Tuesday, January 31, 2017

Five Days at Memorial by Sheri Fink

Pulitzer Prize winning journalist Sheri Fink writes on what happened at Memorial Medical Center in New Orleans during Hurricane Katrina and the aftermath in the riveting Five Days at Memorial.  It was heartbreakingly sad and if you've seen me in the last week, I'm sure I was depressed because this book made me question everything about everything.  It's brilliantly written, researched, and I'm going to recommend it to everyone.  I'm going to focus on the following three areas here, but I'm really limiting myself since each page brought me a new ethical dilemma: triage, infrastructure, and euthanasia.

How does one triage in an emergency? When you have limited resources, do you give the resources to the sickest, who otherwise wouldn't be given a chance a survive or the healthiest who have the best chance of survival?  If you're going to be all utilitarian about it, what is the greatest good for the greatest number? What does "good" even mean in medicine - more days alive, better quality days of life, less pain, or what?  It sounds like there were several triage plans in place in different hospitals in New Orleans during this crisis and that's because there are no studies about what is the "most effective" triage system.

Which brings me to the lack of emergency planning on behalf of every institution - the hospital, the corporate entity that owned the hospital, the city government, the state government, the federal government, the radio stations, and the military.  The hospital knew the generators would flood in even a modest flood.  The radio stations were throwing around the term "martial law," which was misinformation that led hospital employees to follow orders from random Coast Guard and National Guard soldiers.  Long before the storm, the city knew that massive flooding would occur if the levees broke, the Army Corps certainly knew, and who knows what the state knew because it's not talking.  I have a hard time blaming hospital doctors and nurses for decisions they made during the storm when they felt abandoned and there was no clear directive to follow.  Hospital employees aren't crisis hardened, they aren't survivors of war, and there's reason to assume that they should have known what to do.  And that's not on the individuals, but on the institutions.

Which brings me to the last point on euthanasia. Yep, it's against the law. But if these employees genuinely believed that there was no hope of rescue and that their patients were going to suffer (remember, they believed this martial law nonsense), then did they have a responsibility?  Does a crisis situation change the rules about euthanasia? There was a very interesting discussion in the book on voluntary versus involuntary and patient-ordered versus non-patient-ordered that really made me question all my beliefs on this.  Obviously, I think involuntary non-patient-ordered euthanasia is just murder. But what if someone is in a coma and unlikely to recover?  They can't tell you what they want.  Obviously, having a living will is useful, but what if there's no electricity and no access to medical records?  I don't know. 

I found the entire book enlightening and stressful. I wondered what I'd do in that situation and I'm not sure I'd make any decisions different from those that the employees made, but I'm not sure I'd be able to live with myself no matter what decision was made. Those employees were stuck between a rock and a hard place and while I hope that all of those institutions are better prepared for an emergency today than they were in 2005, I'm not sure I'd be willing to bet my life on it.

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