The two drugs that investigators say were used to euthanize patients at a New Orleans hospital -- morphine and Versed -- are powerful painkillers whose doses must be carefully monitored because of their potentially lethal effects, particularly when used together.
Morphine is an opiate narcotic. It is lethal in high doses because it blocks the signals from the brain that tell the lungs to breathe, leading to death from a lack of oxygen.
The effect is often observed during anesthesia for surgery, said Dr. Robert Kaufman, an anesthesiologist at UCLA Medical Center. "Patients frequently are quite comfortable. They simply don't care if they breathe or not," he said.
If the anesthesiologist doesn't intervene to restore breathing, such patients will die.
Versed, a member of the same class of drugs as Valium, is a sedative commonly used to calm patients before surgery. It also depresses breathing, although not as powerfully as morphine. The two drugs together can act synergistically, however.
It would most likely be given to ensure that the patient was asleep when breathing stopped, Kaufman said.
Both drugs are widely dispersed to tissues throughout the body and, upon death, would no longer be metabolized. Traces of their presence could thus be found in the tissues for weeks to months after the death.
Dr. David Goldstein of the Keck School of Medicine of USC said he was stunned by the allegations that a doctor and two nurses employed by Tenet Healthcare gave lethal injections to some patients at a LifeCare Holdings facility at Memorial Medical Center in New Orleans.
"The Katrina situation was so unbelievably unusual in the United States that it is a wholly unique moment," he said. Even so, he said, "you couldn't easily come up with a justification" for the alleged euthanasia.
There is only one setting where a physician could ethically and morally shorten a patient's life, said Goldstein, who is co-director of the USC Pacific Center for Health Policy and Ethics: "In the care of patients in the terminal stages of life, physicians will say, 'I can give you medicine that will relieve your suffering, but it could shorten your life. Would you want me to do that?' "
If the patient says yes, Goldstein said, the question and answer would be recorded in the patient's chart, as would the administration of the drugs. There would be no reason to deny it because such action is permissible in most states.
Whether or not the patients in this case had a "do not resuscitate" order was irrelevant, he added. Such an order says the physician should not take extreme measures to revive the patient if his or her heart and lungs stop working, "but it doesn't mean you can hasten their stoppage."