September 4, 2013

Sympathy for the euthanists.

Sherri Fink's "5 Days at Memorial: Life and Death in a Storm-Ravaged Hospital" looks like a great book, based on the description in this NYT review. It appears to be an exciting and subtle account of what happened in an ICU at a hospital after Hurricane Katrina knocked out the power and delayed evacuation for 5 days. A doctor and 2 nurses were arrested for murder, based on the high levels of morphine and other drugs in the bodies of 20 of the 45 patients who died, but the grand jury did not indict them. 
Dr. Fink maintains a reporter’s detachment.... In following the machinations of a central witness — Dr. Frank Minyard, the city coroner, a colorful politician.... Dr. Fink shifts her focus from the horrific conditions in Memorial to considerations of justice. She gives proportional weight to Virginia Rider, a state investigator of Medicare fraud tasked with gathering evidence on the hospital deaths.

“Growing up in a state where politicians exploited every opportunity for corruption, she had deposited her faith in the burnished version of the American justice system her teachers had described in school,” Dr. Fink writes of Ms. Rider. “She believed, even to her ripe old early 40s, that good would prevail over evil. She had given so much of herself to this ideal.”

Ms. Rider’s passion may suggest a naïveté about the gray area in moral dynamics when things fall apart, but her confrontation with Dr. Minyard, after the grand jury refuses to indict, is a stunning scene. Dr. Fink does not condemn those Ms. Rider deemed guilty. But by reporting the depth of those gruesome hours in Memorial before the helicopters came, and giving weight to medical ethics as grounded in the law, Sheri Fink has written an unforgettable story.
Dr. Fink may "maintain a reporter’s detachment," but the reviewer, Jason Berry (author of "Render Unto Rome: The Secret Life of Money in the Catholic Church") gives off a whiff of enthusiasm for euthanasia. Do you notice? Or is it just me? I'm looking for early symptoms of acceptance of euthanasia, which I believe will creep in as we Baby Boomers become more and more of a burden. Berry stresses Fink's evenhandedness, which makes me want to read the book but makes me suspect he'd prefer more opinion. It's fairly mild to say "may suggest a naïveté about the gray area in moral dynamics when things fall apart," but to my perhaps oversensitive perception, it suggests the opinion that sophisticated minds see — in all that complexity and nuance — a place for euthanasia.

23 comments:

Inga said...

I would wager that if one measured the blood levels of morphine in any hospice or nursing home patient that is nearing the end, it would be said that their deaths were hastened. On the other hand, would one want one's death to be prolonged?

Dying isn't just laying there peacefully in most cases. Air hunger and other processes create anxiety, I have seen dying patients fling themselves out of their beds in their anxiety and restlessness. Morphine helps with this, plus anti anxiety meds, plus meds to dry secretions that collect in lungs. These meds ease the discomfort of dying. I would want to have a serene passing, instead of one filled with pain and extreme anxiety.

As baby boomers who are closer to the end of our lives, than the beginnings, I would suggest asking the question and discussing with our loved ones, what we would want to happen during our own dying process.

PatHMV said...

There was a well-written series of newspaper articles in the Atlanta Journal Constitution which told much of this same story. I blogged about it at the time at Stubborn Facts about a year after the storm. The article seems to have been taken down from the AJC website, but the text appears to have been archived here by somebody: https://groups.google.com/forum/#!topic/lsuid/GKmjEfifo2k

The focus of this article is the difference between what happened at the government-run Charity hospital and the privately owned Tulane hospital.

I don't like the idea of examining too closely the decisions that are made in these types of circumstances. Just like I don't want to know what really happened in the life boat --- did the survivors eat one of the weaker ones? was he dead before they decided to do that? --- I don't want to judge whatever decisions people make when faced with nearly inhuman, desperate survival situations.

What happens when civilization has broken down, does not exist in anything approaching its normal form, does not provide much guidance for how we should behave when we are more safely within its confines.

That's not to say that somebody's not using those happenings to build propaganda support for or against a particular position. They may very well be. But I think we should resist any urge to learn "lessons" about best policies and practices from such extreme circumstances.

bearing said...

There is a moral difference between

(a) administering morphine in order to ease pain and anxiety -- even if it will, as a side effect, hasten death -- and

(b) using morphine in order to hasten death.

I don't know whether the difference would be something that's measurable in blood levels (although a deliberately high overdose might well show up).

