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Murder or Treatment?

By TChris, Section Crime in the News
Posted on Thu Jul 20, 2006 at 07:26:45 AM EST
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by TChris

Is Dr. Anna Pou a hero or a criminal? Some physicians think Louisiana's attorney general is on shaky ground charging Dr. Pou and two nurses with murdering patients who were stuck at New Orleans' Memorial Medical Center during Hurricane Katrina.

By all accounts, Dr. Pou is a skilled and dedicated physician. She chose to stay at the hospital for days after the hurricane passed, hampered by heat, the absence of electricity, and dwindling supplies of medicine. The prosecution claims that Dr. Pou and two nurses "went from room to room with a set of syringes and vials, injecting at least four patients with a combination of drugs intended to kill those who could not easily be evacuated from the hospital."

The state's forensic pathologist found traces of both morphine and a central nervous system sedative in the tissue samples of several patients who died, drugs that they were not supposed to have in their bodies.

But what does this prove? That a doctor in desperate circumstances engaged in mercy killings, or that she used whatever drugs she had at hand to ease the suffering of patients while awaiting rescue?

"I'm fundamentally unconvinced of the framing of the story," said Dr. Steven Miles, a professor of medicine at the University of Minnesota and an expert on the care of dying patients. "I'm not inclined to believe this is a euthanasia scenario or a physician-assisted suicide scenario."

One reason, Dr. Miles said, is that the drugs found in the dead patients -- morphine and the sedative Versed -- are not all that deadly and may not even have been what killed the patients. Many patients develop tolerances to the drugs and can handle high doses, he said. Barbiturates, readily available in a hospital, would be a far more efficient way to kill somebody if that was the intent, he added. ...

He also pointed out that two million deaths a year occur in medical settings, and 85 percent to 90 percent of those are preceded by decisions to withhold or end life support. The vast majority involve sedation.

Some witnesses claim they heard Dr. Pou talking about administering "lethal doses" of morphine. Even if that's true, will a jury second-guess what may have been a medical judgment that doomed patients should die in peace, not in pain?

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    Murder or Treatment? | 69 comments (69 topical)
    Re: Murder or Treatment? (none / 0) (#1)
    by Talkleft Visitor on Thu Jul 20, 2006 at 07:38:02 AM EST
    Could an ADA plan on running for higher office soon? Is that what this is about? If so, let's hope it backfires.

    Re: Murder or Treatment? (none / 0) (#2)
    by Deconstructionist on Thu Jul 20, 2006 at 07:44:43 AM EST
    First, a successful prosecution for any degree of homicide would have to prove the administration of the drugs was a proximate cause death. Then, the issue would be intent. Usually, in the absence of malice it could not be murder-- even 2nd degree. Nnow, many murder statutes 9and common law murder) create a special class of 1st degree murder that includes "murder by poison." I think however, that it is clear that a homicide by poison still isn't murder unless malice is established. In the absence of intent to kill it could not be voluntary manslaughter. However, even in the absence of intent to kill there would still be arguments of invoultary manslaughter, negligent homicide and the like. A purely negligent act causing a death can be a crime in many circumstances. Is this a good circumstance in which to pursue an investigation? Yes, obviously. Is it a proper case in which to file charges? Impossible to say without knowing a lot more about the evidence.

    Re: Murder or Treatment? (none / 0) (#3)
    by squeaky on Thu Jul 20, 2006 at 08:27:07 AM EST
    Then, the issue would be intent. Usually, in the absence of malice it could not be murder-- even 2nd degree
    It is interesting that someone who clearly had the patients care as a top priority is under scrutiny for doing something humane. The state and WH administration clearly did nothing, which created the mess and, has no culpability? Seems mighty twisted to me. Negligence of the biggest order. The doctor is being used to deflect the issue of culpability.

    Re: Murder or Treatment? (none / 0) (#4)
    by jimcee on Thu Jul 20, 2006 at 08:38:56 AM EST
    Leave it to Squeaky to politicize a local DA's rather dubiuos decision to prosecute local medical personel. As usual she blames Bush but why not Rove after all he has been called Bush's brain?

    Re: Murder or Treatment? (none / 0) (#5)
    by Deconstructionist on Thu Jul 20, 2006 at 08:59:42 AM EST
    The AG is a Democrat. He may well have political considerations in mind, but takling heat off the Administration seems unlikely to be among them.

    Re: Murder or Treatment? (none / 0) (#6)
    by squeaky on Thu Jul 20, 2006 at 09:10:23 AM EST
    The state and WH administration clearly did nothing, which created the mess and, has no culpability? Seems mighty twisted to me. Negligence of the biggest order. The doctor is being used to deflect the issue of culpability.
    Politize?? er, let's see, the state is Dem and the WH is Repub. The fact that the doctor stands accused takes heat off all those responsibe for the mess in the first place. It is a classic example of scapegoating. Is that clear. I imagine that my poor writing skills are to blame here. Maybe someday I will take a class.

    Re: Murder or Treatment? (none / 0) (#7)
    by Deconstructionist on Thu Jul 20, 2006 at 09:26:22 AM EST
    "The fact that the doctor stands accused takes heat off all those responsibe for the mess in the first place. It is a classic example of scapegoating." How so? Doesn't it just cause MORE attention to the fact that these people died? How does MORE publicity about loss of life help either national, state or local leaders? It might help the AG personally if he can succeed in being viewed as doing the right thing WHEN THE OTHER POLITICIANS just wish it would go away, but it certainly can't help any of the other politicians.

