Monday, 3 March 2008

The Case Of Dr Hootan Roozrokh

Back in January this year, beleaguered British Prime Minister Gordon Brown-Trousers announced his support for a new scheme that would allow doctors to remove organs from (hopefully) deceased patients without needing consent from either the patient or their relatives.

I assumed that the whole thing was yet another media stunt to divert attention from the ever-deepening vat of embarrassment in which his Government found (and still finds) itself. Indeed, in this somewhat sarcastic post, I likened the proposals to an ultimate recycling scheme, and pointed out that the National Health Service would not, by its own admission, be able to cope with the influx of spare parts if the farcical notion should ever be implemented.

I also said, "And what about the risk of patients being polished off before their time so their squishy bits can be recycled? Burke and Hare would look very tame indeed compared to widespread premature organ donation!" Human nature being as it is, it seemed like a natural - if not inevitable - extrapolation from the basic concept.

Little did I know when I wrote those words that something of the sort is already alleged to have occurred in California, USA. According to this gruesome story from CNN, "A respected California transplant doctor faces charges he hastened a comatose man's death to retrieve his organs -- a far-reaching case that could impact the nation's organ donation industry."

According to CNN, Dr Hootan Roozrokh is alleged to have brought about the premature death of 25-year-old Ruben Navarro by ordering the excessive use of drugs on February 3, 2006. Navarro had suffered from a debilitating nerve disease since the age of 9. Needless to say, Dr Roozrokh denies the charges against him, which include one of "dependent adult abuse" for allegedly administering excessive amounts of a drug cocktail that included morphine and Ativan.

The case is complex, to say the least. Clearly, the patient was about to die, and was, I assume, willing to be an organ donor when he had, in fact, died - hence the presence of Dr Roozrokh and his team. Further, speed is vital in such operations. So much so that, by the time Navarro actually died, there had been an eight hour delay which left the needed organs unusable.

Equally clearly, Dr Roozrokh will probably argue that, whatever he may or may not have done (and you can bet he will say he didn't do anything wrong!), his ultimate objective was to save lives which COULD be saved - unlike that of poor Ruben Navarro. Doesn't that count for anything?

Well, yes, I can see how it might. But surely there must be ethical lines that we cannot permit doctors to cross? Can it be right to kill one patient so that another may live, even when they're already on the wrong side of Death's door? What if, by waiting just that little bit longer, you lose both patients? Aren't you then effectively killing the one you could save, just as surely as you'd be killing the one you couldn't if you'd acted sooner?

Perhaps not. Perhaps it is their illness which kills them, rather than the doctor who won't kill to save them. Or is that just an easy way of letting the doctor off the hook, of avoiding moral debate? I'm a logical kind of chap, and I can see advantages in hastening the death of a terminal patient to save the lives of others.

But nothing is ever that simple, is it? At what point do you decide to take that step? How long do you allow that patient to live before you kill them off for the spares? Taken to extremes, you might as well do them in as soon as the terminal diagnosis is made, but that could rob them of months, or years, of life. Come to that, nobody lives forever - why not compulsorily remove vital organs at the age of 30, whether there's anything wrong with the donor or not? That way, you're more or less certain to get something in reasonable condition, aren't you?

That's obviously nonsense, but it illustrates the point - you can't just decide to kill one patient to save another. Even in borderline cases, it's so full of risk that it's just wrong. But what about cases in which, knowing all of the above, the donor and their relatives agree to be killed off ahead of time in order to save lives? Wouldn't that be acceptable?

To me, yes, it probably would, and I'd most likely be such a donor myself. But there's another problem. How do you know that's what really happened in every case? Might not doctors adjust records a little? After all, it's happened before - think Harold Shipman!

All of which is presumably why, according to CNN, transplant surgeons usually aren't even in the room until the patient is declared dead. This case looks set to open a huge can of worms that could have a very unfortunate impact on organ donation, both in the US and here in the UK, and I'll be watching it closely. But, whichever way it is ultimately decided, it turns the spotlight back onto the risks associated with compulsory organ donation, and shows that my original post, albeit somewhat flippant, wasn't necessarily too far off the mark.

Billy Seggars.


krishna said...

do not accuse the doctor of killing the patient. he was about to die and the only blame here is that transplant surgeon was present in the theatre when the death occured. it would have been the responsibilty of the hospital [where the patient was housed] to take care that transplant surgeons were not allowed into the theatre.

oldmanskates said...

100 mg Morphine is not unusual in these cases. High doses of morphine can supress respiratory drive leading to respiratory arrest & cardiac arrest but this patient was already on a ventilator. The patient died 7 hours later. It does not appear to be of menevolant intentions.

Anonymous said...

Check out the Hootan Roozrokh blog there are facts that may enlighten you.

Anita said...

I have heard of a case where the father was asked to give permission to shut down the oxygen given to his son because the doctor told that there is no way that the son is going to live. The father didn't give permission and now the boy has grown up to be a perfectly healthy man. The doctors analysis will not be correct always.

Anonymous said...

There is something wrong here . . . . Its not so much the amount of morphine prescribed, but the KNOWN dangerous interaction with Ativan; this interaction is very well known to cause respiratory arrest! What WAS the ativan for anyway? Fine, the patient had neurological symptoms from his adrenal leukodystrophy, but he was already receiving an antispasmotic for those (boclofen). The "high normal" dosage of ativan is 10mg per day - yet this patient was given EIGHT times that amount (80mg) in the OR!!!! Also - if the patient was not yet deceased, what in God's name were they doing already harvesting his organs (???) the list of which included his heart and kidneys??? The accepted test to determine if a patient is "brain-dead" is the Apnea test (inability to breath on their own) and these two administered a huge dose of a drug that is known to cause an interaction that PRODUCES APNEA!!! Could it be that just maybe they were simply trying to use the drugs to produce apnea and thereby appear to pass the test that would permit them to proceed with the organ harvest? IMHO, BOTH of the transplant surgeons should be found guilty!