I'd hate to have to make such life-or-death decisions. What would you do in these situations? Could one or more of these doctors receive a Nobel Peace Prize? https://www.wsj.com/articles/dr-vallentines-decision-1505487165 Scattered across the Mediterranean, migrants trying to reach Europe face death every day. Crews on rescue ships must make agonizing judgments about whom to save. By Drew Hinshaw | Photographs by Edu Bayer for The Wall Street Journal ABOARD THE GOLFO AZZURRO—An urgent plea woke the ship’s doctor, John Vallentine, at 6:30 a.m. He was needed on the bridge. The rescue ship was steaming south in the Mediterranean Sea in a race to reach a deflating rubber dinghy packed with migrants. Italy’s coast guard had transmitted the coordinates, along with a warning the makeshift craft could soon sink. A voice crackling across the radio told of another emergency. A lone West African man plucked from the sea by a nearby vessel was grievously ill with a soaring fever and convulsions. “He is unconscious and not responding,” the radio voice said. Dr. Vallentine and the crew of the Golfo Azzurro had a decision to make. They could help the stricken man, which would delay their mission to find the dinghy. Crew members knew from experience what happens when inflatable crafts fail. Seawater and fuel pool in the middle, weighing boats down into the sea. The liquids form a corrosive mixture that eats away at the flesh of those stuck in the crowded boat. Panic erupts and people drown. The other option would be to continue on their course. They didn’t know the dinghy’s exact condition or whether another ship could rescue it. And without immediate medical care, the man on the boat a half-hour west would almost certainly die. As a professor of medical ethics back home in Australia, Dr. Vallentine delighted in challenging students with the kinds of complex moral questions that can make the practice of medicine uncomfortable. Those often centered on issues of privacy and social responsibility, such as whether doctors should warn police about a mentally ill patient who owns guns. In the chaos of a humanitarian disaster, such as when thousands of African and Middle Eastern migrants try to cross the Mediterranean in flimsy vessels, there are few rules about whom to help and in what order. “It’s all about finite resources in a world of infinite need,” said Dr. Vallentine, who is 70 years old. “Do I look after this one, that 10, this 600?” Some philosophers and ethicists say the overriding consideration should be to preserve as many lives as possible, even if it requires sacrificing individuals along the way. Others argue that all lives are equally worth saving and it is wrong to deny help to those who need it. In practice, doctors use all kinds of methods to prioritize care in the pandemonium of a catastrophe. The notion of triage was a creation of battlefield medicine during the Crimean War. Some doctors handle the gravest cases first, others favor children over adults, and others stick to a first-come, first-served system, finding it hard to give up on a suffering patient to help others they haven’t yet seen. The decision in front of him reminded Dr. Vallentine of an exam question from his medical training. If he was treating a casualty in a war zone and the area suddenly became dangerous, would he leave, saving himself and letting his patient die so that he could treat more people on another day? He recalled his answer: “I said I would leave.” That suggested that the Golfo Azzurro should go look for the dinghy. The consequences here were immediate, not hypothetical. He told the captain and nonprofit group that operates the ship that he wanted to save the single sick man. They agreed. A quick radio call let the Italian coast guard know that the bobbing dinghy would have to wait. CHAPTER I Dr. Vallentine hauled himself up a rope ladder draped over the side of a fishing trawler floating alongside his speedboat. The vessel, run by another aid group, was overloaded and out of drinking water. More than 100 migrants thronged the deck, many wrapped in foil emergency blankets, their faces tight from exhaustion. Dr. Vallentine picked his way through the crowd to reach his new patient, a square-jawed man with a goatee lying unconscious on a mattress, and knelt to examine him. Another migrant identified the sick man as Samuel Osei of Ghana and said he was 36 years old. Mr. Osei’s face was contorted, his mouth frozen open, his neck stiffly extended and eyes shut. The crew said he had been having increasingly frequent seizures, but they had been too busy to do much for him, because four women aboard were pregnant and thus a bigger priority to the crew. Dr. Vallentine rubbed a knuckle hard against the stricken man’s sternum to see if he would react to pain. He didn’t. Dr. Vallentine and a nurse strapped Mr. Osei onto an orange plastic stretcher. Crew members lowered him over the side and onto a speedboat that dashed to the Golfo Azzurro. A crewman on the Golfo Azzurro worked the radio, trying to find a ship or helicopter that could get Mr. Osei to a hospital in Italy. There was only so much they could do for him in the middle of the Mediterranean. The receiver crackled. “This is Italian warship,” a navy officer responded. He ticked through a series of questions. What were the patient’s vital signs? Could he walk? Then the officer asked: “Is this a migrant?” “Yes, Italian warship, this is a migrant,” the Golfo Azzurro crewman replied. The response from the naval vessel: “We cannot do a medical evacuation.” Italy’s navy said later any offer of help would have revealed its location and put the ship at risk. Italy’s navy was interdicting human traffickers, and the leader of an army controlling much of eastern Libya had vowed to use force if its warships sailed into Libyan waters without permission. The Golfo Azzurro was in international waters. CHAPTER II Below deck, Mr. Osei suffered a seizure, his arms thrashing wildly as crew members tried to lift him onto a hospital bed in the Golfo Azzurro’s sick bay. Dr. Vallentine gave Mr. Osei an intravenous injection of an anticonvulsant drug while a nurse pumped air into the unconscious man’s lungs with squeezes of a resuscitation bag. The doctor also gave Mr. Osei antibiotics and painkillers to try to bring down his fever. They started bathing Mr. Osei with cool water to lower his temperature, which hovered above 104 degrees, and administered oxygen through a mask. Dr. Vallentine suspected Mr. Osei had either meningitis, a potentially fatal brain infection, or severe heatstroke. The prognosis seemed grim either way, with Mr. Osei’s high fever and erratic breathing. The doctor climbed up to the bridge and grabbed the radio to plead with a nearby Italian coast-guard vessel. “I need a helicopter,” he pleaded. “Can you get me a helicopter?” Silence. Then the coast guard said no helicopters were available. They would see about sending a ship to help, they added. In the Golfo Azzurro’s clinic, the nurse reported that oxygen supplies were running low. The crew located a Swedish coast-guard patrol with some spare. A speedboat shot from the Golfo Azzurro to the boat—then waited. About an hour later, a Swedish naval officer handed down a canister of oxygen. She shouted: “We have 700 people on board! We are very busy!” ‘Well, I can tell you what’s going to happen if they don’t get him,’ the doctor said. ‘Twenty-four, thirty-six hours, we will sit here, and he will die.’ Even with the oxygen, Mr. Osei’s only hope was an evacuation from the rescue ship. “We cannot do anything more for him,” Dr. Vallentine told the Golfo Azzurro’s captain. “I think really he must go.” Dr. Vallentine asked if there was any news from the Italian coast guard. “They said they would call back in one minute, but one minute was a lot of minutes ago,” a crew leader said. “So we are waiting.” “Well, I can tell you what’s going to happen if they don’t get him,” the doctor said. “Twenty-four, thirty-six hours, we will sit here, and he will die.”