    Re: Murder or Treatment? (none / 0) (#8)
    by Dadler on Thu Jul 20, 2006 at 09:32:09 AM EST
    Decon, I have to disagree. This case will do nothing but distract attention from the real issue -- incomeptence and neglect by those in political power. Trying a few doctors won't make a ripple in addressing the real culpability that needs to be addressed. The nation being dubiously "at war" has turned most of the press into even more compliant and cowardly little followers, and most of the public follows generally to start with. The national intellect is broken. I'll believe something real is being done when people with the means to make a difference, who didn't, are held accountable.

    Re: Murder or Treatment? (none / 0) (#9)
    by squeaky on Thu Jul 20, 2006 at 09:42:34 AM EST
    Someone has to hang for this and it is not going to be the ones whose negligence precipitated the situation in the nursing homes. A scapegoat is in order. Dr. Anna Pou and her two nurses fit the bill. Seems classic to me.

    Re: Murder or Treatment? (none / 0) (#10)
    by Deconstructionist on Thu Jul 20, 2006 at 09:51:04 AM EST
    "Trying a few doctors won't make a ripple in addressing the real culpability that needs to be addressed." Exactly-- and that works both ways. It doesn't help address the larger systemic issues but it also doesn't take any attention away from them. If anything it brings more attention to them.

    Re: Murder or Treatment? (none / 0) (#11)
    by squeaky on Thu Jul 20, 2006 at 09:58:42 AM EST
    Exactly-- and that works both ways. It doesn't help address the larger systemic issues but it also doesn't take any attention away from them. If anything it brings more attention to them.
    Kinda like lynch mobs? Maybe I misread something here but I do not see the part where Dr. Pou is suing the state and federal government for negligence.

    Re: Murder or Treatment? (none / 0) (#12)
    by jimakaPPJ on Thu Jul 20, 2006 at 10:00:27 AM EST
    From the post:
    will a jury second-guess what may have been a medical judgment that doomed patients should die in peace, not in pain?
    A medical judgment? Have we came to the point that a Doctor can use "medical judgment" to determine if someone should die? Absent any evidence that the patients asked to die, then this is murder, pure and simple.

    Re: Murder or Treatment? (none / 0) (#13)
    by Deconstructionist on Thu Jul 20, 2006 at 10:18:13 AM EST
    "A medical judgment? Have we came to the point that a Doctor can use "medical judgment" to determine if someone should die" It depends on how you look at it. "Medical judgment" is involved in decisions to withhold life support and it will not be withheld even where a patient wishes are clear unless doctors, usually at least 2, certify the chances for recovery are very slight. I hope we never come to point where the ultimate decision rests with doctors (or other third-party actors not chosen by the individual) but the individual or those he has entrusted with making such life and death decisions surely have to consider "medical judgment" as to the viability and quality of prolonged life. However, a world where a doctor, even in a crisis not of his making, is allowed unilaterally to decide decide to kill people is not one I endorse. Obviously, the argument that "other people put me in this situation" so they bear ALL the responsibility for my actions is a weak one. Obviously, the argument that because the person put in that situation took wrongful action, I am absolved of responsibility for my contribution to the situation existing is a weak one. Normal people are fully capable of making these distinctions and quite easily see through the transparent motives of both.

    Re: Murder or Treatment? (none / 0) (#14)
    by kdog on Thu Jul 20, 2006 at 10:28:37 AM EST
    From the limited info available...I'd say the doc should be in line for a medal of freedom...not a murder rap.

    Re: Murder or Treatment? (none / 0) (#15)
    by squeaky on Thu Jul 20, 2006 at 10:32:12 AM EST
    From a TL NOLA thread: ppj:
    The facts are that if the area is not secure, you can't ask aid workers to risk their lives. So law and order must be the first priority. I favor shooting back and killing a few of these criminals in a very effective and public manner.
    Not to mention that you were all for martial law where innocent people can be shot at will indiscriminately, but doctors suspected of humanitarian euthanasia are tried as criminals. And not to mention that the alleged shootings of rescue workers was all hype. Ah, your insight into the ethics of murder is breathtaking.

    Re: Murder or Treatment? (none / 0) (#16)
    by Deconstructionist on Thu Jul 20, 2006 at 10:35:54 AM EST
    Are you kidding? Unless the accusations are completely without merit, at best she is guilty of merely an appalling lack of composure and judgment in a crisis for which she need not be punished criminally. If the accusations are true, she should not be practicing medicine, even if one thinks criminal prosecution is inappropriate. That someone would praise her for doing what she is accused of doing is frightening.

    Re: Murder or Treatment? (none / 0) (#17)
    by Joe Bob on Thu Jul 20, 2006 at 11:07:20 AM EST
    ...drugs that they were not supposed to have in their bodies.
    Drugs such as morphine and Versed are legal drugs when prescribed by a physician. So, who decides that the drugs "were not supposed to be there"? How do the state pathologist or the prosecutor make that decision?

