Forced Abandonment and Euthanasia: A Question from Katrina

Kenneth Kipnis Forced Abandonment and Euthanasia: A Question from Katrina INTRODUCTION' I DO NOT K NOW W HAT H APPENED ON THE SEVENTH FLOOR OF MEMORIAL Medical Center (MMC) during the darkest hours of the New Orleans catastrophe.1 We do know that, in addition to staff, patients and family m em bers, hundreds of others had sought shelter in the hospital as hurricane Katrina approached Louisiana on Sunday, August 28,2005. By Monday afternoon the storm had passed but the levee walls along the city’s canals had begun to fail. A foul m ixture of waters from the New Orleans sewer system and Lake Pontchartrain was coursing through the streets, eventually reaching the low-lying area where the hospital stood, inundating the lower floors of its buildings and submerging the cars in the hospital’s parking lot. From the outside, MMC had become an island. On the inside, th e electricity and plum bing were failing. The staff would have no lighting, no elevators, no toilets, no running water, no overhead pagers, no refrigeration, no air conditioning, no telephones, no ventilation, and no powered medical devices. The flood had crippled the hospital’s capacity to provide standard medical care for its patients and, with perhaps 2,000 patients and refugees crowded together, Memorial Medical Center may have become a health hazard. Notwithstanding this, the staff continued to care for patients, moving those they could to the roof of a nearby parking garage, w here they m ight be evacuated by helicopters, or to the second floor, where they m ight board w ater craft.2 social research Vol 74 : No 1 : Spring 2007 79 As the days passed, many of those in the hospital were able to leave. But many hundreds remained, including the sickest patients who could not be moved, and the staffwho were staying on to care for them until help arrived. There had been assurances of a timely rescue. But early Thursday morning—three days after the hurricane—it was announced that those still in the hospital would be on their own (Deichmann, 2006:110). There would be no rescue by federal, state, or local government agencies. Dr. Richard Deichmann, the hospital’s chief of medicine, described the effect: It was a phenom enal blow to hear that nobody was coming to get us. The w orst thing for us was always w aiting for someone to come and get us and then never showing up. There was this feeling of betrayal all the time. That freezes your ability to do things. And th at is w hat happened Wednesday and Thursday (Meitrodt, 2006). Some clinicians may have concluded, perhaps reasonably, th at both they and their patients had been abandoned. After days of enervating heat, darkness, and sickening stench, some clinicians are said to have ended the lives of some patients before leaving the hospital themselves. No living patients were left behind. Alleging that there had been homicides, Louisiana’s attorney general subsequently ordered the arrest of a doctor and two nurses. It is unclear, at this writing, how m any indictm ents there will be. It is too early to make a confident judgm ent about w hat the condi­ tions were at MMC betw een its isolation in Katrina’s floodwaters and the final evacuation by Tenet, the corporation that owned the hospital and that sent helicopters for the last survivors. Nor is it now possible to say who did w hat during the crisis and w hat they believed and intended at the time. Journalists have given us a prelim inaiy account, the courts may follow w ith further evidence, and historians will eventually have the last word. But we may never know the full stoiy. Despite the obscurity of the actions and circumstances, Katrina has posed a new question th at complicates our thinking about caring 80 social research for patients at the end of life. Can the conditions in a collapsing health care delivery system ever excuse euthanasia? The focus here is on the ethical norm s that should govern health care professionals working in extremis. There is a need for responsible standards that, in fairness, should be honored...