Flutterby™! : Medical care, triage and journalism 2009-08-28 17:44:56.169926+00

Medical care, triage and journalism

2009-08-28 17:44:56.169926+00 by Dan Lyke 5 comments

So there's a New York Times article looking at procedures during the Hurricane Katrina aftermath at a New Orleans hospital. Seems like a slightly biased against the doctors account of medical professionals doing the best they can in horrific circumstances, with what feels like a little attempt at stirring up some public outrage at doctors who apparently used morphine to hasten the deaths of those they felt they couldn't save.

This same article was published over at ProPublica, and was apparently partially funded by that organization. Not sure what that means yet.

The MeFi thread that links to this article has a number of interesting comments, including one that takes the author of the article to task for a bunch of interesting omitted information.

And for bonus linkies, I haven't delved in to this nurse's LiveJournal account of being on duty during and after Katrina yet.

#Comment Re: made: 2009-08-29 18:07:05.040739+00 by: m [edit history]

One of the more eye opening events of personal experience is being present during a public interview on a scientific topic on which one is knowledgeable, but have no stake. Then seeing how various reporters (sometimes coming with the appellation science journalist) and popular article writers do great violence to the statements of the expert speaker.

When issues become emotional, the reporting gets worse. I have observed this as well. Sometimes the stories written by different journalists sounded like different occurrences. Sometimes so great a disparity existed between what was written and what I observed, I wondered if any of the writers and/or I were present.

A lot of the sentences in some of the information presented could be parsed in a number of ways to a variety of antithetical meanings, without even considering the possibility of misinformation or outright prevarication. One term that a few sources bandy about is "homicide". In general deaths are natural, self-inflicted, accidental or the result of homicide. Homicide comes in a large variety of flavors including amongst others, unintended, justifiable, and intentional. Each of these come in a variety of subcategories. Each State gets to define what the term homicide means, and what its varieties include. The law, by its very nature, is always open to reinterpretation of such meanings through written black letter law, case law, and patterns of practice.

There seems to be little fact available that all sources agree upon. What I find most startling about this case is the failure of the DA to obtain an indictment. DAs usually have very high success rates with Grand Juries. So high that many States are considering eliminating Grand Juries as the arbiter of indictment. Knowing nothing about Louisiana Grand Jury practice, batting averages, history or politics, I find three possible conclusions. First, that there was absolutely no case whatsoever. Second, that there was a case, but the DA blew it through incompetence. Third, that the DA failed intentionally whether there was a case or not. Anybody have any other ideas as to the meaning and relevance of the failure to get an indictment?

The case opens interesting questions, but America generally can not decide upon the ethics of assisted suicide for the terminally ill. It is hardly ready for a discussion of possibly consensual or non-consensual euthanasia -- in the full meaning of the term consensual. We have yet to resolve the use of analgesics to relieve suffering in individuals where there is almost no risk of any untoward result. Indeed, we seem to be regressing on that issue.

I think there's a line between euthanasia and ending suffering. Depending on the situation, the doctors may not have crossed this particular line. Having only one side of the argument, and the media (who usually only introduce facts that support their side of the argument) may not be providing the entire story to let the reader judge for themselves.

Sometimes not setting a case precedent by allowing people to be prosecuted under blind laws is a powerful statement in and of itself. Letting the average person get emotionally tied up in a jury trial in a case they have no real understanding of or comprehension of (medical and technology cases come to mind) can be very dangerous in determining laws that will form the future of how medical care can be performed.

If I'm in a situation where I will die after hours of suffering, or die quietly due to a morphine overdose within a few seconds, leave me option number two... don't make the doctor even more scared of litigation after the fact by armchair quarterbacks and people who don't understand the gravity of the situation. Not having the full details of everything that happened though, I'm awaiting the strong possibility of having to taste my own shoe leather in the near future though.

I can't see your next meal being tough to chew JT, I agree with everything you just said, both for what I would want personally and also for the ethical standard at the societal/governmental level. No one can base their opinions on facts or information as yet not disclosed, but only on the information available. If it turns out that there was indeed some death cult amongst all the medical staff involved (terribly unlikely), then my opinion of the particular case might change, but my general belief of the appropriate behavior would remain the same.

m, it doesn't have to be a public interview on a scientific topic, it can be something as mundane as entertainment. Being at Pixar during the Toy Story release and watching the reviews and articles float in from around the world, many of which could only have been rewritten from press releases, and seeing all the inaccurate information and typos introduced, was extremely instructive.

In this case the article has some huge gaps and presumptions and I'm amazed that it got past the editors at the New York Times, although it does reinforce that perhaps Judith Miller and Jayson Blair weren't outliers.

However, whatever the breathless ax-grinding of the author of the article, I'm hoping that tales like this will foment both some discussion on disaster preparedness and on triage and euthanasia. On the latter, yeah, I've no desire for a prolonged painful death, and I think we need more discussion of the mercy that doctors and nurses sometimes do but that's one of those dirty little secrets because life is sooooo precious.