    Re: Murder or Treatment? (none / 0) (#18)
    by jen on Thu Jul 20, 2006 at 11:13:53 AM EST
    good luck finding a doctor or nurse during the next hurricane.

    Re: Murder or Treatment? (none / 0) (#19)
    by jen on Thu Jul 20, 2006 at 11:13:55 AM EST
    good luck finding a doctor or nurse during the next hurricane.

    Re: Murder or Treatment? (none / 0) (#20)
    by jen on Thu Jul 20, 2006 at 11:14:20 AM EST
    good luck finding a doctor or nurse during the next hurricane.

    Re: Murder or Treatment? (none / 0) (#21)
    by Talkleft Visitor on Thu Jul 20, 2006 at 11:20:47 AM EST
    Of course this is politically motivated. Compare it to this case: Bush Again in Schiavo Dispute in which Jeb Bush is attempting to prevent the Florida state nursing board from disciplining the LPN, who went on CNN to claim that Terri Schiavo laughed, cried, talked, and was terribly abused by her husband Michael, for breaking patient confidentiality. Medical professionals are supposed to serve the religious right agenda, not stand up for their own ethics.

    Re: Murder or Treatment? (none / 0) (#22)
    by Sailor on Thu Jul 20, 2006 at 11:45:49 AM EST
    That someone would praise her for doing what she is accused of doing is frightening.
    If they were going to be abondoned to die anyway sending them out peacefully is a more desired option.

    Re: Murder or Treatment? (none / 0) (#23)
    by squeaky on Thu Jul 20, 2006 at 11:56:54 AM EST
    Deconstructionist-Have you already forgotten the conditions in NOLA. What are the ethics when someone near death, and bedridden has been forsaken either by the state, fed, or owners of the nursing home. I don't understand why ppj would ask this inflamitory and rhetorical question given the context:
    "A medical judgment? Have we came to the point that a Doctor can use "medical judgment" to determine if someone should die"
    and why you would opine:
    However, a world where a doctor, even in a crisis not of his making, is allowed unilaterally to decide decide to kill people is not one I endorse.
    The context of NOLA obviates the question. Is the question still valid in a war zone? triage? Martial law had been declared. Given the worst case scenerio that there was intention to euthanize: As a doctor do you just leave the patients to die a painful natural death unattended or do you make their death l more bearable? Perhaps this case is all about insurance wars or civil suits against the owner of the nursing home. There is something else driving this case and it is does not seem to be about justice.

    Re: Murder or Treatment? (none / 0) (#24)
    by Deconstructionist on Thu Jul 20, 2006 at 12:31:39 PM EST
    "Deconstructionist-Have you already forgotten the conditions in NOLA. What are the ethics when someone near death, and bedridden has been forsaken either by the state, fed, or owners of the nursing home." No, I am well aware of the situation. That's a complex issue, but I think, give them the best care possible and don't intentionally kill them is beyond debate. "I don't understand why ppj would ask this inflamitory and rhetorical question given the context: "A medical judgment? Have we came to the point that a Doctor can use "medical judgment" to determine if someone should die" and why you would opine: However, a world where a doctor, even in a crisis not of his making, is allowed unilaterally to decide decide to kill people is not one I endorse." Why is any of that hard to understand? "The context of NOLA obviates the question. Is the question still valid in a war zone? triage?" Priorotizing resources and denying scarce resources to one because they will do more good for another is not at all the same as killing people "Martial law had been declared." Your understanding of martial law is that it makes it OK for doctors to kill people? "Given the worst case scenerio that there was intention to euthanize:"' That's not the "worst case scenario" but it is the most plausible explanation for an intentional killing under the circumstances. However, intentionally killing people is not excused simply because an individual unilaterally decides it is best for the patient. "As a doctor do you just leave the patients to die a painful natural death unattended or do you make their death l more bearable? " There is a difference between administering a dangerous narcotic for the purpose of alleviating pain and unintentionally causing death (although that could still be a crime if the dosage was determined with a failure to exercise due care) and administering it for the purpose of killing someone. "Perhaps this case is all about insurance wars or civil suits against the owner of the nursing home. There is something else driving this case and it is does not seem to be about justice. " It appears to be about family of the deceased being enraged after hearing other medical personnel who were present acuse the doctor of killing their loved ones. What is funny, is how rapidly you would do a 180, if you learned the doctor was acting on instructions from federal officials.

    Re: Murder or Treatment? (none / 0) (#25)
    by jen on Thu Jul 20, 2006 at 12:52:28 PM EST
    sorry about the triple post, this thing went wonky

    Re: Murder or Treatment? (none / 0) (#26)
    by jimakaPPJ on Thu Jul 20, 2006 at 01:08:07 PM EST
    Squeaky - The patients in question were not in a war zone, and it can be seen that the conditions were not as bad as we were led to believe by the media and the NO mayor. i.e. During the storm the estimates were 10,000 or more. Turned out to be about 1500. So,how acurate was the Doctors' info? But either way, the killing of people, even sick people, can not be tolerated.

    Re: Murder or Treatment? (none / 0) (#27)
    by desertswine on Thu Jul 20, 2006 at 01:14:31 PM EST
    sorry about the triple post, this thing went wonky
    No apology is necessary. It was worth saying three times.

