Ethicists: No Way to Justify Mercy Deaths

Despite horrific medical conditions including triple-digit temperatures, no electricity and useless lifesaving equipment, ethicists and even some doctors caught in Hurricane Katrina's aftermath say there's no way to justify killing a sick or dying patient.

"You've got at best mercy and panic, but that doesn't add up to an excusable homicide," said University of Pennsylvania bioethicist Arthur Caplan.

No one knows if that happened in New Orleans, but a doctor and two nurses were arrested Tuesday on suspicion of murder charges. They are accused of giving fatal doses of morphine and a sedative to four patients stranded at a New Orleans hospital after the catastrophic storm last August.

The worst-case scenario would be if the doctors "tried to save themselves and didn't want to feel guilty leaving the patients behind and killed them," he said.

The best-case scenario, he said, would be if the accused "believed all possibility of maintaining people on technology has come to an end, you're out of power and your battery power is running out and you say, 'I can't let these people suffer.'"

"Under American law, neither scenario would be excusable," Caplan said.

Dr. Steven Miles, a professor of medicine at the University of Minnesota's bioethics center, said it's more likely that those charged were trying to relieve patients' pain "in a resource-poor environment and were doing the best they could."

He said there are documented cases where patients have required seemingly lethal morphine doses to relieve extreme pain, and that he doubts the charges will be proven.

"I'm inclined to believe this was palliative sedation that's been misread," Miles said.

Mercy killings would be "not only highly frowned upon, but also rare," he said. "It's highly unlikely that's what happened here."

Caplan called the charges "further fuel on the fire of what went wrong in New Orleans. You've got public officials who don't do the right thing, you've got FEMA, and now you've got medicine."

Dr. Max Brito, a Chicago physician who was in New Orleans for a meeting when Katrina hit, had firsthand experience with desperate medical conditions there but said he can't imagine resorting to mercy killings even in the direst of circumstances.

"I would never do that," said Brito, an assistant professor at the University of Illinois at Chicago.

He helped set up a makeshift clinic in the hotel where he was stranded. Patients included a boy trapped on a rooftop who was brought in with pneumonia. Nurses in the hotel crafted a stethoscope out of a paper cup to listen to his lungs.

"It was a tough situation," Brito said. But even patients stranded in flooded hospitals eventually "would have gotten out of there."

The situation wasn't so dire "that someone would have to go to that extreme," he said of the alleged killings.

Dr. Janis Tupesis of the University of Chicago went to Baton Rouge, La., shortly after the storm hit to work in a clinic set up in a convention center, treating patients "who literally escaped with the clothes on their backs."

He said he learned later about the unbearable hospital conditions in New Orleans.

"It's difficult to say what's right and what's wrong in that situation," Tupesis said. "I can't even imagine what kind of stress they were working under."

Still, he said, "it would be difficult to see any circumstances where I think that would be OK."

The doctors' oath is to do no harm, and American Medical Association ethics say mercy killings or euthanasia are "incompatible with the physician's role as a healer."

Because the accused physician, Dr. Anna Pou, was an AMA member when the alleged crimes took place, the group's ethics council will be monitoring the case and may carry out its own investigation to see if disciplinary action is warranted, an AMA spokesman said.

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