Like Anna Pou’s actions at Memorial Hospital, New Orleans, in the days following Hurricane Katrina, my thoughts about her actions are complex and varied. Anna Pou, who has faced criminal charges in the wake of her treatment of patients during the Katrina disaster, is considered by some to be a hero or savior, and by others, a violator or murderer. The debate about Pou stems from her lethal injection of several patients during the height of the Katrina crisis at Memorial hospital in the days following the storm’s touchdown in New Orleans.
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Sheri Fink, doctor and staff reporter at ProPublica, has written an insightful article about the events surrounding Pou’s actions that fateful week in 2005. Published by the New York Times, Fink’s article, entitled “Strained by Katrina, a Hospital Faced Deadly Choices,” paints the story of the desperate and rapidly deteriorating conditions caused by Katrina at Memorial hospital, as well as the moral and ethical struggles that doctors (such as Pou), nurses and medical staff were faced with in result of the limited resources (including hospital equipment, food, temperature regulation and sanitation equipment) that the disaster left hospital workers with. As Fink relates, once the power was lost and the backup generators short-circuited due to extensive flooding, medical professionals were left with little resources by which to treat the “more than 180 patients” that had left to be evacuated (Fink, 2009), some of which depended on electric-run equipment for their lives.
According to the formal investigation that was conducted after the disaster, Pou is alleged to have given several patients a lethal concoction of drugs with the intention of ending their lives. Pou has admitted to injecting several of the sickest patients, claiming that “her intention was only to ‘help the patients that were having pain and sedate the patients who were anxious’” (Fink, 2009). The results of the injections, regardless of their intentions, were fatal for some patients. This has led to much public scrutiny about whether or not Pou and her nurses “euthanized” her patients and whether or not the “mercy killing” was appropriate or justified (Fink, 2009).
In a sense, the way I feel about Pou’s decisions is dependent upon her true intentions of them, which may never be publically known. If the intention simply was to make patients as comfortable as possible, then I completely understand and agree with the decision to inject patients with the available drugs that could assist in relieving their discomfort. This decision, however, also has its complications, even if the intentions behind the injections were as pure and simple as relieving patients of pain. Based on what I gathered from Fink’s article, some of the patients that were injected were not in extreme discomfort, nor were they in critical condition. Furthermore, evacuations, though complicated, were being performed at intervals without any indication that the remaining patients and staff would be abandoned for any length of time. Perhaps a few Tylenols would have been the better choice, or, perhaps the better choice would be to let patients be uncomfortable for awhile if it meant no risky injections would have to be given. Pou and her colleagues have expressed the concern that some patients “wouldn’t make it” (Fink, 2009), however, wouldn’t giving potentially-lethal injections of drugs be just as harmful or dangerous to the patients as a delayed evacuation?
If the decision was to euthanize the patients from the outset, I’m not so sure I would agree with that. Aside from the fact that all people have the basic right to live, I’m not sure that the decision to euthanize patients is ever for “the greater good” (Fink, 2009). In the notorious cases of Dr. Kevorkian, who euthanized terminally ill patients at the patients’ request, morality and ethics were called into question even when the patients themselves requested and granted permission to allow Dr. Kevorkian to assist them in their deaths (which the patients themselves were ultimately responsible for carrying out). In the case of Dr. Pou and her assisting nurses, she did not assist patients in their own euthanization; rather, she made the decision for them and carried out the fatal injections herself. I don’t think this choice was hers to make. In my opinion, she took her role as caregiver too far. The decision became one that was no longer about comfort care but rather, about fatal outcomes. The role of the doctor is to assist in one’s quality of life, not to orchestrate one’s death. And it is certainly not to determine who has the right to life and who doesn’t.
Because Pou and her nurses may have taken their roles further beyond the limitations of a doctor’s authority, I do not think her actions were moral. Her intentions may have been, but not her actions. From a rule utilitarianism perspective, Pou would not be wrong in following a procedure designed to produce the happiest effect (comfort or release from suffering). But from an act utilitarian perspective, Pou may not necessarily be cast in the same regard. If Pou knew that a potential consequence of the injections would be death, and she chose that route in light of this potential consequence, then she would in fact be in moral violation of her ethical responsibilities as a doctor. According to act utilitarianism, decisions are moral or amoral as determined by the consequences of the decisions. With a known consequence of death, the decision to inject would be morally and ethically wrong. Injecting safe types and amounts of drugs is comfort care. Injecting dangerous, risky concoctions of drugs knowing that death may be consequential isn’t comfort care, it’s reckless endangerment. Even if we call it mercy killing, it is still killing. And in the circumstances surrounding Memorial hospital, I’m not sure I’d call it mercy killing at all. If a soldier on a battlefield, for example, is mortally wounded, impaled or shattered and is clearly going to die and is in clear agony in his known final moments, a gunshout wound to the head at the request (and I stress, at the request) of the injured would be a mercy killing. Ending the lives of non-critical patients without their awareness or consent is not mercy killing -- it’s homicide.
Both euthanasia and mercy killing can fall on either side of the morality fence when it comes to utilitarianism. On the one hand, mercy killing and/or euthanasia can be seen as an act of relief, the intention being to end one’s suffering which is, by extension, a goal in pursuit of the happiest possible outcome (emancipation from agony). On the other hand, euthanasia and mercy killing beg the question, can being dead and ending one’s life be equated with happiness, something reserved for the living?
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