    Re: Murder or Treatment? (none / 0) (#28)
    by HK on Thu Jul 20, 2006 at 01:26:12 PM EST
    JimakaPPJ wrote:
    From the post:
    will a jury second-guess what may have been a medical judgment that doomed patients should die in peace, not in pain?
    A medical judgment? Have we came to the point that a Doctor can use "medical judgment" to determine if someone should die?
    Read the section of the post you quote again. It does not talk about doctors deciding if someone should die, but how someone should die. The post talks about the possibility of the doctor facing a choice between having their patients die slowly in pain or swiftly in peace. From what I've read, there is very little conclusive evidence that this doctor practised euthanasia. I do not see how it can be proven what her intentions were in administering the drugs. We know supplies were limited. Maybe she improvised with the drugs she had to alleviate suffering. Maybe she didn't intend to kill those patients; maybe it wasn't those drugs that were the cause of death anyway. All we have is one person's testimony that a 'fatal dose' was mentioned. I think it is a waste of time and money bringing this case at all. And in the event that she did practice euthanasia, I believe that she was acting in the best interests of her patients.

    Re: Murder or Treatment? (none / 0) (#29)
    by Deconstructionist on Thu Jul 20, 2006 at 01:36:59 PM EST
    "From what I've read, there is very little conclusive evidence that this doctor practised euthanasia. I do not see how it can be proven what her intentions were in administering the drugs." Those are questions of fact, not issues of law, ethics and morality. I don't know enough to pass judgment on what version of events is more credible. My point is that under the law, accepted medical ethics, and any version of moralitywhich I find acceptable, it is wrong for doctors unilaterally to decide to kill people. The circumatances might well mitigate the appropriate punishment but it's a frightening world where intentional killing without consent of a person ever becomes legally, ethically or morally acceptable. That YOU think she acted in the best interest of the patients should not be relevant (how you can make that judgment based on the available information is puzzling in any event). Killing someone else doesn't become acceptable because you approve of it. Self-determination is one thing. Third party determination is entirely another.

    Re: Murder or Treatment? (none / 0) (#30)
    by Scrutinizer on Thu Jul 20, 2006 at 01:39:59 PM EST
    I consider killing other people to be wrong, except in cases of self-defense. I apply that to the death penalty (no matter how evil the offender was), and I apply it to aggressive foreign policy opportunism (ie, our incursion into Iraq). Now, if these medical personnel did what is alleged they did (although I'm not sure how it would be proven), it's just as wrong. While medical practitioners do have to do triage, especially in the mess in NO, euthansia is not a right, nor is it an acceptable form of medical treatment. The most that the medical community is allowed to do is cessation of life support assistance and palliative care. They cannot legally take active steps to end someone's life. If these people were convicted, then any punishment would have to take into account the unnatural conditions that prevailed in NO, but if they did what was alleged, then they don't need to be practicing medicine, and they certainly don't deserve medals of freedom for this action.

    Re: Murder or Treatment? (none / 0) (#31)
    by Deconstructionist on Thu Jul 20, 2006 at 02:02:47 PM EST
    It would be proven the same way it would be proven in any criminal case by direct and circumstantial evidence. If people could only be convicted where there was a video of them committing the act while they narrated their intentions, my job would be very easy (although sometimes the evidence is pretty much that bad). If other people who were present doctor testify in a mnner the jury finds credible: "She said she was going to administer a lethal dose of narcotics because she decided it was the best if the people died." "I saw her administer the drugs." Then medical experts testify credibly: "Post-mortem examination shows that the cause of death was directly related to the presence of the drugs." That would be more than enough evidence to support a conviction for at the very least voluntary manslaughter. If the evidence was a little different and was more along the lines of another doctor testifying that: "She said she wanted to make sure the patients felt no pain but she ignored my entraties that the dosage she was going to give deviated from the accepted standard of care and presented a high degree of risk of death." she could still be found criminally culpable of a lesser degree of homicide.

    Re: Murder or Treatment? (none / 0) (#32)
    by jen on Thu Jul 20, 2006 at 03:27:12 PM EST
    http://en.wikipedia.org/wiki/Triage

    Re: Murder or Treatment? (none / 0) (#33)
    by Deconstructionist on Thu Jul 20, 2006 at 03:45:04 PM EST
    Jen: From your link: They are so severely injured that they will die of their injuries, possibly in hours or days ...; they should be taken to a holding area and given painkillers to EASE [NOT CAUSE] their passing.

    Re: Murder or Treatment? (none / 0) (#34)
    by jen on Thu Jul 20, 2006 at 03:47:46 PM EST
    yes, but the drugs are given, and would be in the system

    Re: Murder or Treatment? (none / 0) (#35)
    by Deconstructionist on Thu Jul 20, 2006 at 03:53:56 PM EST
    I'm NOT assuming she acted with intent to kill. this particular doctor may well be falsely accused of that. What I am saying is that it is wrong for a doctor (or anyone else) to cause death intentionally without consent-- under any circumstances.

    Re: Murder or Treatment? (none / 0) (#36)
    by Deconstructionist on Thu Jul 20, 2006 at 03:56:32 PM EST
    I've also pointed out that a negligent act causing death CAN be the basis for a lesser degree of homicide under the law (often thus termed negligent homicide). I'm not saying I believe the facts in this case would warant that because I don't know enough about the facts.

