Internet Journal of Law, Healthcare and Ethics

On July 18, 2006 Dr. Anna Pou, a surgeon and respected medical school professor, and two nurses, Cheri A. Landry and Lori L. Budo were arrested on suspicion of second degree murder. Charles C. Foti, the Louisiana Attorney General, accused them of using lethal injections to kill four elderly patients at Memorial Medical Center in New Orleans in the aftermath of hurricane Katrina. The case has been turned over to the Orleans Parish District Attorney, who will present it to a grand jury before deciding whether to bring charges. Thirty-four patients died at Memorial Medical Center as a result of hurricane Katrina and this has led to intense speculation about how some of them died. According to newspaper accounts many of the patients were evacuated from the hospital, which was surrounded by five feet of water, had no electricity, dwindling food and medical supplies and was baking in 100-degree-plus heat. The sickest, however, were left behind. “The four victims were actually patients of LifeCare Hospital, an intensive-care unit that leased space from Memorial Hospital and had a separate staff. With chaotic evacuations taking place, many by boat, Dr. Pou and a Memorial Hospital official who has not been charged by Mr. Foti told witnesses that the LifeCare patients ‘were probably not going to survive,’ according to the affidavit released from the office of Attorney General Foti.” 1 The affidavit further states that the arrests grew out of accusations by four supervisors for LifeCare Hospitals. “As hopes for a full rescue seemed to fade on the third day after the storm, three of the LifeCare employees say that Dr. Pou told them she was going to inject a ‘lethal dose' into patients who seemed unlikely to survive. The affidavit goes on further to state that witnesses saw Dr. Pou and the two nurses fill syringes and go into patient's rooms.” 2 Medical tests revealed that morphine and another powerful sedative, Versed, were found in tissue samples of the four patients. Medical records show that none of the four patients had been receiving either drug in their regular medical treatment. 3 In reality, it appears there is little direct knowledge of what actually happened inside the rooms of these patients. The defense lawyers have questioned the credibility of the LifeCare employees. The company has acknowledged that 24 of its 55 patients died as a result of the storm, and that its top administrator and medical director were not present during these days. 4 The affidavit also suggests that many staff members at the hospital were familiar with Dr. Pou's plan and that it was openly discussed; and portrays witnesses as being barred by staff members from entering an area on the second floor where LifeCare patients were housed in the final days. 5 Again, much of this is speculation and has not been confirmed. Numerous medical, legal and ethical questions have arisen as a result of these findings. Were Dr. Pou and the two nurses scapegoats for the delays in evacuating the hospital? Were they scapegoats to cover-up the incompetence of the top administrators at LifeCare? Were Dr. Pou and the two nurses heroes for having volunteered for storm duty and remaining at the hospital for five days or are they criminals who took the law into their own hands and committed homicide? Was this an act of homicide or were the patients suffering and in need of high doses of pain medication for palliation? At the present time no one has been charged in the investigation. Investigators have subpoenaed more than 70 witnesses and are examining volumes of evidence. Lawyers for the three accused health care professionals argue that “the facts will reveal heroic efforts by the physician and the staff in a desperate situation.” 6 This situation comes down to determining whether the pain medication was given with the direct intention to ease the pain of these patients in a desperate situation or to directly terminate the patients. Unfortunately, according to New Orleans Coroner Frank Patient Deaths in New Orleans: Mercy Killing or Palliative Care? 2 of 5 Minyard, the bodies of the four patients were not retrieved from the hospital until two weeks after the storm and were in advanced stages of decomposition. This undermines the accuracy of toxicology tests. 7 Therefore, there are real questions about the reliability of the forensic evidence. This incident has prompted a national debate about mercy killing and the role of physicians in hopeless situations. Was this an example of medical professionals attempting to “play God” or was it a form of palliative care? This case hinges on knowing the precise facts of the case. One ethical principle that can be used to understand this case is the principle of double effect. THE FUNCTION OF THE PRINCIPLE OF DOUBLE EFFECT The principle of double effect is a fundamental principle in Roman Catholic moral theology. As the name implies it refers to one action with two effects. One effect is intended and morally good; the other is unintended and morally evil. It is not an inflexible rule or mathematical formula, but rather an efficient guide to prudent moral judgment in solving difficult moral dilemmas. 8 Historically, many ethicists believe the premises for the principle can be found in the writings of Thomas Aquinas in his famous explanation of the lawful killing of another in self-defense in the Summa Theologicae II, q. 64, a. 7c. However, other ethicists argue that the four conditions of the principle were not finally formulated until the mid-nineteenth century by Jean Pierre Gury. 9 The principle of double effect specifies four conditions that must be fulfilled for an action with both a good and a bad effect to be morally justified. The action, considered by itself and independently 1. of its effects, must not be morally evil. The object of the action must be good or indifferent. The evil effect must not be the means of producing 2.

Peter A. Clark

The Internet Journal of Law Healthcare and Ethics

Patient Deaths in New Orleans: Mercy Killing or Palliative Care?

