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Ethical Decision-Making During a Disaster
Do you agree with the life-and-death choice made by the medical staff of one New Orleans hospital in the desperate days after Hurricane Katrina?
Sheri Fink
Publish Date: May 25, 2016
OR Excellence
Sheri Fink, MD, PhD Sheri Fink, MD, PhD

Speaker Profile

  • Pulitzer Prize winner and New York Times bestselling author of the book, "Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital," a landmark investigation of patient deaths at a New Orleans hospital ravaged by Hurricane Katrina.
  • Also the author of the book "War Hospital: A True Story of Surgery and Survival."
  • Holds a medical degree and a doctorate in neuroscience, both from Stanford University.

The floodwaters of Hurricane Katrina marooned Memorial Medical Center in Uptown New Orleans, literally cutting the hospital off from the world and stranding hundreds of people at the hospital for 4 days. The hurricane knocked out power and running water, and sent the temperatures inside above 100 degrees. As the floodwaters rose and the fear and anxiety heightened, exhausted caregivers had to make agonizing life-and-death decisions. Which patients should be rescued first by Coast Guard helicopters? Which should be rescued last, if at all? And could doctors and nurses hasten the death of certain patients?

Of the 45 corpses mortuary workers eventually carried from Memorial, an investigation months after Katrina suggested that more than 20 patients may have died because some medical and nursing staff intentionally hastened the deaths of critically ill patients with lethal doses of morphine or the sedative midazolam, believing they wouldn't survive. Nearly a year after Katrina, a physician and 2 nurses were arrested for second-degree murder in connection with the deaths of 4 patients. (Charges against the nurses were later dropped, and a grand jury chose not to indict the physician.)

Hear from Sheri Fink, MD, PhD, the Pulitzer Prize Winner and author of the bestselling book "Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital," the culmination of 6 years of reporting into what happened in those desperate days at Memorial. In her OR Excellence presentation, Dr. Fink will take you inside a hospital fighting for its life and into a conversation about the most terrifying form of healthcare rationing. Dr. Fink will also challenge you to make ethical patient care decisions in high-stress situations, to make tough choices under circumstances you hope you'll never experience but for which you need to be prepared.

  • Disaster preparedness. The doctors and staff at Memorial had drilled for disasters, but for scenarios like a sarin gas attack, where multiple pretend patients arrived at the hospital at once. Never had they drilled for the simultaneous ravages of a hurricane and flooding. Memorial was situated on one of the low points in the bowl that is New Orleans, 3 feet below sea level, but amazingly nowhere in its hundreds of pages of emergency preparedness plans was there a plan for evacuating over water.
  • Book - Five Days At Memorial
  • Disaster-plan around your vulnerability. Yes, it's hard to grapple with worst-case scenarios, but my argument is we need to think about those and plan realistically. For example, Memorial's main emergency power transfer switches were located only a few feet above ground level, leaving the electrical system vulnerable to flood waters. This was a big infrastructure vulnerability. A major flood would certainly result in the hospital losing all power, yet they failed to fix that vulnerability or plan for the reality of it.
  • What's your vulnerability? What's the vulnerability in your area: hurricanes, earthquakes, tornados, terrorist attacks or pandemic influenza? Plan around what are the likeliest of the unlikely scenarios that can hit you. You need to know what is the problem in the place where you work. Memorial was not prepared when Hurricane Katrina hit.
  • Healthcare Ethics 101. I'm going to ask tough questions to help prepare attendees for ethical decision-making during high-stress situations. Should lifesaving interventions, including evacuation, go to the sickest first? Doctors at Memorial decided that the sickest individuals in the hospital — including all patients with Do Not Resuscitate orders — were to be evacuated last, an idea that was nowhere in the hospital's disaster plans. Is it ever okay to euthanize a patient if there's reason to think the patient won't survive a disaster situation? Which patients should get a share of limited resources, and who decides? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them? The more that we think about things in advance, the better the chance we can deal with them in the moment.
  • You hold the power. Preparedness can be divided into 3 levels: infrastructure, organization and individuals. Everybody is a leader in some way. You may not be able to influence building structure, but you do have influence over how your organization responds and how you respond. You have the power to make a difference, to become a champion of preparedness. OSM