Hippocratic ethic of preserving life

The Hippocratic ethic of preserving life holds that medicine’s defining commitment is to protect life, not to bring about death—even when a patient is suffering, a crisis narrows the available choices, or a clinician believes death may be near. In the book, this tradition is both a historical boundary between curing and killing and a demanding standard against which actions at Memorial Medical Center during Hurricane Katrina are judged. Its force lies not in offering an easy answer to every emergency, but in insisting that intention, professional duty, and the treatment of each patient cannot be collapsed into a calculation of which outcome seems most efficient.

Origins and the boundary of medical practice

The account locates this ethic in the Hippocratic tradition, including the oath associated with the refusal to give a lethal drug even when asked. The rule marks a distinction between medicine that treats illness and medical knowledge used to cause death. By making that distinction part of professional identity, the tradition places a limit on what a physician may do, rather than treating every requested or apparently merciful act as an acceptable extension of care.

The book develops the boundary through Margaret Mead’s interpretation of ancient Greek medicine, as recounted by Maurice Levine. Mead described the separation of healing from killing as a decisive change: in her account, earlier traditions could unite the power to cure with the power to kill, while the followers of Asclepius were committed to life regardless of a person’s rank, age, or perceived worth. That breadth matters. The ethic is not simply a promise to save patients judged likely to recover; it rejects making a patient’s social standing or intellectual capacity a measure of whether that life merits medical protection.

Mead also warned that society might press physicians to use their skills to end lives considered defective or burdensome. Her argument makes the ethic institutional as well as individual: the physician’s commitment to preserve life may need protection from public demands, not only from personal temptation. The book sets this position beside the real difficulty of care when suffering is severe and resources are strained, without suggesting that the historical principle by itself resolves every question about treatment or dying.

Historical tests under pressure

The principle is tested against episodes in which compassion, military necessity, and the preservation of life appear to conflict. In 1799, during the plague among Napoleon Bonaparte’s troops in Jaffa, Napoleon proposed that suffering patients be given an overdose of opium, saying he would want the same treatment himself. The army’s chief medical officer, René-Nicolas Dufriche Desgenettes, refused. His stated professional duty was to preserve life; he also recognized that some patients might survive.

The danger became more immediate less than two weeks later, when Turkish troops approached and Napoleon ordered that hospital patients too weak to retreat be poisoned with laudanum. Desgenettes again refused. The chief pharmacist administered the drug instead, apparently in an insufficient dose; Turkish troops later found patients alive and protected them. The episode gives the ethic a concrete test: the pressure of war did not make Desgenettes accept a physician’s role in deliberately ending patients’ lives. It also complicates any claim that apparent proximity to death makes survival impossible.

The account contrasts this professional boundary with the nineteenth-century campaign by non-physicians who argued that anesthetic drugs might be used not only to relieve the pain of dying but to hasten death. Many doctors opposed that proposal, partly because they feared it would erode public trust. The dispute clarifies a central distinction in the ethic: allowing an illness to take its course was understood as different from actively causing a patient’s death. That distinction later becomes crucial to the book’s examination of palliative care and the decisions made in a disaster.

Emergency care at Memorial

At Memorial Medical Center, emergency conditions put ordinary professional roles and procedures under strain. As floodwaters threatened the hospital and staff anticipated power failure, Susan Mulderick’s hastily assembled command meeting took on, in Karen Wynn’s account, the character of a military operation. Nearly two hundred patients needed safety. Staff discussed moving patients most dependent on life support or mechanical assistance first, including intensive-care patients, newborns, high-risk pregnant patients, dialysis patients, and bone-marrow-transplant patients vulnerable to infection if power failed. This was an attempt to protect life through prioritization, but it also placed difficult judgments about urgency and order at the center of care.