I have the difference carefully spelled out in my advance health care directive. Even if it doesn't make a difference to me, it may make a difference to my caregivers. I prefer to instruct them so they are not trapped in a choice between avoiding complicity in euthanasia and following my wishes.

(note: I'm GenX, not boomer.)

raf said...

I can accept that there are circumstances where euthanasia is a merciful option. As it is legalized and becomes accepted as a "normal" way to end life, I would expect an increase in coercive euthanasia. "You owe it to your family not to be a burden." "Limited health-care resources would be more productively focused elsewhere." Then the definitions of such terms as "burden" and "productive" become important -- and start sliding. Let's face it; euthanasia has always existed. It is restricted to the most necessary cases to the extent that it is not officially approved of. That is changing. The change may be slow enough that we leading edge boomers may not be caught, but you later boomers and gen-xers may find it is not as benign as you imagine when it is your turn.

Big Mike said...

I'm looking for early symptoms of acceptance of euthanasia, which I believe will creep in as we Baby Boomers become more and more of a burden.

Yup. It's coming. Our wages kept Social Security afloat for the "Greatest Generation" and the generation that followed, now when it's our turn to collect we'll see Obamacare's healthcare rationing and euthanasia.

Big Mike said...

I read about the case a few years ago, and all my sympathy is with the doctors on the scene. They recognized that moving their patients would represent a serious risk to those patients' health, they correctly determined that their hospital's structure could stand up to Katrina (which it did), but their mistake was assuming that after all the billions of dollars spent and explicit guarantees from the U.S. Army Corp of Engineers that the levees would hold.

After the levees failed they seem to have battled heroically to save as many patients as they could.

David said...

Whiff? I was catching a strong odor.

David said...

There is a moral difference between

(a) administering morphine in order to ease pain and anxiety -- even if it will, as a side effect, hasten death -- and

(b) using morphine in order to hasten death.


The two situations you posit seem to have no factual difference. At the very least the factual line is hard to draw from case to case. How do you determine the moral difference, when the factual difference is so hard to discern?

bearing said...

"How do you determine the moral difference, when the factual difference is so hard to discern?"

Sometimes the difference is not discernible from the outside of the person making the decision. It is a sort of examination of conscience.

If a small amount of morphine will ease pain and allow restful sleep, and a large amount of morphine will cause death, then choosing the larger amount is one factual difference.

If a patient's suffering can be eased by non-lethal means, but lethal means are chosen, then that is one factual difference.

Beyond that, it is a matter of self-examination on the part of those making the care decisions. And that is often how it goes with difficult moral situations.

Michelle Dulak Thomson said...

raf,

Let's face it; euthanasia has always existed. It is restricted to the most necessary cases to the extent that it is not officially approved of. That is changing.

I remember a George Will column (a long, long time ago, late 70s?) about a couple, German immigrants, both in their 80s. IIRC, the woman was in such pain that the only words she could utter were "Feuer" and "Pein." Ultimately, her husband shot her, to save her more of the same.

Will's point then was what mine would be now. We make this illegal because we want it to be a genuine last resort, something you would give up your own freedom, your own life even, rather than not do. If it's less important to you than that, it should not be done.

And you are right that it will become more common, and for reasons much less valorous than stilling the hideous suffering of a loved one. The "Don't be a burden to your family" argument, and particularly the "What, you're going to piss your children's inheritance down the drain for the sake of a few more months?" argument, are decades old already.

Roux said...

I was in Baton Rouge when all of this took place. Post Katrina was a mad house and the clinical staff in Memorial Hospital were abandoned with no help on the way.

Without electricity and running water a hospital is not a good place to be. It got bad real quick. You have about 24 hours before you have to start making decisions about who's going to live or die.

IMO the staff was heroic. The real crime was when La. Attorney General Charles Foti tried to prosecute the doctor and two nurses. He thought this would make him the next governor. He was very surprised to find many Louisianians had little sympathy for him.

David said...

Well answered, Bearing. Admirable restraint.

jaed said...

Sigh.

This wasn't euthanasia. Some of the people who were killed were not dying, in other words; they were simply people the doctors thought not worth moving. One was smothered. Others were killed by injection - and by killed I do not mean "given painkillers as treatment, and the needed amount of painkiller hastened their death"; I mean deliberately injected with lethal drugs in order to cause their immediate deaths.

