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What Should Doctors Do For Patients In Disasters When They Cannot Be Saved?
Arthur Caplan   Mar 19, 2011   MSNBC  

In the wake of the devastating earthquake and tsunami in Japan, rescue workers found 128 elderly people abandoned by medical staff at a hospital six miles from the damaged Fukushima Dai-ichi nuclear power plant. The tsunami also killed nearly half the 113 residents at a retirement home in Kesennuma. Eleven of those who lived died of exposure, and the other 53 are in a shelter with only kerosene heaters to keep them warm in near-freezing condition.

For the most part, help can’t get to the ailing and injured. Doctors without Borders says it may pull out of the area near the nuclear plant. In Japan, where nearly one in four residents is over 65, the disaster will likely take the largest toll on the elderly.

“We’re trying to comfort and help them, but we can’t do too much,” Keiko Endo, a nurse at the Kesennuma shelter told the Associated Press.

The crisis calls to mind America’s devastating natural disaster of 2005 - Hurricane Katrina. In the aftermath, workers in New Orleans hospitals were left frantically trying to care for ailing patients without electricity, water, supplies - or anyone to rescue them. The ethical questions raised during that national disaster about what should be done for those left helpless and dying are so difficult that Americans never directly answered them.

In New Orleans, Tenet’s Memorial Medical Center was marooned by the floodwaters. As temperatures climbed to 95 degrees and above, the hospital became a fetid, smelly hell. Most doctors and nurses left. Some patients were too sick, too fragile, or too obese to be moved. Dr. Anna Pou and two nurses heroically stayed on with their patients.

Without power, they knew those kept alive by technology would face terrible deaths. Nine of them did die. Each of those had massive doses of narcotic drugs such as morphine or Versed present in their bodies. There is no doubt in my mind, as I wrote in a report to the Attorney General’s Office for the State of Louisiana, that they died as a result of active euthanasia -mercy killing. Was that the right thing to do? I do not think it was.

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Arthur L. Caplan, Ph.D., is the Drs. William F and Virginia Connolly Mitty Professor and head of the Division of Bioethics at New York University Langone Medical Center in New York City.


  Just read (another) treatise on oligoanalgesia.  I doubt very seriously Dr. Pou was actively attempting to eithanize, after all were that the case she would have been much quicker about it wouldn’t she?

These and your contemporaneous comments about the contribution of ‘heroes’ who should be paid, raise an interesting issue.  Now that we are to have socialized medicine, what responsibility does the individual owe the society?  There are many personal choices which are legal or at least only modestly illegal which continue to raise the cost of health care.  Which continue to have 20% of the people using 80% of the resources.  What does society owe them, when their problems are predictable and their own doing.

I believe in end of life care and analgesia.  What sort of hell do you think Dr. Pou’s patients were in for without any medication?

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