Bioethics in Brief is a newsletter of the Center for Bioethics and Humanities, committed to promoting clinical health care and health policy which is patient-centered, compassionate, and just. Opinions expressed in the newsletter are those of the authors and do not represent the position of the Center.
Why Treat a Baby Killer?
"Moments after the helicopter landed at Upstate University Hospital, Adam Theall was brought into the emergency room with at least 14 state police bullets in his body. Troopers say they watched Theall aim a shotgun at his 3-month-old son, shoot and kill the boy, and then turn the gun on police. The troopers responded by firing. Theall’s condition was critical. He needed immediate medical intervention. And so, a team of doctors and nurses was faced with an ethical question that every medical professional must face at some point in his or her career: How does one put aside personal beliefs to save a life, knowing the patient landed in their care because of his or her own alleged abhorrent deeds?”
—Syracuse Post-Standard, June 27, 2010
Do some people, because of their alleged crimes or because they are regarded as hostile or threatening to society, such as prisoners, undocumented immigrants, the criminally insane, or even enemy soldiers, simply not deserve medical treatment? Or should doctors, nurses, and others on the clinical team treat everyone regardless of whom they are or what they have done? When a person comes to the emergency department in need of immediate medical attention, the reflexive response is to take care of the problem, few questions asked, except as they relate to the medical emergency. Our personal feelings are suspended. Why is this?
The first reason is this is the way we have been taught. We do not reason whether this or that person does or does not deserve medical care. We see a problem and try to fix it. Behind whatever conditioned response we may have is the ancient principle, connecting us to the Hippocratic tradition nearly 2,500 years ago, of treating every patient the same, without qualification for whom that person is. We are enjoined to put the patient first and treat all patients with compassion, no matter how they differ from us.
Other reasons are embedded in law and international agreements. Prisoners, regardless of crime or severity of sentence, have the legal, as well as moral, rights to appropriate medical care. The Geneva Convention requires that prisoners be treated humanely (Article 13) and receive the medical care they require (Article 30).
These rules do not erase the dilemmas for medical professionals that are created by patients for whom we have ambiguous or antipathetic feelings. Might a physician have second thoughts about treating a person who had most certainly committed a horrendous act? Might a nurse in a field hospital in Afghanistan wonder whether the enemy soldier she is caring for has killed or injured U.S. soldiers, perhaps the very U.S. soldiers that are in adjacent beds? On what basis should we make a decision not to treat—our own personal or political beliefs? Surely, then, we are poised above the familiar “slippery slope.”
Even if we follow the ancient and enduring principle that we should provide care for all patients who need it, regardless of our feelings about individual patients, there may be circumstances, generally involving the use of scarce resources, in which our feelings about certain patients might influence the decision of which patient to treat first. For example, who has operating room priority if two patients in the emergency department need urgent surgery, one an ordinary citizen injured in an automobile crash, the other a person who was observed to commit a horrendous act? Or who gets the endotracheal tube in a field military hospital where such tubes are in short supply?
Our behavior in addressing these situations is guided by ethical principles, by how we have been taught to behave, and by law, but we still may be troubled and have questions. Some dilemmas are vexing and beg discussion, among our colleagues and perhaps with one of the ethics consultants, available seven days a week to students, faculty, and staff throughout Upstate.