there is a far cry of difference between triage during a disaster, with the necessity to focus limited resources, and actively administering compounds without permission or consent that will hasten a person's death. other than that, i'm not trying to make a determination whether or not her actions were the right thing to do. i'm not placing judgments on anyone. i was not there.
but, the facts as they've been relayed so far is that there was a situation were one doctor and two nurses were known to have been walking around talking about euthanasia just prior to administering potent respiratory depressant medications to patients who were listed as DNR. in my mind, many physicians - many physicians - often equate a DNR with it being acceptable to withdraw support. (this is a huge re-training issue for many healthcare providers - the "why bother" attitude - and all physicians should be stalwart in not even letting those two concepts comingle in your mind).
but, this goes even one step farther. she actively made the decision to administer these compounds without explicit permission. in light of this, i cannot help but believe that the fact that they knew these patients were DNR made their actions seem reasonable at that time, and in no small influenced their decision to act and do what they perceived to be the right. and, ultimately, maybe it was the right thing to do. that's not my call to make. but, her actions are certainly something i personally never would have done, regardless of the circumstances. if that can be considered judgmental by some, then so be it. but, i'm only in charge of me and can only ultimately control what i do. i can't and don't expect everyone else to follow my lead, and i'm happy to change my opinion when there is overwhelming evidence that i've been mistaken about something.
yet, along with that, that brings up even bigger points around this issue. where was everyone else when she and her team were doling out these medications? where were her colleagues? she could not possibly have been the only physician in the hospital at that time. it seems that, if these were justifiable actions, there would've been a consensus even after the dust has since settled. and, maybe there is/was and this will come out in court. but, in any other circumstances, she would not have been able to act alone as a physician in such a manner. that is the crux of this issue.
so, in my estimation, this does need to go to court. this does need to be adjudicated if not for any other reason than to clarify when it is and is not appropriate to administer lethal care in such circumstances. there does need to be clarification as to whether or not her actions were criminal.
and, jet, as far as your roundabout way to attempt to call what you perhaps erroneously perceive as my "limited life experience" into question concerning the points i've raised, it is irrelevant. it is also none of your business. suffice it to say that i'm probably older than you and have accomplished equal, if not distinct, things in my life. still, you don't know me, what my past life experiences were prior to med school and entering anesthesia training, what my core beliefs are, or my current or prior accomplishments and achievements happen to be - don't attempt to guess at them or somehow try to make them a legitimate debate tactic in this discussion. this issue has nothing to do with me personally - so stop trying to make it so. you do grandstand when you are passionate, and it is more than occassionally annoying. furthermore, just because someone is an attending doesn't mean they can't and don't make mistakes. remember that.
what i am talking to here is the yet-to-be-fully-elucidated facts surrounding this incident, and the mitigating circumstances regarding those facts. it is not about whether dr. pou's actions were the "right thing to do", but whether or not they were legal and acceptable with regards to the ethical and legal responsiblities doctors have to their patients in the medical profession as well as what the limits of physician behavior society will accept happen to be. it is also, like it or not, about what the concept of DNR means. we are not above the law nor are we above the ultimate best interests of our patients. this is part and parcel to the reason why we are not given surrogate decision making capacities to those in whom we are charged with caring.
so, right now, my best wishes and hopes for a quick and fair resolution to this matter go out to dr. pou. i can only hope she doesn't feel that their DNR status justified her actions, and that her defense team is not foolish enough to make this part of the defense strategy. in the meantime, don't indict me for attempting to raise valid issues that we all face on a daily basis as physicians, sharing ideas about the potential thought processes surrounding what may have been going through her mind at the time she did what she did, and attempting provoke deeper thought on this issue. i'm not ready to take sides yet, and neither should anyone else be. i will continue, however, to look on with dispassionate interest and bring up discussion that i feel is relevant.
if you don't like that, tough.
