Thursday, August 27, 2009
Image via WikipediaProPublica (in conjunction with the New York Times Magazine) has published an excellent analysis of the conditions in Memorial Medical Hospital in the Hurricane Katrina aftermath and flooding. Dr. Sherri Fink reviews the system issues as well as the human factors in an in-depth analysis. It is gripping reading which makes you feel as if you were in the same horrible conditions Dr. Anna Pou and the rest of the care team faced. It was clearly a tragic situation where 45 people died in awful conditions, the least we could do is learn from this awful story. Interestingly there was a physician named John Thiele who is a pulmonoligist but apparently trained in palliative care as indicated by this passage:
"Thiele practiced palliative-care medicine and was certified to teach it. He told me that he knew that what they were about to do, though it seemed right to him, was technically ‘‘a crime.’’ He said that ‘‘the goal was death; our goal was to let these people die.’’"Topics covered in the article particularly relevant to palliative care include:
- the role and varied meaning of DNR orders
- the administration of morphine and/or versed as a potential cause of death
- the role of medical professionals in civil emergency and potential liability
- patient centered care and the difficulty of informed consent in emergencies
- the ethics of rationing medical resources (medicines, personnel, technology) in emergency
- the role of the chaplain and others for staff support
- the meaning of dying with measurable opioids in your blood
- the selection of a triage protocol when mortality risk is high
- the difficulty of prognostication and it's role in every medical decision
- the role of double effect
"Doctors, nurses and clinical researchers who specialize in treating patients near the ends of their lives say that this ‘‘double effect’’ poses little danger when drugs are administered properly. Cook says it’s not so simple. ‘‘If you don’t think that by giving a person a lot of morphine you’re not prematurely sending them to their grave, then you’re a very naïve doctor,’’ Cook told me when we spoke for the first time, in December 2007. ‘‘We kill ’em.’’"See I told you that you should read it. Read the whole article before casting any judgments on the above quotes please.
We have covered the case of Dr. Anna Pou at Pallimed in the past here and here.