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Experts discuss ethics of ending life

By Ann O'Neill

Memorial Medical Center in New Orleans, Louisiana


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Euthanasia (also includes Assisted Suicide)

(CNN) -- When and how to end one's life is one of the most emotionally charged and divisive issues of our times.

One need look no further than the legal drama surrounding the end to Terri Schiavo's life in Florida last year, or the arguments over Oregon's physician-assisted suicide law now being decided by the U.S. Supreme Court.

But those cases, medical ethicists say, can't compare to the situation confronting health care professionals in Louisiana after Hurricane Katrina as the water rose and the electricity went out, and no one came to help for days.

Louisiana Attorney General Charles Foti told a legislative committee earlier this month that his office was investigating dozens of deaths to determine whether hospitals or nursing homes abandoned or euthanized patients, or whether mistakes were made in their evacuation.

The issue of ending someone's life is complex, experts in medical ethics say. Withdrawing treatment from terminal patients who request it differs greatly from physician-assisted suicide and euthanasia.

In a major disaster, life and death decisions must be made in desperate conditions.

"In the aftermath of Katrina, they were doing triage-type medicine," said Stuart Finder, senior medical ethicist at Vanderbilt University Medical Center in Nashville, Tennessee.

"It happens in war," he said. "If one soldier is injured worse than the others, and it takes more effort to save that one than the six who have lesser injuries, we save the six. That's well established."

Finder placed himself in the shoes of the Louisiana doctors.

"Imagine if you're in a situation when somebody has a ventilator and the electricity goes out, and then the generator goes out," he said.

"You have someone who is going to slowly suffocate, a person who is going to die," he said. "If you're in that situation, you ask, 'How do I relieve the suffering of this person who is dying?' "

He said it would be reasonable to administer morphine to ease the pain of dying. For a frail, terminal patient even a little bit of morphine can be enough to bring death.

Louisiana's 1995 law criminalizing assisted suicide carries a maximum penalty of 10 years of hard labor, but it makes specific exceptions for physicians who withdraw treatment at a patient's request or administer drugs to ease pain and not to cause death.

Any medical professional who deliberately hastened the deaths of patients in post-Katrina Louisiana crossed the line, said Aine Donovan of Dartmouth College in New Hampshire.

"No one in their right mind would do that to elderly people in a crisis situation," said Donovan, executive director of Dartmouth's Ethics Institute. "There is no moral way anyone could excuse just bumping them off."

Donovan said Oregon's physician-assisted suicide law, known as the Death with Dignity Act, has strict standards. It must be at the request of a rational patient with less than six months to live. Three doctors must sign off on the terminal prognosis.

"Never, not under any circumstances, under any condition ever" should the decision be made during a crisis, she said. "You can't make rational choices in a crisis mode."

Finder sees a gray area where such actions, while illegal, might be morally justifiable if a physician or nurse intended to shorten suffering in a hopeless situation.

"In a crisis situation like what was going on in the immediate aftermath of Katrina, they are doing triage-type of medicine," said Finder, who counsels doctors, families and patients on how to handle the issues of life and death.

"You try to intervene where you know you will have the most likelihood of effectiveness," he said. "Someone who is frail, toward the end of their life, those people are going to get shunted to the side "

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