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Lethal injections are not good medicine

| Patient | September 29, 2011

Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.

Lethal injections involve delivering a fatal dose of drugs resulting in unconsciousness, paralysis, cardiac arrest then within minutes, death.  Dr. Marc Siegel’s recent commentary on “Doctors and Death Penalty Cases” notes that “… physicians helped design the lethal injection protocol. We provide the intravenous access, monitor the patients, administer the injections, and declare death. — That’s not at all what I thought I was signing up for when I enrolled in medical school.”

Bioethics helps us question our beliefs and values as they unfold in the treatment and care of patients. We should consider, first do no harm.

Since 1980 the American Medical Association code of Medical Ethics has opined against physician participation in capital punishment including lethal injections. As of 2010 the American Board of Anesthesiologists (ABA) will revoke the certification of members who participate in execution by lethal injection. ABA board member, Dr. Mark Rockoff makes a salient remark, “if lethal injections are medicalized, it could make it look like operating rooms are like death chambers, that anesthesiology drugs are death drugs and anesthesiologists are executioners. That would all undermine public confidence in the medical profession.”  These decisions are not based on the appropriateness of the death penalty.

Overwhelming schedules, research demands and high volume patient case loads should not push us away from this challenging dialogue and/or opportunity for advocacy. The debate here is personal, political and inter-professional one that should not be avoided by health care professionals.

Katherine Ellington is a medical student who blogs at World House Medicine.

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  • Edwin Leap

    Will physicians have their certifications revoked for performing abortions?  Or for performing ‘assisted suicide,’ if that ever becomes normative?  And what’s the difference?   I see the problem and I understand.  I wouldn’t want to perform an execution either, but we seem a little conflicted here.  If we’re opposed to execution we should certainly be opposed to abortion.  If we’re OK with abortion, execution should be no problem whatsoever.

    • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

      There is quite a lot of difference. The conflict is only in the mind of those whose BELIEVES equate a fetus with a person who is alive. The debate about abortion is the debate about when life begins. You believe it begins at conception. This is your BELIEF this isn’t a fact. Others believe differently e.g. when brain develops or when a fetus is able to survive outside the uterus. The fetus isn’t a living human being it only has a potential to become one.

      “Assisted suicide” is also a completely different subject. The person wants to kill himself or herself because the terminal condition is such that the life in unbearable. It’s also free will of a person in question. I am not arguing for- or against- it, only pointing out the difference. The physician helping in assisted suicide acts to prevent further suffering.

      Execution is killing of a living person (not a collection of cells that can’t survive or think by themselves) that is healthy and doesn’t wish to die.

      Regardless, abortion and assisted suicide are different subjects and are not the topic of this thread.

      • http://www.facebook.com/profile.php?id=1404048836 David Behar

        But rent seeking, left wing hypocrisy is highly relevant. You refuse to face the obvious contradiction between killing violent adult males to protect the public, after their procedural due process rights have been protected to the nth degree, and killing viable third trimester babies without any due process, who have done nothing to anyone except offend a feminist.

        • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

          Again, abortion isn’t the subject of the post. As to “due process” – it’s not infallible. How many people on death row were freed because of DNA evidence? Regardless, the subject isn’t death penalty per se but physician participation in it.

          As to abortion, the third trimester abortions are not elective but happen for medical reasons. As to hypocrisy, it’s in your comment because you essentially hijack a thread about a death penalty to talk about a completely different issue. Even if you consider abortion wrong, two wrongs don’t make a right. But X happens too isn’t a valid argument when subject Y is discussed.

          • http://www.facebook.com/profile.php?id=1404048836 David Behar

            Woould you care to address the absolute immunity for all subsequent crimes of prisoners with on LWOP, and the hundreds of innocent people they massacre each year, including other prisoners? Thanks to left wing protection of the vicious, ultra-violent criminal, hundreds of innocent people are murdered in prison each year. Only advances in trauma care prevent that number from being in the thousands. Those murders are blood on your hands, because they have the foreseeability of planetary orbits. They will happen to someone every year, as a guaranteed fact.

            Why would left wing people want to protect these violent predators? They generate big government jobs. Their victims generate nothing and may rot. So all Board prohibitions are false, are pretextual, and in bad faith. They want to preserve doctor jobs by saving the lives of serial killers, terrorists, and other murderous criminals. You swim in this left wing sewer and  you have no awareness of the air, the land above you.