    Re: Murder or Treatment? (none / 0) (#37)
    by Deconstructionist on Thu Jul 20, 2006 at 03:59:05 PM EST
    "I'm NOT assuming she acted with intent to kill. this particular doctor may well be falsely accused of that. What I am saying is that it is wrong for a doctor (or anyone else) to cause death intentionally without consent-- under any circumstances." To clarify, I am speaking in a medical situation not univerally. A kiling in self-defense could be intentional without connsent but be justified -- and war and capital punishment have to be analyzed differently.

    Re: Murder or Treatment? (none / 0) (#38)
    by jen on Thu Jul 20, 2006 at 04:44:44 PM EST
    The problem is, in the hideous situation they were in, with no power massive heat , drugs running out, everything running out. The caregivers were all faced with hiddeous choices. Triage is a nasty thing in times of war and disaster. What little they taught us in animal care school in the army was appalling -- and they were talking about DOGS. The kinds of decisions doctors have to make are soulbreaking. Prosecuting doctors and nurses after the fact is seriously risking the wellbeing of people in future disasters.

    Re: Murder or Treatment? (none / 0) (#39)
    by Deconstructionist on Thu Jul 20, 2006 at 05:04:13 PM EST
    That may be a "extra-legal" reason for not prosecuting but such practical concerns don't change the law, ethics or maorality at issue. Doctors should not intentionally kill without consent. That should a sacrosanct principle. (Many would argue that docs shouldn't kill WITH consent but that's debatable.) If the evidence of intent is dubious do I think she could be convicted? no, and maybe not even if the intent evidence is persuasive. Do I think she should be prosecuted if she was merely negligent and overdosed people only intending to ease suffering under horrific circumstances? No, and I'd say that theory has almost no chance with a jury. But, it frightens me no end to see people saying that --if the accusations are true-- she should be praised or considered a hero. I hope they aren't true, but praising someone for intentionally killing an innocent helpless person because "Oh well, they'd have died anyway, has scary ramifications. There are lines that should not be crossed because eveytime it is crossed it makes it a little easier to go a little further the next time.

    Re: Murder or Treatment? (none / 0) (#40)
    by jen on Thu Jul 20, 2006 at 05:18:51 PM EST
    It frightens me no end that profesionals, placed in the worst possible scenarios they can be, have to worry about being prosecuted for their decisions afterwards.

    Re: Murder or Treatment? (none / 0) (#41)
    by Deconstructionist on Thu Jul 20, 2006 at 05:30:10 PM EST
    That is FAR too broadly stated. Having their reasonable judgment as to appropriate care second-guessed is one thing (and many state "good samaritan" laws immunize providers from liability for negligence in such circumstances) but using that rationale to put INTENTIONAL KILLING beyond review is not even remotely justified. Obviously, a DECISION TO KILL could not be evaluated before the fact so saying it should not be evaluated after the fact is tantamount to sayinh anything goes. Let's assume a personis seriously injured in a gruesome accident on a remote highway in which many are injured. A doctor comes up and says: he's suffering and I don't think he can live. I need to deal with the others," so he pulls out a syringe and kills him with a lethal dose. that should be beyond review? It would be wrong to question the doctor's decision after-the-fact?

    Re: Murder or Treatment? (none / 0) (#42)
    by jen on Thu Jul 20, 2006 at 05:34:49 PM EST
    or the doc could simply leave him

    Re: Murder or Treatment? (none / 0) (#43)
    by Scrutinizer on Thu Jul 20, 2006 at 06:46:43 PM EST
    That is FAR too broadly stated. Having their reasonable judgment as to appropriate care second-guessed is one thing (and many state "good samaritan" laws immunize providers from liability for negligence in such circumstances) but using that rationale to put INTENTIONAL KILLING beyond review is not even remotely justified.
    I agree with your reasoning here, but if memory serves Good Samaritan laws don't apply to licensed health care providers. They are meant to shield people who try to help at the scene of accidents/disasters/bad things who do not have medical training from malpractice suits, etc. I think that Good Samaritan laws still require that someone giving assistance act "reasonably" in a particular situation. Health care providers are still held to a professional standard of care, though. If my wife and I stopped at the scene of an accident and I tried to offer assistance, I would recieve the benefit of Good Samaritan protection. My wife, on the other hand, is a nurse practitioner, and could be sued for malpractice if she did something that caused harm to an accident victim. Some providers will pass by an accident scene for that very reason, especially if they are in a specialty that is removed from emergency medicine. I completely agree with you that there is a huge divide between palliative care and intentionally killing a suffering patient. The former is expected, the latter is unacceptable without prior consent (and legally dangerous, with revision of existing laws).

    Re: Murder or Treatment? (none / 0) (#44)
    by jimakaPPJ on Thu Jul 20, 2006 at 08:05:30 PM EST
    HK writes:
    The post talks about the possibility of the doctor facing a choice between having their patients die slowly in pain or swiftly in peace.
    What this speaks of, again, is having a doctor decide when and how a person will die, without the consent of the person or the law. That's wrong. There really is nothing that can justify it. Simpler. It isn't their job.

