A complex predicament that medical caregivers and society at large could someday have to face: A crisis forces caregivers to administer narcotics and sedatives to severely ill patients with intent to kill.
Administering drugs to relieve pain or suffering, with the knowledge that death might occur unintentionally, is among the highest acts of compassion a caregiver can perform. Terminal sedation and pain control are mainstays of hospice and end-of-life care.
Unfortunately, no bright line separates the two extremes. There is, rather, a gray zone defined by the circumstances of each case as well as the motives and actions of the participants.
Case in point: A doctor and two nurses were arrested Tuesday on second-degree murder charges that, in the chaotic days after Hurricane Katrina hit New Orleans, they deliberately injected severely ill patients with lethal doses of narcotics.
Caregivers who administer narcotics and sedatives with intent to kill, I believe, should be prosecuted. And yet, there may be mitigating circumstances.
Were the patients terminally ill or certain to die without medication, food and electricity?
Were the patients destined to be abandoned with no one to look after them, victims of incompetent planning?
Did some patients, knowing their fate, request these medicines?
To ask such questions is not an exercise to exonerate the New Orleans caregivers but is an attempt to comprehend their motives and possibly put their alleged culpability into perspective.
Just as with abortion and the death penalty, the disparate religious, political and personal viewpoints of our nation’s citizens make it impossible to achieve complete consensus on mercy killing. Even Dr. Jack Kevorkian, a zealous advocate of physician-assisted suicide, has modified his stance.
In cases such as the present one, society is better served in defining what is impermissible rather than seeking consensus on what is permissible. But, based on the facts, that process must be tempered with understanding and compassion for the accused.
If the trial of the doctor and nurses in New Orleans is conducted appropriately, it will not answer the question of when caregivers can terminate life. But it should clarify the bright line that physicians should not cross when administering lethal medicines and provide insight on a caregiver’s thinking when confronted with a tragic situation with no good options.
The list of Hurricane Katrina’s legacies now includes a new chapter in the medical ethic of “first, do no harm.” Hopefully, the resolution also will offer alternatives for caregivers when they are faced with similar difficult decisions in the future.
