It has been five years since Hurricane Katrina ravaged New Orleans and devastated people, pets, and the entire Gulf Coast community. A year ago, New York Times Magazine featured a profound article that struck a personal and professional cord with me. Sheri Fink’s article, titled The Deadly Choices at Memorial, chronicles the legal and ethical struggles faced by Memorial Medical Center’s doctors and nurses in the aftermath of hurricane Katrina. I connected on many levels with this report, as my clinical veterinary practices requires me to guide pet owners through quality of life dilemmas often ending with the decision to humanely euthanize their beloved pet.
I after reading the article, I started to write my perspective on this topic. Work and life interfered, but I was recently motivated to complete my project after reading “Better” by Atul Gawande. Gawande brings to light to the role of human medical practitioners face when electively putting a person to death. Gawande compelled me to share my feelings on human euthanasia in the wake of hurricane Katrina.
The post-Katrina floodwaters caused power outages at Memorial and created the need for urgent patient evacuation. Medical supplies were rapidly depleting, climate control was nonexistent, and the threat of violent civilians entering the hospital was growing. Memorial’s doctors, nurses, and other medical practitioners worked under extreme conditions of high stress and sleep deprivation to provide patient care during Memorial’s evacuation.
Hospitalized patients suffered from a variety of heath conditions making evacuation of some patients potentially life threatening or impossible. Those afflicted by more severe medical conditions died or reportedly were euthanized with a cocktail of injectable narcotics including Morphine and Midazolam. Morphine is an opoid pain reliever, while Midazolam is a benzodiazepine derived muscle relaxer, sedative, and anti-anxiety medication.
Memorial’s doctors made their decision to euthanize based on the likelihood severely ill and terminal patients would survive the evacuation process. Louis Armstrong New Orleans International Airport served as makeshift care facility for those transported from Memorial. Basic nursing care was so insufficient at the evacuation site that a Memorial doctor claimed that the patients who received the injectable drug combination would not have survived beyond the temporary treatment premises.
As a veterinarian and animal health advocate, determining that a patient’s interests are best served by euthanasia is a circumstance I routinely face. Working in an emergency practice, I face situations where the decision to euthanize a pet is made on an urgent basis. Patients present for evaluation after being hit by a car, in the advanced stages of terminal illness, and unresponsive after ingesting toxic substances (among the myriad of other critical situations). The decision to not pursue further treatment is achieved with the intention of ending an animal’s suffering in the face of an unlikely, time consuming, or costly recovery.
Once the decision to end the pet’s life has been achieved, I minimize discomfort by administering pain relieving medications similar to those used by Memorial’s doctors. The life ending injection is an overdose of a barbiturate anesthetic, which rapidly causes respiratory and cardiac arrest. All efforts are made to that ensure the patient’s final moments are painless.
I empathize with Memorial’s doctors as they made life or death decisions they faced in post-Katrina environment in New Orleans. Before we judge, criticize, or punish the parties involved, consider what you would do in the desperate chaos that consumed Memorial. As an advocate of humane euthanasia for both animals and people, I support the decisions made by Memorial’s doctors to end the suffering of patients already hovering near the brink of death and unlikely to survive the evacuation process.
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{ 6 comments… read them below or add one }
This certainly is a sensitive issue. While we do it to our pets all the time, it seems a completely different bowl of wax when it concerns humans. How much suffering without hope is enough …?
One episode of House was about this issue, it was very interesting. Coincidentally I saw one old movie dealing with the issue also. In that one, however, a doctor treating cancer patients had a patient in so much pain, begging him to ‘help’ her. Eventually he did. And the he did again. And again. When his girlfriend was suffering with terminal cancer he offered her the same service but she refused. She left him. Few years later they met and she was alive and well! That clearly caused a huge moral dilemma to that particular doctor.
It surely is a hard thing to wrap one’s head around. Suffering without hope or putting one out of their misery? I think that if the suffering is great and the hope minimal it would make sense. I am scared of death, but I am scared of pointless suffering also.
So I really don’t know what I would do. But I think none of us can really judge one way or another without going through identical situation.
Thank you for your perspective of nonjudgement for the Memorial doctors who were forced to make such tough decisions under the extreme duress of Hurricane Katrina. I would not want to be in their shoes and forced to make such a complicated decision with so many potential consequences.
Dear Mahaney,
I find your take on this – and it’s not an uncommon one – truly disturbing.
Strip away the feeling statements and what you have left is this: Physicians in a disaster situation should not be subject to the rule of law.
I agree that there were mitigating factors to take into account in the Katrina killings – and there would have been no one better than a jury of people who lived through that disaster to render judgment on what went on there. The current situation – in which Pou simultaneously is a popular speaker at health-related events – while denying she did anything other than provide palliative care – is a farce that serves no one.
I’d urge you to go reread the NY Times article published just about a year ago. At least one of the probably homicide victims was a medically stable paraplegic man who weighed almost 400 pounds. He had no DNR. He was totally aware of who he was and what was going on. Staff who organized evacuations state they were never informed of this patient, whose name was Emmet Everett. He begged staff (according to the article) not to leave him behind.
