September 14, 2012

Pulitzer Prize-winning Journalist Fink Discusses Ethics in an Emergency at Academic Convocation

Emmanuel College officially opened the 2012-2013 academic year on September 11th with the celebration of Academic Convocation in the Jean Yawkey Center Gymnasium. Members of the Class of 2013 donned their graduation robes for the first time, in recognition of their status as seniors. Dr. Sheri Fink, Senior Fellow at the New America Foundation in Washington, D.C. and the Harvard Humanitarian Initiative at Harvard University in Cambridge, Mass., delivered the keynote address, discussing ethics in times of emergency and the moral issues raised in her story "The Deadly Choices at Memorial," for which she won the Pulitzer Prize in Investigative Reporting in 2010. The article, co-published by ProPublica and The New York Times Magazine in August 2009, served as the College's summer reading selection for incoming first-year students, along with Dave Eggers's Zeitoun. Emmanuel's Vice President of Academic Affairs Dr. Joyce De Leo introduced Dr. Fink.

Dr. Fink spoke of the ethical decisions made by the staff at Memorial Medical Center in New Orleans in the days after Hurricane Katrina, when conditions at the hospital turned desperate. Due to power failure, the staff was unable to provide anything more than the most essential care, and a ranking system had to be assigned regarding which patients to evacuate first: the healthiest, strongest patients who had the greatest chances of survival? Or the most critical patients, who would likely not survive the 100-degree temperatures at Memorial for more than a few hours? The staff decided that babies in the neonatal intensive-care unit, pregnant mothers and adult intensive-care patients should get first priority and that all patients with "Do Not Resuscitate" orders should be evacuated last.

During the grueling evacuation process, the medical staff administered a high dose of a combination of morphine and benzodiazepines to sedate some of the most critical patients. In the end, around two dozen patients were injected and died that afternoon at Memorial Medical Center.

"The 'rule of double effect' is a Catholic theological principle that doctors in the U.S. embrace...it's considered permissible to give drugs with the goal of relieving pain, even if there's a risk that the patient might die," Fink said. "Should that patient die, the distinction between murder and ethical medical care would come down essentially to the intention of the person administering the drug."

While some nurses claimed they only intended to ease the pain of some of the sickest patients while they awaited evacuation, another doctor understood that the injections were a way to euthanize the patients not likely to survive the trip through the hospital's machine room and up the parking garage's metal steps to the helipad. He told Dr. Fink, "The goal was death. Our goal was to let these people die."

"Do disasters sometimes make it necessary to break ethical rules?" Dr. Fink asked. "Or do exceptional times call for exceptional commitment to our deepest moral values?"

She reminded Emmanuel's students that nobody is all good or all bad. "We are all very complex and baffling mixtures, and it really is a constant struggle throughout life to be those better angels... Thinking about these situations in advance, as you will do throughout this year, is one way to prepare to beat the toughest dilemmas."

Dr. Fink also stressed the importance of learning from history. She recounted her visit to Memorial Medical Center the day before Hurricane Isaac hit New Orleans in August 2012. She noted the patient rooms were empty, as the hospital had chosen to evacuate the hospital and close all but the intensive care unit in advance of the storm, "giving public officials and hospital workers a chance to do things better this time."

Dr. Fink encouraged students to use their time in college to become adults, to take responsibility for who they are and who they want to be, to be agents of change and to make their marks on the world.

"The secret is, there is no one right cause or passion, there are so many good things to do in the world," Dr. Fink said. "Your job is to discover what speaks to your hearts, what impassions you, what outrages you, what do you find just so unfair? If each one of us found that one thing and devoted some of our energies to fixing it, how much better would this world be?"

Dr. Fink has reported on health, medicine and science in the U.S. and internationally. Her stories have appeared in such publications as the New York Times, Discover and Scientific American and on Public Radio International's The World. As a staff reporter at the non-profit news organization ProPublica, Fink received the Pulitzer Prize in investigative reporting, a National Magazine Award in reporting, a National Headliner Award, a Sigma Delta Chi Award from the Society of Professional Journalists, and a Dart Award for excellence in coverage of trauma for "The Deadly Choices at Memorial." In 2010, Fink was the lead reporter and co-editor of "Rationing Health," a radio series on PRI's The World that examined healthcare rationing around the world. The series received reporting awards from the Overseas Press Club, Association of Health Care Journalists and Global Health Council.

Fink's book, War Hospital: A True Story of Surgery and Survival (Public Affairs, 2003) won an American Medical Writer's Association special book award and was a finalist for the Overseas Press Club and PEN Martha Albrand awards. Fink received her M.D. and Ph.D. from Stanford, and worked with humanitarian aid organizations in more than a half dozen emergencies in the U.S. and overseas. Fink was the recipient of a Kaiser Media Fellowship in Health from the Kaiser Family Foundation and a Public Policy Scholarship at the Woodrow Wilson Center.

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