    Re: Murder or Treatment? (none / 0) (#45)
    by jimakaPPJ on Thu Jul 20, 2006 at 08:20:26 PM EST
    Squeaky - Perhaps you can tell us how shooting looters is the same as a Doctor deciding thst it is in the best interest of a patient to die, now.

    Re: Murder or Treatment? (none / 0) (#46)
    by Che's Lounge on Thu Jul 20, 2006 at 08:37:09 PM EST
    You people don't have one iota of knowledge about what you are talking about. Decon rationalizes while Jim tells us that it wasn't THAT bad. Neither of you were there yet you both pontificate endlessly from the comfort of your homes. What a waste of bandwidth.

    Re: Murder or Treatment? (none / 0) (#47)
    by squeaky on Thu Jul 20, 2006 at 09:00:14 PM EST
    PPJ- I am pointing out your position on the sanctity of life. Both situations took place under very extreme, to say the least, conditions. Martial law was declared. You advocated shooting people, and if they got it wrong a few times, no big deal. Next you condemn someone for working under triage conditions for possibly easing a bed ridden geriatric patient's death who otherwise would have been left to die a certain horrible and painful death from dehydration, starvation, lack of medicine, etc. To me the ethical line you draw for condoning murder in one example while getting all high and mighty in another case is sociopathic. Or is it that you are able to compartmentalize the looters death because in your mind, they were less than human, and just perfect for target practice?

    Re: Murder or Treatment? (none / 0) (#48)
    by HK on Fri Jul 21, 2006 at 01:43:13 AM EST
    That YOU think she acted in the best interest of the patients should not be relevant (how you can make that judgment based on the available information is puzzling in any event).
    Decon, you are making lots of judgments based on the information available. I think most people here have acknowledged that the information is incomplete and that the debate we are having can only be based on what little we know. If you think that there is too little information to draw any conclusions, then how come you have so much to say? While your professional perspective is valuable, I think you are forgetting that this is a blog, not a court of law. While most commenters have some relevant knowledge, common sense and rationality, no one is suggesting that this case should be settled on sparse information and opinion.
    What this speaks of, again, is having a doctor decide when and how a person will die, without the consent of the person or the law. That's wrong. There really is nothing that can justify it. Simpler. It isn't their job.
    Taking on a shift days long in desperate circumstances wasn't her job either, Jim. I'm not saying that this excuses what she may have done, but I am pointing out that the rules (NOT the law) are necessarily flexible in emergencies. It's fine to say that you think she broke the law, but to opine that she was acting outside her job is to say that you think she should have gone home when her shift ended. I imagine that she now may wish that she had.

    Re: Murder or Treatment? (none / 0) (#49)
    by Deconstructionist on Fri Jul 21, 2006 at 04:18:08 AM EST
    I'm not making juudgments about the FACTS. I don't know anywhere enough to have an opinion on what really happened. I'm not offering any opinion on how THIS case should be decided on the facts. I merely offer how the law applies to various possible scenarios and my opinion as to the legal, moral and ethical duties faced in such a situation. I am making the judgment that it is always wrong for a doctor to intentionally kill a patient without consent. I'm not making any juudgment that is what happened.

    Re: Murder or Treatment? (none / 0) (#50)
    by Talkleft Visitor on Fri Jul 21, 2006 at 04:39:57 AM EST
    So the drugs used to off the patients was fine. How about using the same drugs in the same amounts for capital punishment?

    Re: Murder or Treatment? (none / 0) (#51)
    by Deconstructionist on Fri Jul 21, 2006 at 05:07:18 AM EST
    Clever point. However, it is a little different. In the "mercy killing" scenario the doctor presumably believes he is promoting the greater good by ending suffering (the problem is it his individual opinion as to the greater good being unilaterally implemented. In the capital punishment context the doctor is killing a reasonably healthy person (paradoxically, they don't kill you while you are really sick; they wait for you to recover then kill you). On the other hand, it's not a long step from "I killed to end what I considered intolerable physical pain" to "I killed to end what I consider intolerable mental anguish.... Then the next step is I killed to end what i consider intolerable physical and mental infirmities that deprive him of any chance of a meaningful life.... To I killed... I killed.... I killed....

    Re: Murder or Treatment? (none / 0) (#52)
    by jen on Fri Jul 21, 2006 at 05:42:47 AM EST
    Shall we try this again. Pray you are not in a disaster. Pray you are not badly hurt. In the next disaster. Doctors will triage. They will approach those too far gone. They will remember the Doctor who was charged. You think doctors arent intimidated by that sort of thing? Think again. They are. Think of people dying with only a blanket and water and tylenol while those who will survive get morphine.

    Re: Murder or Treatment? (none / 0) (#53)
    by HK on Fri Jul 21, 2006 at 05:54:55 AM EST
    I'm not making juudgments about the FACTS.
    Neither was I, Decon. I was offering ifs and maybes, as you have. Nor did I state that it was right for a doctor to kill a patient without their consent. I simply said that I believed from what I had read that this doctor was acting with her patients' best interests in mind. That doesn't make it right, it just questions the issue of intent. I realise that you prefer to talk about the issues in this case in terms of principles, but I feel that although the law is there to provide ground rules, each individual case must be examined on its own merits. Do you truly think that anyone here is advocating doctors having the right to unilaterally decide that it is acceptible to end the life of a patient against their will?