The neonatal evacuation shows that preservation required more than getting patients onto an aircraft. When the last group of critically ill babies was prepared to leave, their helicopter had a flight plan to a hospital west of Baton Rouge rather than the hospital expected to receive them. Richard Deichmann told the nurses that the babies could go wherever the pilot was headed. The nursing director refused to release them unless the pilot obtained approval to fly to Baton Rouge, where the intended hospital was located. Approval came within minutes. A later message confirmed that all the babies had arrived, including the infant whose oxygen level matched its earlier reading on high-tech equipment. The episode presents nurses asserting responsibility for the continuity of care against a hierarchy that ordinarily placed physicians above them.

The investigation later exposed a different and more troubling tension between comfort and hastened death. In her interview, Mulderick said that her discussions about medication concerned palliative care and comfort, not accelerating death. The interview indicated that the idea of medicating patients on the Thursday in question came from her; at the same time, pharmacy prescriptions showed that Ativan and other ordinary comfort drugs had already been prescribed for those patients by Anna Pou and other doctors during the disaster. Those facts complicate the suggestion that the medications needed to be introduced to Pou as a new means of providing comfort. They do not, by themselves, settle the question of intent, but they sharpen the distinction at the heart of the ethic: relieving distress and deliberately causing death are not interchangeable aims.

Accountability and the aftermath

Richard Deichmann’s colleague Horace Baltz applied the ethic directly to Memorial’s response. In a letter after Ochsner Health System purchased Memorial and partly reopened it under the Baptist name, Baltz rejected the idea that simply serving during a disaster was extraordinary valor. He defined genuine professional courage instead as opposing euthanasia, securing narcotics and sedatives, removing DNR orders, discouraging nurses from carrying out orders that would ordinarily have been rejected, confirming safe destinations for evacuees, and holding hospital leadership accountable. He argued that the crisis was not unique to Memorial, but that its reactions were troubling; blaming governmental abandonment, in his view, could not excuse corporate neglect or disregard for law and ethics inside the hospital.

The book also shows that the moral consequences did not end with the evacuation or the investigation. Gina Isbell continued to have nightmares about her patients, felt guilty about the staff she had selected to work during the storm, and grieved for patients who died. Karen Wynn found that legal preparation and discussion of the events could make her feel as though she was reliving them; she recognized symptoms of post-traumatic stress in herself and colleagues and no longer wanted the responsibilities of nursing management. These accounts do not establish a single verdict about every action taken at Memorial. They show instead that professional duty, perceived responsibility, and later suffering remained entangled for those who had worked through the crisis.

John Thiele’s later account offers another perspective on the ethic’s distinction between a poor prognosis and the certainty of death. After becoming critically ill himself, he experienced a prolonged period of sedation and later described frightening dreams. A nurse who had worked at Memorial believed he seemed remorseful about the patients he had injected, but Thiele rejected that interpretation and remained confident in what he had done. He nevertheless drew a sharp distinction between his condition and those of some Memorial patients: although his chances of survival seemed poor, he considered his problems potentially reversible. For him, the possibility of recovery was decisive. His reasoning brings the ethic’s hardest question into focus: whether a grim prognosis is enough to withdraw the presumption of continued treatment, or whether the possibility of recovery obliges clinicians to keep treating.

Significance

The Hippocratic ethic of preserving life supplies the book with a durable measure of professional responsibility, but not a simple formula for disaster medicine. Emergency triage may require patients to be moved in an order shaped by dependence on equipment and vulnerability; palliative care may properly aim to relieve distress; and evacuation can itself expose patients to danger. The tradition insists that these decisions be distinguished from an intention to cause death and that a patient’s life not be dismissed because of age, status, disability, or an uncertain prognosis.

Its narrative significance is therefore argumentative as well as historical. The book places an old professional boundary beside a modern hospital crisis, where command structures, improvised rescue, medication, and institutional accountability collide. Desgenettes’s refusal, the nurses’ insistence on a safe destination for the newborns, Baltz’s demands for accountability, and the lasting distress of staff illuminate different dimensions of the same obligation: preserving life is not only a matter of medical technique, but a standard for how clinicians and institutions exercise authority when ordinary protections fail.