To understand the pressures doctors and nurses faced, readers needed to know exactly what it felt like to be trapped in a sweltering hospital in a city that had descended into chaos. Do you think Fink does an excellent job of recreating those conditions?
Sheri Fink in his article "5 Days at Memorial" demonstrates the choices the nurses and the doctors had to make on the ethical dilemmas they encountered. Fink does an excellent job of revealing the conditions that were present in Memorial Hospital during the occurrence of Hurricane Katrina. Fink challenges the ethical decisions of the doctors and nurses during the administration of treatment and evacuation of patients. The doctors made the wrong choices when treating and evacuating their patients.
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What do you think of the behavior and decisions made by the medical staff? Where you shocked by the lethal injections of morphine? Or do you agree? Per Dr. Cook, “It was actually to the point where you were considering that you couldn’t just leave them; the humane thing would be to put ‘em out.” What do you think?
I think that the medical staff at Memorial Hospital behaved and unethically made decisions manner. The medical team conducted slowed deaths of the patients who were in critical conditions because they could not be evacuated. The medical professionals made quick decisions on leaving patients as Fink states “Let’s put our pets out their misery, let’s do the same with our patients”. I was shocked by the decision of administering lethal injections of morphine to patients. I think a team of medical professionals made the decision on administering the harmful drugs and there were conflicts when coming into an agreement. I think Dr. Cook should be charged for supporting the administration of harmful drugs.
What shocked or disturbed you the most? The actions of the staff? The unpreparedness of the hospital? The horrific conditions everyone operated under? Or were you not surprised at all?
I was shocked by all the three things. I was disturbed by the actions of the medical staff of Memorial Hospital. The medical professionals gave the healthy patients the first chance of evacuating. The patients with critical conditions were given the last opportunity to evacuate. Fink states “those in fairly good conditions would be categorized ‘1’ and would be the first to evacuate” (Fink, 2013 p.137). Further, Fink states “quicken their deaths or abandon them’ (Fink, 2013 p.161). The nurses got orders from doctors and had to oblige. The decisions of the medical employees were against the AMA (American Medical Association) standards. The AMA provides that the health care providers should give the patients with critical conditions the priority (American Medical Association, n.d.).
What legal and ethical standards must healthcare workers uphold in a disaster? Should they be held to the same rules that operate during normal conditions? Is there a gray area in ethics when things go disastrously wrong?
The healthcare providers should take into account the four principles of bioethics when dealing with ethical dilemmas during the disasters. The policies include non-maleficence, autonomy, justice, and beneficence. Subsequently, the medical professionals should take into account the principle of triage. The healthcare providers need to distribute the medical resource per the values of justice and beneficence (Quincy Area EMS, 2013). The WMA (World Medical Association) suggests that the medical professionals should administer treatment to save many lives of the patients. The medical professionals need to take into account the principle of informed consent. The patients should be given the information about their treatment. The patients will then accept or reject the treatment. The legal and ethical measures should be held at higher standards during disasters as compared to normal conditions. The gray area in ethics during emergencies is to save patients who are recovering over the ones who are critically ill.
What are your thoughts about the decision on day 2 to cease all medical treatment? Was the being prudent or premature and why?
The decision for the healthcare professionals in ceasing all treatment was unethical. The patients’ under medication required the medicine for them to survive. It is the responsibility of the medical professionals to administer treatment to save many lives during emergencies. The decision was premature because it did not fulfill the obligation of the medical professionals.
In such conditions, who should be saved first? Who should make those decisions?
In case of emergencies, the patients with critical conditions, babies and, the old individuals should be given the priority during the evacuation. The management of the hospital is responsible for making the evacuation decisions.
How significant a role did the media play (and their false report of martial law) in the decisions that were made at Memorial? Should the media be held accountable for wrong information?
It is clear that people heard rumors. The media is not responsible for the chaos that occurred in NOLA after the occurrence of the Katrina disaster. The media is responsible for the wrong reports they made. An assessment of media ethics should be carried out to determine the journalists' compliance in making statements about the Katrina disaster.