    Re: Murder or Treatment? (none / 0) (#54)
    by Talkleft Visitor on Fri Jul 21, 2006 at 08:57:27 AM EST
    It's obvious to me that none of you were in that hellish situation. do you know the heat in a New Orleans building when the windows don't open in August and September? No matter how bad anyone else's evacuation/being on their roof/getting the hell out stories are, none compares in sheer horror to those who were in Charity, Methodist, Memorial and other hospitals where they lost power, generators, food, water, and other life essentials. Staff gave up their own food and water for other staff and patients. At Charity, they were giving themselves IVs just to stay hydrated. At Methodist, patients' family members threatened the lives of staff members. To hear some of you pontificating, to hear Charles Foti furthering his own political ends at the expense of people who went through hell VOLUNTARILY for patients, makes me sick. None of you writing here obviously knows what that hell was like. And you seem unwilling to put yourself in Dr. Pau's place. You should be unwilling. What she and other medical people went through in Katrina's wake, no one living in a civilized society, let alone in America, should ever have to go through. The suicide rate of nurses who stayed after Katrina is the highest in an already high rate in the N.O. metro are months later. Decon, you are writing as if these things happened in the course of just a busy or stressful day. They did not. Pray that you are never in that situation.

    Re: Murder or Treatment? (none / 0) (#55)
    by Talkleft Visitor on Fri Jul 21, 2006 at 11:06:49 AM EST
    I'm with jen on this. No one knows what really went on there, so it is ridiculous to spout off about it as though you did know. Maybe the doctor wasn't giving what she thought were lethal doses? Or, perhaps she should have just left them to their own fates, just as the compassionate White House did. And to the troll who mentioned martial law in an attempt to draw some war parallel, you should know that people who are badly wounded in combat situations with no hope of being saved are indeed sometimes given a field mercy-killing (more often than you would care to know about), because the alternatives are worse.

    Re: Murder or Treatment? (none / 0) (#56)
    by Talkleft Visitor on Fri Jul 21, 2006 at 11:11:38 AM EST
    To: bootsybooks. You said it all better than I did, but I failed to see your post - sorry 'bout that.

    Re: Murder or Treatment? (none / 0) (#57)
    by jimakaPPJ on Fri Jul 21, 2006 at 11:42:52 AM EST
    HK writes:
    but to opine that she was acting outside her job is to say that you think she should have gone home when her shift ended. I imagine that she now may wish that she had.
    First, my comment is not towards the particular doctor. I do not have enough information to either approve or disapprove. I speak from a generic viewpoint. And that, again, is simple. It is not up to the doctors to decide to kill someone in "mercy." If you can't see the danger in that there is nothing I can add. Squeaky you got it. Killing looters, good. Killing medical patients, bad.

    Re: Murder or Treatment? (none / 0) (#58)
    by squeaky on Fri Jul 21, 2006 at 12:01:36 PM EST
    Squeaky you got it. Killing looters, good. Killing medical patients, bad.
    There you have it, black and white. As I said, a sociopath. Anyone who advocates killing on sight those who, hungry and thirsty, "steal" food and water during a natural disaster is really twisted. It must burn you up to imagine the money our government spends on providing due process fot those accused of petty theft. Think of all that money that could be used instead to kill moslems and those suspected of looting. Mob lynching saved lots of time and money in your book, huh ppj?

    Re: Murder or Treatment? (none / 0) (#59)
    by chemoelectric on Fri Jul 21, 2006 at 12:35:04 PM EST
    We do more for dying dogs than for dying people. When Sigmund Freud was near death he had his doctor give him a fatal dose of morphine, which in every way improved Freud's ending over what would have happened otherwise. No big show, no Kevorkian circus, no point to prove, just one doctor asking another to end it well. It is a right and proper way to die.

    Re: Murder or Treatment? (none / 0) (#60)
    by Talkleft Visitor on Fri Jul 21, 2006 at 12:42:53 PM EST
    Decon.: Are the amounts fine? I mean if no one here has problems with the way the people died, drifting off to eternal sleep, no muss no fuss. Wouldn't the receivers of it under captial punishment also drift off to slumber forever also? That would take care of some threads on this site from last month.

    Re: Murder or Treatment? (none / 0) (#61)
    by BigTex on Fri Jul 21, 2006 at 12:46:45 PM EST
    As a doctor do you just leave the patients to die a painful natural death unattended or do you make their death l more bearable?
    Squeak - you don't give paliative treatment that you know will be fatal. You follow standard professional ethical guidelines, one of which is do no harm. Decon is right on the money here. Here's a quote from an anon female doctor who killed her patients in the wake of Katrina. Because the quote is anon, it's not possible to verify that the female doc there and here are the same.
    I didn't know if I was doing the right thing ... I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose...You have to understand these people were going to die anyway.
    Basic patient dignaty requires the patient should have the option to refuse a fatal treatment, even if it means that they suffer more in death. The doctor wasn't treating the patients like they were humans, she were treating them as ill animals who are being euthanized for their own good. Someone should always have the right to refuse treatment so long as the refusal does not make them a threat to others. Until we reestablish slavery and let people have property rights in each other again, no one should have the authority to make a decision to off someone because it is the more humane thing to do. This is a violation of a basic civil right, the right to bodily integrety.

