition where they were unable to answer, or to understand the situation, I have no problem with what the staff did. And if they did ask, and the patients agreed, I also have no problem with it. But if some of the patients were lucid enough to make the decision for themselves, and the staff failed to ask them what they wanted, that is inexcusable.

It's a difficult choice to make, but the choice first and foremost belongs to the patient.
posted by DevilsAdvocate at 6:00 AM on September 15, 2005

And what about the family, were these people all abandoned there to die without anyone checking on them, not even before an announced natural disaster?

Assuming that not all of them were alone in the world, it sounds strange that no relatives have come forward to speak to the press. To me that's the second thing that makes the story very dubious. The first being the source.
posted by funambulist at 6:09 AM on September 15, 2005

Yeah, at this point I have to call bullshit as well, unless TCS can produce that Monday CNN report. Bullshit, that is, on the scope of the story as presented - I have no doubt someone in some hospital had to grapple with this. But the fact that despite this being all over the Internet for the better part of a week and no serious news outlet has confirmed any part of it (how come "William 'Forest' McQueen" isn't quoted in any other hurricane coverage?) seems extremely suspect.
posted by soyjoy at 7:24 AM on September 15, 2005

while this may not hit the US press for some time

This was reported in the GulfNews on 9/12/2005.
posted by MonkeyC at 8:52 AM on September 15, 2005

MonkeyC, that's Gulf as in the Persian Gulf, not our Gulf.

And it's shorter version of the Mail article from the day before - not a second source.
posted by soyjoy at 6:46 AM on September 16, 2005