In a word? No.
But this is more because (other than not being an Intensivist/palliative care physician) I like my job, I have zero desire to stick my neck out and be on any reports being tabulated on out of the norm practices, I don’t want to be sued, and 1000mcgs as a bolus is likely just unnecessary, etc.
I don’t think pushing 250mcg x 4 q5min or maybe 500mcgs to tolerant pts is automatically criminal murder. Still, would I push 500mcg’s? Probably not. Again, because I don’t want the appearance of hastening death etc. Would I be comfortable titrating to effect quickly, in say 10min, even if that dose added up to 500+? Yes. Resoundingly so. But I would document personally present titration.
I just think the doses alone, as extraordinary as they are shouldn’t be considered criminal unless they clearly show criminal intent. Intent to relieve any and all discomfort, or the appearance of discomfort, in a much more hasty way as Husel did, while misguided to many I don’t think is AUTOMATICALLY murder. It’s clearly outside of standard of care, it’s likely to be found to be hastening death and therefore by the law and our ethics will be determined to be illegal. He’s screwed, he’ll never practice medicine again, and he’s seriously at risk of going to jail for a very long time.
Now I could be wrong and he could be a sociopath who either enjoyed euthanizing patients or liked his census to be absent of any he deemed unlikely to recover so he took things into his own hands. But as it stands now I choose to believe he had a misguided desire to absolutely insure no pain or suffering was shown and this somehow got positively reinforced into regularly giving huge doses. The fact I wouldn’t have pushed 500mcg+ doses does not disprove that his intent was relieving suffering to terminal patients or prove his intent was overtly malicious. It just implies his outlook, comfort level/narcissism, local hospital factors added up to his actions.
He very well may be the madman he’s portrayed as. Or not. The doses aren’t the key.