新奥尔良患者死亡：安乐死还是姑息治疗？

Is it medically and ethically appropriate to shorten and sterilize a six-year old girl to make it easier for her parents to properly care for her now and in the future? This is the question that confronted Seattle's Children's Hospital when the parents of a sixyear old girl named Ashley approached the Ethics Committee requesting approval for various procedures that would improve the quality of life of their daughter. Ashley, called the “pillow angel” by her parents, suffers from a developmental brain condition known as static encephalopathy. Her profound developmental disabilities and her inability to ambulate, provide numerous challenges for her parents and caregivers. If her growth could be permanently arrested while she was still small in stature, then according to her parents, the benefits would give Ashley a better quality of life and allow her parents to continue to care for her at home. The Ethics Committee recommended the procedure to keep Ashley small. High-dose estrogen treatments over the last two years both inhibited growth and rapidly advances maturation of the epiphyseal growth plates, bringing about permanent attenuation in size after a relatively short period of treatment. In addition to the high-dose estrogen treatment, physicians removed Ashley's uterus, to prevent potential discomfort from menstrual cramps and pregnancy in the event of rape, and removed her breast buds because of a family history of cancer and fibrocystic disease. Ashley also had an appendectomy for preventative reasons. This treatment has now been named the “Ashley Treatment.” The debate surrounding this treatment contrasts those who argue that the Ashley Treatment violates the child's human rights and is for the sake of convenience for the parents versus those who argue that this treatment is not only in the best interest of the child because it will provide a better quality of life but is also in the best interest of the parents and society as a whole. Determining whether this treatment is in the best interest of the child is both a medical and ethical issue because substantive questions have arisen about this procedure. Are there uses of medical technology that are inconsistent with respect for the human person? If the Ashley Treatment becomes widely accepted, could this lead to the use of more controversial procedures that might reduce the size or reproductive capacity of other vulnerable people? If this treatment becomes a part of standard medical practice, could it affect insurance coverage and rates? These questions are important because other families are contemplating the same procedure for their children.

Lauren Vasta

The Ashley Treatment: An Ethical Analysis

阿什利治疗：一项伦理分析

Bullying and harassment in the workplace is an old problem. According to the charted Institute of Personnel and Development (CIPD), over the last 20 years, organisations have moved from the perception that it does not happen here to acceptance that it does and the introduction of policies to address the problem. Work place bullying and harassment have been recognised in all sectors of the workforce, particularly in a hospital's setting.

Al-Daraji Wi

An old problem that keeps re-emerging without a clear solution

一个反复出现且无明确解决方案的老问题

Embryo Donation/Adoption: Medical, Legal and Ethical Perspectives

胚胎捐赠/收养：医学、法律和伦理视角

Jill R Friedman

David W Crosson

Matthew Fadus

Concierge Medicine: Medical, Legal and Ethical Perspectives

礼宾医疗：医学、法律和伦理视角

The vaping epidemic has gripped the youth of the nation and is negatively impacting both personal and public health.Millions of young adults, youth and even adult smokers have been subjected to the risks of vaping without being fully informed.Various Ecig companies' practices directly led to widespread use of their product among youth populations.Recently, more than 2,172 cases of vaping associated lung injury have been reported with 37 deaths and counting.Other than the fact that E-cigs containing both THC and nicotine were used by these patients, the cause is unknown.This paper aims to address the medical, legal and ethical implications presented by the vaping epidemic.To this end, it explores the current state of vaping, as well as the history behind it.Followed by an evaluation of the medical and pharmacological effects vaping has on individuals.The ethics of vaping in relation to both society and the individual will be discussed in the context of the goals of tobacco regulation and public health.We will then address the legality of E-cig companies' policies in regard to product design, advertising, and effective regulation of E-cigs.The risk of vaping is severe, and many are uninformed regarding the contents and risks of their E-cigs, partly due to the practices of E-cig companies.The company JUUL will be referred to often as a standard for the industry since it is the most popular and well-known E-cig brand among youth.

P Clark

J Nguyen

S Zheng

T Jenkins

R Cramer

O Nguyen

The Internet Journal of Law, Healthcare and Ethics

互联网法律、医疗保健与伦理期刊

In 2012, New York City passed a health code provision requiring that religious Jewish circumcisers, Mohelim, keep on file a signed parental consent that explains the position of the New York City Department of Health and Mental Hygiene ("the department") concerning risks of Metzizah be'Peh "with direct oral suction" (MBP).In MPB, the Mohel, a religious practitioner, very briefly places his mouth with wine on the wound to suck away a small amount of blood.The department claims this activity is responsible for a small number of cases of herpes simplex virus (HSV) in infants.This article reviews the department's claims, as well as the claims of its challengers, and applies five secular public health ethical constructs to the department's actions.After the analysis, the article concludes that the department has not made an ethical case to impose regulations on this religious practice.

Akiva Turner

Metzizah Be’Peh: Public Health Ethics and an Attempt to Regulate Religious Circumcision

Metzizah Be’Peh：公共卫生伦理与规范宗教割礼的尝试

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Internet Journal of Law, Healthcare and Ethics

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Patient Deaths in New Orleans: Mercy Killing or Palliative Care?

The Ashley Treatment: An Ethical Analysis

An old problem that keeps re-emerging without a clear solution

Embryo Donation/Adoption: Medical, Legal and Ethical Perspectives

Concierge Medicine: Medical, Legal and Ethical Perspectives

The Internet Journal of Law, Healthcare and Ethics

Metzizah Be’Peh: Public Health Ethics and an Attempt to Regulate Religious Circumcision

Concierge Medicine: Medical, Legal and Ethical Perspectives

An old problem that keeps re-emerging without a clear solution

Embryo Donation/Adoption: Medical, Legal and Ethical Perspectives