Introduction
Significant emergencies, such as natural disasters and multinational disease outbreaks, are rare occasions that put additional pressure on healthcare professionals due to the large number of affected persons. They may increase the patient load and require physicians to ration their supplies and determine whether treatment is possible for specific individuals. An example of such difficult circumstances was the outcome of Hurricane Katrina, which occurred in August 2005 and affected many people’s lives (Gibbens, 2019).
The story of Dr. Anna Pou raises questions about the ethical principles of autonomy and beneficence. Although significant emergencies are made more complex due to the lack of resources, doctors should not deviate from their moral standards, as such behavior would undermine the ethical principles of autonomy and beneficence.
Background
In 2005, New Orleans and its neighboring territories experienced a significant storm. Named Hurricane Katrina, this event is now considered one of the worst disasters in US history (Jan et al., 2021). The number of victims directly impacted by the storm is estimated to be around 1,200 people, and many more passed away due to its destruction of infrastructure (Witter, 2022). This natural disaster also affected the healthcare system, as it required urgent rescue and treatment of the victims.
Dr. Anna Pou was at the center of the disaster at the time, working as a physician in a hospital in New Orleans. While struggling to respond to the emergency and finding no prepared rescue plan, Pou and other staff members chose to select patients for evacuation (Witter, 2022). Furthermore, the hospital personnel administered a combination of sedatives and painkillers to those in pain (Witter, 2022). A later investigation confirmed these actions, but Pou objected to calling them euthanasia, arguing that her decisions were based on principles of comfort care (Witter, 2022). The physician also stated that the overwhelming amount of work and the lack of planning made her feel abandoned by the system, resorting to the last available means of treatment.
Autonomy
Healthcare is guided by several ethical principles that determine the patients’ rights and help physicians make decisions in different scenarios. Autonomy is one of these moral bases – it implies that all people have worth and the power to make choices and decisions (Wynia, 2020). When considering treatment, autonomy means that patients consent to physicians performing procedures or administering drugs (Wynia, 2020). Therefore, if the patient’s actions do not harm others and are not limited due to incapacitation or incompetence, this person should have control over their care planning (Wynia, 2020). In standard scenarios, autonomy is followed with the help of informed consent.
However, emergencies place both patients and physicians in a challenging environment. On the one hand, patients are met with unusual circumstances that may increase the risk of harm to themselves or others. On the other hand, doctors may experience a lack of available treatments and tools to help every patient in the same capacity. Hurricane Katrina was such an event – many people could not access care due to physical barriers and the lack of timely rescue operations (Witter, 2022). Simultaneously, hospitals did not have enough space or could not serve the increased number of patients (Witter, 2022). Therefore, the requirement to ask for informed consent or provide equal opportunities became challenging.
These problems of limited resources and staff became the foundation for Pou’s defense. Nevertheless, her and the staff’s actions go against the basic idea behind patient autonomy – patients’ right to agree to specific treatments (Balducci & Colloca, 2020). The administration of painkillers and sedatives to accelerate people’s deaths and the decision to postpone evacuating sick people undermines their worth as human beings and places them beneath healthier individuals (Balducci & Colloca, 2020). While emergencies create challenges for healthcare workers, they should not result in professionals abandoning their ethical standards.
Beneficence
Another vital principle that lies at the foundation of ethical healthcare is beneficence. It means that doctors aim always to act to help others and produce positive results (Wynia, 2020). The physicians must find ways to improve patient health and choose their actions based on the prospect of aiding and not harming. For instance, doctors who tend to a patient in pain should find ways to reduce that pain while treating other conditions that may be a reason for the patient’s discomfort.
Emergencies such as the increased number of victims during Hurricane Katrina place more strain on doctors and reduce the time they can spend with each patient. During this particular event, many hospitals, including Memorial Medical Center, where Pou worked, were overwhelmed and did not have plans for disasters in place (Witter, 2022). The patients already at the hospital needed to be moved to another hospital as the building was cut from power and many vital facilities were not operational (Witter, 2022). This has led to Pou deciding that aiding in some patients’ deaths was the best solution for saving others.
However, such actions go against the principle of beneficence as they assume that only some patients deserve treatment and improvement while others cannot be saved. Resource scarcity during emergencies causes doctors to make the difficult decision of allocating them to victims, compromising their duty to treat patients with kindness and mercy (Iwai et al., 2022). Pou explained that she was helping the patients through the pain (Witter, 2022). Nevertheless, the use of sedatives to ensure patient deaths displays a straightforward approach of not considering patient recovery as an option.
Policy Recommendation
To prevent such ethical dilemmas from happening in the future, a policy recommendation would be to develop a standardized crisis response plan and require all hospitals to follow these guidelines. Emergencies such as natural disasters are inevitable and must be approached in a manner that respects patients. If a patient is in a condition where they cannot make any decisions, physicians should talk to their family members and do anything necessary to improve their health. Patients’ lives should be prioritized in a situation where there are scarce resources. Thus, the plan should outline the limits of triage and emphasize the need to treat each person with dignity and respect.
Conclusion
In conclusion, natural disasters and other emergencies are associated with the issue of risk concerning autonomy and beneficence. The lack of resources and the need to act quickly limit physicians’ choices. The absence of emergency plans increases the risk of unethical behavior, as seen in the example of Hurricane Katrina. Therefore, policy should be created to address crisis response planning and urge hospitals to uphold specific ethical standards in all situations.
References
Balducci, L., & Colloca, G. (2020). Natural disaster and rationing of care. Journal of Geriatric Oncology, 11(5), 750-752. Web.
Gibbens, S. (2019). Hurricane Katrina, explained. National Geographic. Web.
Iwai, Y., Holdren, S., Rosen, L. T., & Hu, N. Y. (2022). Narrative trajectories of disaster response: Ethical preparedness from Katrina to COVID-19. Medical Humanities, 48(2), e8. Web.
Jan, A. N., Muralidhara, G. V., & Kumari, S. (2021). Ethical dilemmas of decision making in a crisis: Tragedy at Memorial Medical Center, New Orleans. IUP Journal of Organizational Behavior, 20(4), 455-473.
Witter, B. (2022). Dr. Anna Pou is still practicing medicine after facing murder charges. Bustle. Web.
Wynia, M. K. (2020). Crisis triage — Attention to values in addition to efficiency. JAMA Network Open, 3(12). Web.
