September 2007. As the floodwaters were rising in the days after hurricane Katrina, the situation went from bad to worse at Memorial Medical Center in New Orleans. When the electricity failed, flashlights became necessary to carry out simple tasks. There was no running water. Human sewage streamed through the hospital corridors. Many patients could not be evacuated, were crying out, and suffered greatly in the stifling heat. Much of the medical staff had already left. The few who remained began to think they might never be rescued.
The conditions were “less than third world,” according to Dr. Anna Maria Pou, who was accused of administering lethal doses of morphine and another sedative to nine patients in the hospital. Many who have learned of her actions have called her a hero, believing she was motivated by true compassion. Louisiana’s Attorney General, however, after consulting with a panel of medical experts, concluded that she perpetrated a multiple homicide.
While the debate continues as to what Dr. Pou did or did not do, compassion and heroism should never be confused with intentionally overdosing patients or loved ones in order to end their lives. The act of directly taking innocent human life is always incompatible with true compassion.
Upon further examination of the facts of the case, experts have suggested that Dr. Pou was not simply managing the pain of her patients by providing them with a medically indicated dose of morphine. Dr. Cyril H. Wecht, past president of the American Academy of Forensic Sciences, was one of the five experts brought in by the state of Louisiana to analyze the deaths. He described the situation this way: “The complete hospital records, autopsy protocols and postmortem toxicological analyses of the nine patients who died were thoroughly reviewed by several highly experienced forensic pathologists, a toxicologist and other medical experts. We unequivocally concluded that the cause of death in all these cases was acute combined drug toxicity and that the manner of death was homicide.”
These same experts also concluded that the possibility of the deaths being due to a tragic medical mistake was statistically unlikely. “Accidental overdoses would need to have occurred nine times between 12 noon and 3:30 p.m., all on one floor, to every patient who was left on the floor,” observed Dr. John Young, former president of the American Academy of Forensic Sciences. After looking into the matter, however, a Louisiana grand jury nevertheless chose not to indict Dr. Pou following a series of closed-door hearings.
In looking at this case, it seems that many have hesitated to call a spade a spade. When I participated in a radio interview recently on this topic, a number of listeners were aghast at what Dr. Pou had allegedly done. Two people, however, called into the show to defend her, and I believe their comments were representative of how many people think about cases like this. “I commend Dr. Pou,” one of the callers said, “for her courage and compassion towards those terminal patients who more than likely wouldn’t ‘survive’ the horrid conditions they were in anyway due to an ‘act of God,’ not man. By looking at her patient's condition and the circumstances around her, she did what needed to be done, keeping her patients comfortable and easing their suffering. I pray that if I were ever in their shoes, I would have a doctor as conscientious and compassionate as Dr. Pou.”
To understand the moral argument in this case, however, it is important to grasp the distinction between killing and allowing to die. It is also important to understand the real meaning of the word compassion.
“Compassion” has a Latin origin meaning “to suffer together with another.” To be compassionate, in the proper sense of the term, means to take another’s pain and suffering upon ourselves, onto our own shoulders, so that we suffer with them in some way. We seek to be present to them, and accompany them in their trials and tribulations as best as we are able.
True compassion as the flood waters were rising would not mean pulling a massive dose out of the vial, looking the person in the face, in their weakness and fear, and thrusting a needle deep into their skin or into their IV tube to cause the light in their eyes to falter and go out. That is not mercy or compassion, and to call it such is a lie. Mercy and compassion would rather seek to care for each patient in the face of difficulties, trying to move them to a higher floor if the waters were rising, and if that were impossible for some reason, then to sit attentively at their bedside, holding their hand and making them as comfortable as possible. True compassion would mean praying with them, perhaps crying with them at times, but above all remaining in solidarity with them as they prepare for what might be their last moments of life on earth.
When natural disaster strikes, we do not abandon those in our care, or ignore them, or betray them by taking their lives in the name of a false and violent compassion. Human beings are not like horses or other animals, needing to be shot when they break a leg or suffer a misfortune. The reason for this is that our pain and suffering have a redemptive purpose and a deeper meaning for each of us, as well as for those around us. Showing true compassion towards those who suffer ends up transforming both us and them in deep and ennobling ways.
For doctors and health care workers who have been entrusted with powerful tools over life and death, this truth is central to their identity. More than two thousand years ago, the renowned physician Hippocrates stressed this when he said: Primum non nocere (First, do no harm). The truly compassionate doctor will strive to use his tools and medicines to attend to the medical needs of his patients, humbly recognizing that those tools may not be able to stave off death in every case. He may have to step aside as the shadow of death draws near and the mortal existence of the person he has been tending to comes to its natural close.
Above all, the compassionate physician can never violate his inner being and identity by becoming one who directly kills others, especially those who, in their most needful and fragile moments, find themselves entrusted to his care.
Rev. Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, MA, and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org