Thursday, July 05, 2007

What Happened in New Orleans: Part 2

There is some new news about the charges of euthanasia against a physician and two nurses in the aftermath in New Orleans of Hurricane Katrina. Nurses Lori Budo and Cheri Landry and Dr. Anna Pou were alleged by the State Attorney General of Louisiana to have killed patients at Memorial Medical Center. The allegations were that they went beyond palliative care, beyond providing medication for pain and discomfort. Sometimes the efforts at palliation end up overmedicating a patient and the patient dies; but the intent is not to kill, and the death is an unintended consequence. The allegations in this case were that these three women had different intent, essentially intent to end life expeditiously, without the incremental approach, the investment of time, that demonstrates the intent simply to control pain and symptoms.

Now, District Attorney for New Orleans Parish has refused the charges against nurses Budo and Landry. That is, he will not take the case and will allow the charges to drop. The intent is apparently to compel their testimony before a Grand Jury. According to the New Orleans Time Picayune, their attorneys are concerned that they might still be subject to state or federal charges issued independently.

It is unclear what this might mean for Dr. Pou. Charges against her have not been refused, and one might conjecture that the point of compelling the testimony of the nurses is to focus responsibility on the physician. On the other hand, the Grand Jury could decide, based on their testimony, that the efforts were palliative in intent and in execution, and that therefore there are no grounds for charges against any of the three.

The basis for determining that palliative care that ends in death is not homicide is the moral principle of “double effect,” or the “second unintended consequence.” I have written before of how important to health care in general is the principle of “double effect;” and also of how I think we need to approach it with humility, if not with fear and trembling. The circumstances at Memorial Medical Center after Katrina were extreme to say the least. The patients were not the only ones suffering with heat and fatigue. To pursue justice in any meaningful sense requires that we hear the story in detail.

However, without testimony we will have little information about how events actually played out. At the time I noted that we knew very little about the facts. Many of us have an interest beyond the academic in the details, because these issues are part of our practice, if, thankfully, in much more controlled circumstances. We are watching and waiting to know the full history of these three practitioners and the patients under their care.

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