    Re: Murder or Treatment? (none / 0) (#62)
    by HK on Fri Jul 21, 2006 at 01:25:49 PM EST
    The consent issue is key. The quote you give, BigTex, does not indicate that the doctor was acting without consent. He/she says that they did not know if they were doing the right thing, but that could mean that they did have consent or they didn't. Equally, we do not know if Dr. Pau was acting without consent. And while there are moral implications tied up in the question of consent, in terms of the law, it makes little difference. Euthanasia, even if consensual, is still illegal. In other words, we may think it would be acceptible if patients had given their consent, but the law does not. Also, we can debate the principles until we are blue in the face, but I think that valid points have been made by bootsybooks, jen and bumbaclatt. I wasn't there and I don't know what I would have done if I had been. Sometimes we must choose between the lesser of two evils and sometimes people make inappropriate decisions with the best of intentions. It's not right, it just is.

    Re: Murder or Treatment? (none / 0) (#63)
    by HK on Fri Jul 21, 2006 at 01:27:33 PM EST
    *Dr. Pou, I mean. Please excuse my mistake.

    Re: Murder or Treatment? (none / 0) (#64)
    by squeaky on Fri Jul 21, 2006 at 01:27:58 PM EST
    BigTex-An unattributal quote? Have you read the article?
    Dr. Pou was known among fellow doctors as a fierce advocate for her patients and a prominent specialist in the difficult field of endocrine surgery. Her father was a doctor, as were two of her uncles, and she was so devoted to medicine that a résumé listing her continuing education courses, scholarly publications and teaching activities stretches for 21 pages.
    She stayed, most others left. Acute care patients that would not survive evacuation were dumped in the hospital from a neighboring hospital. Here is how these acute care patients would have had to be evacuated:
    He said the sickest patients could not have been evacuated on the inflatable boats being used. And he said that to take patients to the roof for helicopter rescues, orderlies had to squeeze them through a 3-foot-by-3-foot hole in a hospital wall and push them on gurneys up the ramps of the parking garage before carrying them onto the roof. Mr. Simmons said some patients also died while being transported under those conditions.
    All told 35 patients died. Again, in my opinion Dr Pou and the two nurses are being used to seek vengance, or political gain, for a epic scale tragedy where incompetance by the powerful was rampant. Justice is not on the table here. It is not suprising to me that the person who stands accused, is both a she and from the Dominican Republic.

    Re: Murder or Treatment? (none / 0) (#65)
    by Nowonmai on Fri Jul 21, 2006 at 05:27:31 PM EST
    A merciful death eased into with an injection of narcotics, or slow death by drowning, oppressive heat, and subsequent disease. I would hope should that become the choice for me, my doctor/caregiver would be wise and compassionate enough to give me mercy.

    Re: Murder or Treatment? (none / 0) (#66)
    by BigTex on Sat Jul 22, 2006 at 01:47:28 PM EST
    Squeaky - the quote I gave was from an article in the wake of Katrina, not the one linked in this thread.
    Kris Wartelle, a spokeswoman for the attorney general's office, said the agency had to investigate the claims at Memorial because it must enforce the law. "Where is the sympathy for the victims? Why is there no outcry for the people who would have not died had they gotten out?" she said. "These are not terminal people begging to be put out of their misery."
    According to the AG's office, these people weren't asking to be put out of their misery. That means that the care givers in question treated their patients like animals, not like humans. This is a gross affront to basic human dignaty, and a complete violation of any sort of ethical code. It's one thing to dispose of property. So long as we have the Constitution, humans aren't property. That's called slavery.

    Re: Murder or Treatment? (none / 0) (#67)
    by squeaky on Sat Jul 22, 2006 at 02:01:03 PM EST
    According to the AG's office, these people weren't asking to be put out of their misery. That means that the care givers in question treated their patients like animals, not like humans.
    No Big Tex, this means that the AG is trying to make his charges stick. Do you always believe what a Prosecutor or AG says, or only when it strikes a religious chord on your fundie heartstrings?

    Re: Murder or Treatment? (none / 0) (#68)
    by BigTex on Sun Jul 23, 2006 at 02:41:49 AM EST
    Suqeaky - no one has yet said these were people asking to be offed. In that light, yes I believe the prosecution. The defense, in the initial reporting last year, and in the recient developments hasn't been that these people wanted to be put out of their misery. That would be the most logical PR move to make. It hasn't been done. The medical system is trying to play the emotion card, but not making the obvious play... that gives the prosecution's statements the ring of truth.

    Re: Murder or Treatment? (none / 0) (#69)
    by aw on Sun Jul 23, 2006 at 07:03:26 AM EST
    Why is there no outcry for the people who would have not died had they gotten out?"
    Well, yes, had they gotten out, it would have been different. They would have died at a later time. But they didn't get out. What would you all have done under the circumstances? Would you have sacrificed your own health and well-being and maybe your life to stay with people who were already dying after working under such horrendous conditions? Would you have said, I'm not leaving, even though there is nothing more I can do for them except hold their hands? I'll stay and watch them die and maybe give them just a little medication to ease their deaths, but not too much?

    Murder or Treatment? | 69 comments (69 topical)