Redneck said:
The ethical part is would you provide a safe dose, risk sedation, or push for an overdose? I'm wondering if you risk sedation and actually kill the person or simply aim to overdose the guy from the start how that would be viewed. As a physician are you supposed to uphold the do no harm even in a situation like this? Could you lose your license? Could you be arrested because you are a professional and should have had the knowledge to not overdose the guy? In short I believe the underlying issues are 1) Do you take that lethal step in good conscience 2) As a physician can you be held to different standard in a life threatening situation
Deliberately overdosing someone would be probably be construed as murder or voluntary manslaughter, unless you could show that there weren't other options available to you. Some states treat businesses like places of residence (which often have a different, more lax, set of standards for justifying use of lethal force). Sedating someone so that they are helpless, then killing them would also be murder, regardless of the fact that they threatened you, since you could merely sedate the individual then subdue him or call the police. In fact, that sounds less like self protection or voluntary manslaughter and more like premeditated murder.
I would say that in this scenario your role as a physician is not your primary role. A physician, acting as a physician, when treating a patient, should act in the patient's best interests while minimizing harms to the patient. Some summarize this idea as the "first, do no harm" principle. Of course, we also allow live organ donation from non-sick individuals (think kidney and partial liver donation), which causes definite harms (without theraputic benefit) to the donors. So the "first, do no harm" priniciple isn't an iron-clad rule, but more of a heuristic. I would also say that the standard duties you have to patients don't apply in the same way to this situation, since the criminal is not your patient, and he is not seeking you out to be his physician or to provide care, but as a mere means to getting high.
A second issue may arise once the criminal is incapacitated or medicated. If he enters distress, I believe you would be morally obligated to save him. Despite the fact that he didn't seek you out to be his caregiver, once he is before you, exhibiting signs that his life is in danger, you should help him (unless he brought a DNR form with him!
) This is just a view on the moral responsibilities you may have--
qua physican--in this strange situation.
Will you lose your license? If you deliberately sedate someone only so that they are easier to kill, I would hope so. Such an action seems both perverse and unprofessional. If you accidentally kill him, maybe not: I know I sound a bit jaded here, but I bet it depends on the politics surrounding you and the case. The state board may need to set an example of you. If you merely incapacitate him (by sedation or giving the person a heavy dose of the narcotic they want, perhaps) then call the police, I can't imagine why either the courts or the medical board would punish you.
Personally, my own belief is that people who are willing to endanger or harm others for their own pleasure or benefit are not needed or welcome in society. His death would not diminish society in any appreciable way, by my lights. The morality of the situation is definitely made more complicated by the fact that you would be a physician. However, I think it may be difficult to argue that the criminal is your patient, so not all the same moral duties would apply. Secondly, the justifications for taking a life are usually quite few in number and strict in application. They also differ state to state. Thank god I live in Alabama, where if someone holds me up or threatens me with a weapon in my residence, car, or business, I can shoot them dead.
