Suffering, Death, and Conscience

By Crispin Sartwell

 

The Louisiana attorney general's office is investigating the claim that terminally ill patients at Memorial Hospital in New Orleans were given lethal doses of medication by doctors or nurses in the days after Katrina. But before we start prosecuting healers for making what must have been the most difficult decisions of their lives, we had better really try to imagine the circumstances they were in.

      The staff at Memorial had assumed that hospitals would be the highest priority for evacuation. Instead, in one of innumerable examples of the deep confusion and ineffectuality of the response, they were largely abandoned for days.

   CNN quoted Fran Butler, a nurse manager: "It was battle conditions. It was as bad as being out in the field." That is putting it mildly.

    There was no power, and hence no monitoring or life-support equipment. The temperatures inside the hospital hovered around 110 degrees during the day. The bodies of those who had died at the hospital before the storm were decomposing. There was no running water, and routine sanitation procedures were impossible.

    Family members of patients and staff and people from the neighborhood took shelter in the hospital and they ran out of food and all other necessities.

    In such conditions, terminally ill patients must have suffered immeasurably. And their caregivers must have suffered with them. They were unable to provide even basic palliative care: effective treatment for pain or relief of basic breathing, nutritional, or circulatory problems, for instance.

   Butler described the staff as desperate, and said "My nurses wanted to know what was the plan? Did they say to put people out of their misery? Yes. ... They wanted to know how to get them out of their misery."

   Dr. Bryant King told CNN that at the point of maximum desperation, a second-floor triage area where he was working was cleared of everyone except patients, a hospital administrator and two doctors.

     They prayed for guidance, and one of the physicians then produced a handful of syringes. "I don't know what's in the syringes. ... The only thing I heard the physician say was, 'I'm going to give you something to make you feel better,' " King said. King himself refused to participate. 45 patients died at Memorial Hospital in the days following Katrina.

     To prosecute doctors or nurses who may have hastened some of those deaths would be obscene. They faced conditions that we cannot really imagine, challenges to their identities and oaths as healers that were impossible to resolve. Whatever decisions they made, they made in prayer: they made in the midst of what could only have been the deepest and most tortured encounter with their own consciences.

    Even Dr. King and others who did not participate must have felt the incredible difficulty of the decisions taken and the sincerity of those who decided the matter differently: evidently no one tried to prevent what occurred.

    Law can lead to injustice when it is applied mechanically, which is to say inhumanly. And it is worth saying that the context in which the law has force and in which alternative procedures can be specified had completely broken down.

     The medical community in Memorial Hospital - the administrators, the doctors, the nurses, and the patients - were abandoned by the law and all the institutions that uphold it. Those in those institutions who would sit in judgment of the conscientious decisions of that community indict only themselves.