Tuesday, July 24, 2007

What Happened in New Orleans: Charges Dropped

I have written before of the case of Dr. Anna Pou and nurses Lori Budo and Cheri Landry, who were alleged to have participated in euthanasia in the days of disaster that followed Hurricane Katrina. Recently charges were dropped against Budo and Landry in order to obtain their testimony before the Grand Jury. Today the Grand Jury declined to bring any charges against Dr. Pou. Although the Assistant District Attorney asked for eleven counts, the Grand Jury returned a decision of “Not a true bill,” eliminating all charges. It is also reported that Dr. Pou has brought a civil suit against the Attorney General of Louisiana, Charles Foti, alleging political conflicts of interest in pursuing charges against her.

I have said that only after the Grand Jury acted could be begin to hear the facts as seen by Pou, Budo, and Landry. I hope that soon we will hear their description of those literally hellish days. I’m sure we will also hear more of the concerns of family members on which the Attorney General said he based his actions. We’ll be watching for more details.

These days the ethics of care in time of disaster is a hot topic among health care ethicists and ethics committees. One of the issues we all consider difficult but necessary to explore is “altered standards of care:” not only how one maintains appropriate standards of care in those circumstances, but how one decided what are the appropriate standards of care in those circumstances. When infrastructure is destroyed and resources are failing or nonexistent, what can you do? Andm ub thinking of what we can do, how do we decide what we should do? The “marquis question,” if you will, is, in the case of a flu pandemic, when you have a third as many mechanical ventilators as patients who might benefit from them, how do you decide who goes on one? But, that marquis question is simply one of a number of equally difficult questions that a pandemic or a disaster, whether natural or man-made, would raise. How do we as health care providers make hard decisions? And, equally important, how do we bring these to the community ahead of time so that if we need to make those decisions the community will be at least somewhat prepared?

The case of Dr. Pou and Nurses Budo and Landry won’t in itself answer those questions. However, their case and the many other cases from Katrina have given us images with which to work as we wrestle with those questions. Most important, they convict us that it can happen here, and that we must do our best to be prepared. Now, part of that is a recognition that there’s no way to really be prepared; but with that recognition comes the corollary conviction that we’re negligent if we don’t try.

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