Louisiana Living-Will Rule

The Louisiana Living-Will Rule provided a way for patients with a terminal and irreversible condition to request in advance that life-sustaining procedures be withheld or withdrawn. During the crisis at Memorial Medical Center, the rule’s limits mattered: a living will and a do-not-resuscitate order addressed different decisions, but confusion between them shaped how some patients were ranked for evacuation.

Definition and Scope

A living will was an advance request concerning life-sustaining procedures for a patient with a “terminal and irreversible condition.” The rule thus concerned treatment decisions in that specified condition and allowed the patient to state a preference before the relevant decision arose. It was not the same as a DNR order, which meant that a patient whose heartbeat or breathing had stopped should not be revived.

The distinction was part of a broader framework for patient choice. A DNR order was signed by a doctor and almost always rested on the informed consent of the patient or a health-care proxy. Informed consent, established in the United States beginning in the 1950s, was intended to protect patient autonomy in medical decisions amid a history of abuses. It required doctors to disclose the nature, risks, benefits, and alternatives of proposed interventions. Neither that framework nor the living-will rule made a DNR order a general instruction to stop treatment or to forgo rescue.

Confusion with DNR Orders at Memorial

As floodwaters threatened the hospital, Memorial doctors made an exception to their general plan to evacuate the sickest and most machine-dependent patients first: all patients with DNR orders were to go last. Four DNR patients were in the intensive-care unit, including Helen Breckenridge and Jannie Burgess. The decision gave a resuscitation instruction a consequence beyond the circumstances it covered, turning it into a criterion for evacuation priority.

Richard Deichmann later explained that he thought the law required a patient with a DNR order to have a certified terminal or irreversible condition. He believed DNR patients should go last because, if disaster struck, they had the “least to lose.” Other doctors accepted the plan for different reasons: Bill Armington said he thought patients who did not want their lives prolonged by extraordinary measures would not want to be saved at others’ expense. But neither the DNR orders nor Memorial’s disaster plans said that patients should be left behind or evacuated last. The rule’s actual distinction between a DNR order and a living will therefore stands in sharp contrast to the broader assumptions attached to DNR status in the evacuation meeting.

Significance in the Evacuation

The rule itself addressed advance choices about life-sustaining procedures; it did not establish a disaster triage policy. At Memorial, however, a mistaken understanding of the legal relationship between DNR orders and terminal conditions helped justify placing DNR patients at the end of the evacuation sequence. The distinction was not merely technical: it separated a limited instruction about resuscitation from assumptions about a patient’s prognosis, treatment preferences, or willingness to be rescued.

The ensuing transfer of Breckenridge downstairs made the consequence visible. A doctor ordered her brought back up because she could not go in the first sweep, despite her dependence on hand-assisted breathing and battery-powered pumps. The scene exposed how a legal category intended to record a patient’s treatment preference could be used, in a crisis, to assign a different meaning to that preference—one that the rule and the orders themselves did not supply.