Discuss the differences in outcomes between Memorial and Charity Hospitals. What role does leadership have in disasters like this?
Charity hospital saved the lives of many patients as compared to Memorial hospital where many lives were lost. The medical professionals of Charity hospital made ethical decisions that enhanced the recovery process of the patients. The main for the success of saving many patients is effective and cooperative leadership in Charity hospital. The leaders at Charity hospital held regular meetings with the medical professionals and volunteers. They could share ideas, give directions, and formulate decisions. The leaders at Charity hospital prohibited their medical professionals and volunteers from engaging in rumors (Fink, 2009). The leaders are responsible for managing medical professionals and patients during disasters. It is the responsibility of the leaders to make and formulate decisions that assist in saving the lives of the patients.
Disasters happen every day around the world. Why, in a major US city with access to plenty of clean water, food, and medicine did things go so wrong in such a technologically advanced place?
Disasters are prone to happen in any part of the world. The hospital made wrong decisions due to lack of preparedness and poor leadership. The hospital was not prepared for any emergencies, and they had to make the wrong choices. For instance, the hospital ceased treatment during the second day due to inadequate medical resources. The doctors made quick decisions because they did not hold meetings with the leaders to discuss the appropriate plan that should be implemented. Although, the hospital has advanced medical facilities they did not have a plan to prevent the effects of the disaster.
Why did the babies on ventilators make it out but not the elderly? Was it a conscious decision as a whole or the matter of individual choices per patient?
The babies were given priority over the seniors. I think the doctors made a conscious decision in evacuating the babies in ventilators machines. Firstly, the oxygen for the ventilators could run out, and it was prudent for the babies to be abandoned. Secondly, some of the old people could walk, but the babies in the ventilators were helpless. I think that the doctors did not make the decisions based on individual patients, but they wanted to save the lives of the children.
Why did the local grand jury decline to bring charges against Anna Pou? Do you agree with its decision? To what degree should Pou be held accountable for her actions?
The local grand jury did not impose charges to Dr. Pou because they perceived that she made ethical decisions. I do not agree with the jury's verdict on declining the charges against Dr.Pou. Dr. Pou is accountable for her actions because she did not consult the management or the volunteers on the ways of approaching the situations. She could have requested the administration and the medical professionals to contribute ideas on approaching the situation.
Ultimately, who is responsible for the deaths that occurred at Memorial?
The doctors and the hospital’s management are ultimately responsible for the deaths of the patients. The doctors could have consulted with the managers to plan the ways of approaching the situation. The doctors made decisions based on the pressure and the availability of resources in the hospital. The managers of Memorial hospital were reluctant in making any move to save the lives of the patients.
What lessons were learned from the hospital disaster at Memorial?
I have learned that the medical providers and patients need help during emergencies. It is prudent for leaders to know the disaster management plans to save the lives of the healthcare providers and patients. Secondly, hospitals should be used as sheltering grounds for disasters. There is a need for a well-formulated evacuation plan where the victims should be transferred after the occurrence of the disaster. A hospital should have a backup safety and communication structure.
What is your most significant takeaway message from the book?
Decisions need to be well thought, and a plan should be created before approaching any situation.
References
American Medical Association (AMA). (n.d.) AMA's Code of Medical Ethics. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page
Fink, S. (2009, Aug 1). The Deadly Choices at Memorial. The New York Times . Retrieved from http://www.nytimes.com/2009/08/30/magazine/30doctors.html?pagewanted=all&_r=1&
Fink, S. (2013). Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. New York: Crown Publishers
Quincy Area EMS. (2013). Mass Casualty, START Triage and the SMART Tag System [PowerPoint slides]. Retrieved from http://www.blessinghospital.org/upload/docs/ Emergency%20Medical%20Services/ContinuingEducation/01STARTTriageandSMARTTAGS-2013.pdf
