Reference no: EM133957417

Mercy Killing

A health care practitioner who deliberately hastens the death of a patient under the guise of "mercy killing" has entered into a practice prohibited under homicide laws. Common and criminal law regard life as sacred and inalienable and look at any premeditated killing as homicide. "Consent and humanitarian motive" is never a defense under the law for murder. "He nonetheless acts with malice if he is able to comprehend that society prohibits his act regardless of his personal beliefs."

Unfortunately, periodically there are cases involving allied health and nursing personnel and mercy killing. Most of these cases come to the attention of authorities as clusters of patient deaths are detected in quality-assurance and risk-management studies. The impact on the communities, the patients' families, and the nursing profession has been profound and negative. The intensity of the negative public reaction is perhaps a measure of how comfortable the average citizen is with the allied health practitioner or nurse as a patient advocate. When that trust is betrayed, there is a natural sense of outrage, "as the good (nurse, therapist, clinician) couldn't possibly act this way."

Mercy killing as an accepted practice is not something that can be entered into lightly, inasmuch as the act of putting someone to death-regardless of motive-involves the closure of all future options. It rules out any possibility of unanticipated discovery of wrong diagnosis, new treatments, spontaneous remission, or improvement as a result of continued treatment. There seems some right reasoning in the caution for prudence, "When in doubt-don't!"

Case Study Katrina: Hard Choices

As the hurricane approached, the hospital staff settled in preparing to wait out the storm. About 1,500 people sheltered in the hospital Sunday night, many were nonmedical, simply seeking a place of refuge. When the storm passed, there was a sigh of relief that the worst was over. However, early Tuesday morning the levies surrounding the city collapsed under the storm surge.

New Orleans is below sea level. Suddenly water was pouring out of the manholes in the streets and the water level rose about a foot an hour. It seemed relentless; by that evening the hospital was flooded with ten feet of water. Power failed, backup generators failed, telephones were out, ventilators stopped, and there was limited food. Staff could hear gunfire outside as looters sacked the corner drugstore. Many people came to the door seeking higher ground, but they had to be turned away, and the doors were boarded over. At this point there were approximately 2,000 people-employees, patients and relatives-essentially trapped in the hospital.

By the fourth day there was hope of rescue, but conditions were desperate. The sewer lines backed up, contaminating the water system, the air temperature rose to over 110 degrees, the odor was horrendous, and breathing was difficult. Potable water was in short supply, all of the staff and patients suffered, but it was on the seventh floor where the situation was most dire. This was a separate long-term facility. These were critically ill patients who, under the best of circumstances, might not survive an arduous evacuation. Given the critical nature of the patients, it was decided not to attempt evacuation of patients with a DNR order. If these patients could not be evacuated, what was to be done? They could not abandon the patients, leaving them to suffer and die. It was at this time that discussions occurred among the staff that it would be more humane to end the lives of those who could not be moved rather than allow them to continue to suffer.

When the crisis was over, there were over 30 dead patients, the largest number of casualties in any of the city's hospitals. In the end, a highly respected physician and two nurses were charged with administering lethal doses of painkillers to four patients.

Queston 1. Because this was essentially battlefield conditions, is there a different standard for ethical decision making?

Question 2. The State Attorney General is quoted as saying, "This is not euthanasia. This is plain and simple murder." Do you agree?

Question 3. Is this a case where "mercy killing" is morally justified, even though illegal? Defend your answer.