The people who were evacuating the hospital (in difficult conditions, because the first floor was under water - basically, they were taking patients out through a hole in the wall of an upper floor) later said that if they'd realized there were still patients needing evacuation, they would have found some way.

“It was actually to the point where you were considering that you couldn’t just leave them; the humane thing would be to put ’em out.”

Haiku Guy said...

As Government bears
The cost of Terminal Care,
Policy will change.

Rick Caird said...

I have been with a couple of people dying from advanced cancer. As the cancer progresses, it take larger and larger doses of pain killer to keep the pain at bay. I recall the doctors asking for permission to give doses that were larger than recommended.

There is little doubt in my mind the higher doses hastened death, but the alternative would have been severe pain. That is hardly a viable alternative unless you are into sadism.

I do not look at this as euthanasia.

richlb said...

The next two socially liberal rallying points have come up the last few days - euthansia and under age sex. Toes are just being dipped in the water to test the public. Time for Hollywood to step in with a few Oscar contenders.

Larry J said...

While I can't comment directly on what happened at that Louisiana hospital, I have recent experience at making an end of life decision. It was the hardest thing I've ever done.

In early August, my mother suddenly developed pneumonia. Until then, she had been a remarkably healthy 85 year old. We took her to the hospital on August 4th. She was moved to the ICU. The next morning, she was having great difficulty breathing and reluctantly decided to go on a respirator to give the antibiotics a chance to work. As late as the 11th, doctors were still giving her a 70% chance of recovery. The bottom fell out on the 13th when she apparently suffered a stroke. On the morning of the 14th, after consulting with my sister and brothers, I told the staff to remove the respirator. They gave her a sedative (not morphine) and removed her from the respirator. Over the next hour, I watched my mother die. She had no chance of recovery and even if she had survived by some miracle, she would've needed continous nursing care and supplemental oxygen for the rest of her life.

It was the right thing to do, but I wouldn't wish having to make such a decision on my worst enemy.

raf said...

@Michelle Dulak Thomson: We make this illegal because we want it to be a genuine last resort....

Thank you. Better expressed than I did.

Marshal said...

I'm looking for early symptoms of acceptance of euthanasia, which I believe will creep in as we Baby Boomers become more and more of a burden.

When insurance companies bore the cost of care government could be relied upon to ensure tough standards, essentially ensuring families made the decision without overt pressure. Now that the cost of care is borne by the government [and therefore competes with government employment for funding] the government cannot maintain its role as a watchdog. "Reforms" to pay medical professionals by the patient rather than by the procedure will only exacerbate and hasten this effect.

One can only hope those who supported vastly increasing the scope of government paid mical care are the ones who feel the impacts.

Achilles said...

Haiku Guy nailed it.

The left has been pushing for doctors to have the ability to end patients lives for a long time and it coincides with giving government more control over doctors.

Popular culture will continue to parade icons on stage to distract the low information serfs with skank-offs while bureaucracy creeps in and coopts our health care. This will end badly.

Achilles said...
This comment has been removed by the author.
FrankN said...

"I'm looking for early symptoms of acceptance of euthanasia, which I believe will creep in as we Baby Boomers become more and more of a burden."

Some years ago, TV in the Netherlands broadcasted a series on a guy who was diagnosed with ALS, i.e., Lou Gehrig's Disease. He had "decided" to avail himself of the newly legislated "right-to-die" in the Netherlands, and his wife was highly supportive.

But as time and episodes went by, the guy was becoming more and more afraid and tearful, and the wife was becoming more and more fed up with his delaying.

The final episode was of only the wife, the guy having finally committed suicide, courtesy of the culture in the Netherlands. She was relieved.

Since then, I've read that palliative care has completely collapsed in the Netherlands, because there is no longer any "need" for it. You are expected to kill yourself and not "burden" family and friends with continued existence.

Saw article some years ago in Philly Enquirer, written by an MD, who noted that the word "compassion" comes from the Latin "cum passio", as in "to suffer with". With euthanasia, we no longer have any "need" or desire to "suffer with" anyone, just go away and stop burdening us with thoughts of you.

We have become a society without compassion. How shameful.

Nate Whilk said...

"...to my perhaps oversensitive perception, it suggests the opinion that sophisticated minds see — in all that complexity and nuance — a place for euthanasia."

Those sophisticated minds probably see that place not in their own bodies, but the bodies of others. Sophisticated minds have a better quality of life a priori, don't you know.