I find myself still trying to come to terms with the article from the August 30th New York Times Magazine, about the “deadly choices” at Memorial Hospital in New Orleans after Hurricane Katrina struck. In that hospital a number of people were given lethal doses of morphine and the sedative midazolam, in what appeared to be a mass mercy killing of those who were felt to have the fewest prospects for rescue and recovery.I try to imagine working three days straight with little sleep, no electricity or waste disposal, looting in the streets outside and feeling abandoned by government at all levels. In spite of all that, I still come to the same conclusion: what they did was wrong.I have spent years doing palliative care. This was not Hospice care, nor the “double effect” of narcotics–most of the patients were not actively dying and several weren’t even on pain medication before the lethal doses were given. This occurred about 3 days after the storm, not a week or two in. The other patients were evacuated shortly afterward. This was, at best, euthanasia without knowledge or consent; at worst, homicide. I think the Grand Jury dismissal simply reflects a city that was too beaten down to be outraged anymore.Interestingly, the thing that disturbs me the most was that the doctors used a DNR document as their primary triage point to decide who would be evacuated first and who would ultimately die. This shows a total lack of understanding of advance directives. The choice to accept or decline heroic (and often low-yield) attempts to prolong one’s life on some future date often has no relationship to the current health status of the person in question.Actions like this are not only unethical–they also fuel people’s concerns that scant resources will lead physicians to make such arbitrary decisions down the road. One can see how the “death panel” fears can get traction when reading a story like this.