Special Report: Katrina Deaths

Ethicist sees difficult situation in Katrina charges

The evidence released so far concerning the suspicious deaths at Memorial Medical Center in New Orleans has John Banja, PhD, assistant director for health sciences and clinical ethics at Emory University in Atlanta, thinking that the clinicians may have stepped over the line separating medical care from murder.

While he acknowledges that the facts are not all known yet, what he has seen so far makes him worry that the clinicians may have gone too far.

"If that doctor and those two nurses injected that morphine with the intention — and that's the important word — with the intention of ending those patients' lives, that seems like homicide to me," he says. "Neither the risk manager or the ethicist is going to condone that."

But Banja also has sympathy for the clinicians involved, even if they did what the attorney general alleges. He suggests that risk managers think about how extreme conditions can affect a person's thinking. The incident could be a good lesson in how the decision-making process is very different under high stress.

"Health care workers normally would be loathe to load up a syringe and inject a lethal dose in someone, so if it happened, it must have taken some incredible conditions to get them to that point," he says. "It would be like the Pope taking the Lord's name in vain or a leopard changing his spots. It's hard to imagine what could bring that on, but we have to try."

The dire situation may explain what happened, even if it doesn't justify it, Banja says. That can be a lesson for patient safety overall. "Catastrophes happen when you encounter a situation that exploits the cognitive weaknesses of a professional. It's not that people just get dumb or homicidal all of a sudden," he says. "That could be what happened here, and it happens every day in hospitals all over. There's a high-stress situation, with lots of demands on an individual, and something in the mind gives way at a critical moment."

While Banja finds it hard to accept the idea of actively killing a patient for any reason, he acknowledges that the clinicians at Memorial Medical Center could have realized they were in an untenable situation. If they thought the patients were going to die no matter what, and that their own lives were in danger if they stayed longer to care for them, euthanizing them may have seemed reasonable at the time, he says.

"From an ethical standpoint, it's hard to justify. You're killing your patients," he says. "I suspect they did what they did, whatever we learn that was, because that was what they thought best at the time. We have to learn from this how people think in these situations, how risk managers can anticipate that and help people prepare for it."

Source

For more information on the ethical questions arising from Hurricane Katrina, contact:

  • John Banja, PhD, Assistant Director for Health Sciences and Clinical Ethics, Emory University, 1462 Clifton Road N.E., Suite 302, Atlanta, GA 30322. Telephone: (404) 712-4804. E-mail: jbanja@emory.edu.