Everett and others deserve their day in court. We expect soldiers in the middle of a war to be accountable to the rule of law. If they can live with that, so can medical personnel.
Wow… I read these articles and I am torn. We recently were faced with the decision to let my dying father who was in agony with final stages of cancer have versed. He begged me that day to help him… please help him. He hadn’t slept for two weeks and had stopped eating. He couldn’t breath without oxygen and if he moved he would go into respritory distress. We had taken him to a hospice facility that day so my mother could get some rest from his anxiety and distress. He begged me all day to please help him get some rest. He was exhausted and lost a lot of his dignity because he could no longer hold his bodily functions. The GP from the previous day told him his problem was anxiety and he had atleast a couple more months to live but the doctors in the Hospice facility told us he would likely die within the next few days because of all of his symtoms, quit eating, quit sleeping, breathing worse, frustration etc… I had been through this with my mother in law before she died and I know this to be accurate. The doctor offered him the Versed and told us and him he would not likely wake up from it. He signed his own papers because even though my mother agreed, she couldn’t pick up the pen. People are quick to judge. Unless they have had a loved one lose all of their dignity without hope of recovering it, watched them struggle to get even one breath, have them beg you for rest repeatedly, watched their fear of knowing it will get worse if nothing is done to alleviate the pain and symptoms, cry because sleep just refuses to come… you get the point… they have no right to judge. Because he chose to be sedated until death came which was only 17 hours later, we got to watch him pass in peace. We got to say our final goodbyes. We were ALL there for him in his moments. We got to hear him say I love you and we got to tell him we loved him! His words still ring in my ear when he said, “I’m going to prepare a place for you” taken by John 14:2. How incredibly sweet those words are! He got his rest he was begging for, his dignity was restored to him, he didn’t struggle any more. He got to have his family with him. He got the peace he needed. We got complete closure. Mind you, I completely agree with God’s word. But I also understand that God is in control. Whether or not the Versed sped up his process, we will never really know. What I do know is that his passing, as morbid as it may sound, was beautiful. What I mean is that there was total peace. His fight was finished and he was with the Lord and we knew it!!
I do not believe deep sedation should be for anyone who is not in their physical final days or hours and I believe every one should be informed of the possibilities. Thank God, the doctor’s had enough compassion to let us all know up front. I do NOT feel like it is assisted suicide but what I do believe is that it gave him the end quality of life that he deserved!! I didn’t get to see my mother-in-law go in peace when she died. She died a horrible death by asphixiating on your fluid. She died in panic and fear. Her face is something I will NEVER get out of my mind. My dad died in peace…. true peace. He even squeezed my mothers hand just a couple of minutes before his last breath. My mother-in-law never got to say goodbye. She didn’t die with dignity nor peace.
A line would have to be drawn in the sand no doubt. And no doubt there will be people who abuse the system. But why rob people who are within their final hours the right to be sedated and why rob them of getting to say “I love you,” or even hearing someone say to them, “I love you and I will see you in Heaven one sweet day?” This is just my opinion (although I feel strongly about it).
Thank you Melissa for your comment.
Many times have I been involved in the end of life process for pets, which is hard on all family members involved. Please accept my condolences on behalf of your father, as I know how hard it was to see him go through the process.
Dr PM
I have absolutely NO problem with giving complete pain relief to anyone facing a hopeless excruciating battle…MY fear is that it will become commonplace for “someone” [other than the person himself, or at least his or her closest loved ones] to decide that another’s life is not worth living …I have two severely disabled sons who lead happy and healthy lives with us…they need total care and yet wake up smiling each day and bring us such joy…yet we have faced situations in hospitals where I didn’t dare leave them alone for fear of what would be done in my absence since so many supposedly knowledgeable professionals considered them to have no real quality of life…
I have also faced a similar situation to the one faced by the Griffin family when my dad was hospitalized at 93 after a brief blackout. However there the similarity ends…dad had no terminal conditions upon being admitted to the hospital for tests…no sign of stroke, heart attack, or pneumonia..no terminal illness…WHY they didn’t send him home immediately I don’t know…I live 600 miles away and wasn’t there when they admitted him. I arrived expecting the worse as I had been told he was gasping for breath [why???] and probably would be dead before I got there….I found him in the midst of a terrible PANIC ATTACK and within an hour had calmed him down so his breathing was back to normal. Over the next two weeks dad was ‘evaluated’ by a mind boggling array of doctors, none of which seemed to have a clue…he was given a devastating drug [Amiodarone] in place of the antiarrhythmic he had been taking for years with good results and THIS in my opinion resulted in extensive lung damage. Dad went into the hospital basically healthy. After the first two weeks he was given the option of going home or going into rehab…the family [other than me] decided rehab was the best choice so I returned home to care for my sons planning to return when dad left rehab so I could help him get set up back in the home he had been living in virtually alone since mom had died years ago…sadly when I returned in two weeks I was flabbergasted to find my dad being dehydrated and starved to death..all his meds were being denied him as well…even his eye drops. Morphine was the only drug they were administering at that poing. He was being euthanized!!! I was totally devastated !!! It’s a nightmare I doubt I will ever recover from.
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