        • http://profiles.google.com/molly.ciliberti Molly Ciliberti

          I bet you love war. Kill those terrorists! Bomb those evil ones! You need to give it a rest. If you don’t approve of abortion then don’t have one. But keep your believes out of my life.

        • Anonymous

          If your want to see them really squirm, ask them to justify abortions after 24 weeks, the clearly documented threshold for survival outside the uterus.

          A child, who can feel pain, is exucuted for the crime of being inconvienent or imperfect.

          But murdering sociopaths are protected.

          It is a crazy quilt of irrational and contradictory beliefs.   Sort of like eugenics…

  • Anonymous

    Well, Violetta, that little clump of cells is alive, it is a unique organism, and it is human (and not some other kind of thing), and if any of these three things were not true, there would not be a need for abortion…. People may not like what I just said, but I believe it is not controversial from the standpoint of science…. but you are right, this is a little off topic.

    The injunction “Do no harm” is no longer in the physician oath. Assisted suicide is ironically an attempt to minimize harm by causing the greatest harm possible. The Hippocratic Oath prohibited both euthanasia and abortion — it is interesting that it is seldom if ever used anymore and the current oaths are bland…. but that is still off topic.

    Yet there is a certain analogy. The death penalty is just another kind of euthanasia, the killing of someone who someone else judges ought not live. And like it or not, abortion has as its object the child who will be born, and it is to prevent a new human being from coming into the world. Even if it’s a future life, it is nonetheless a concrete life and not an imaginary one. And so Edwin Leap’s leap may not be so far fetched. 

    There is a great irony in that those who most strenuously oppose the death penalty tend to be those who most ardently support abortion and assisted suicide and euthanasia. And vice-versa. But at least with the death penalty, in most cases, the person to die is guilty of some grave crime, but in abortion and euthanasia, the opposite is true. If the skill of a physician to kill ought to be used on anyone, it should not be innocent people.

    I happen to generally oppose all three. I support the existence of the death penalty but only its rare use in extreme circumstances. Also, I do not believe it is the duty of a physician ever to act as executioner.

    • http://lifeinthefastlane.com CHBiscuit

      Execution is usually a political tool to appear tough on crime to appeal to a sick social sense that it is a deterrent. No such deterrent exists and those societies tend to have high crime.

      As a scientist and someone who has done developmental biology, that zygote, embryo and even for much of the foetal stage, is not yet “human” per se, anymore than an organ or skin tissue would be human, it’s a collection of cells undergoing divisions and differentiation in accordance to hormones, trophic factors and Hox genes present and their interaction with the cells. At that stage, it can’t be argued it’s fully human unless you have an ideologically pre-conceived notion of what human means. I therefore think it is justified to allow people to choose if they really are in any place to have a child. Balancing the needs of a sentient real human being who would be born versus whether one can meet these needs, whilst it’s just a cellular mass is responsible not harmful. Allowing people to decide to stop developing cells, is far more ethical than forcing others to bring a child into the world who will be emotionally or resource deprived and thus not have a decent quality of life, given what we know of how childhood sets up life long psychological health.

      Further, to call execution more ethical than euthanasia really beggars belief. On one hand we have a person whose existence is pain and suffering and on the other a healthy individual who may possibly be rehabilitated or may be entirely innocent but for the sake of a “tough on crime” or other political statement and overzealous prosecutor may have been condemned. I see a big difference here. I can’t agree that anyone having legitimate power to earmark an individual for death against their will. I think the big problem here is seeing the physician as an enforcer of values external to the patient’s. That the physician will choose that you have to live regardless of your suffering, or that you must die for your crimes. No one wants to be treated by an “enforcer”. Sure sometimes a physician must attempt to make a patient change some habits, but there are more tactful ways than alienating a profession by changing the way the public perceives them from healer into moral enforcer.

      • Anonymous

        CHBiscuit, please understand I am trying to engage you with respect and level-headedness, even if I take an opposite view. But, honestly, what you say about the zygote/embryo does not disprove what I said but actually affirms it. The developmental processes you mention prove it is a separate, complete (though developing) and living organism of some sort, with a predictable developmental trajectory. As an organism it belongs to some species of animal, does it not? It cannot represent its own species, neither genetically nor metaphysically. As the product of human reproduction, it must belong to the human species. It is a separate concrete living organism of the species “human.” It can be nothing else. At the very best, your reasoning must lead you to wonder about whether it is a human being and leave you in doubt about its non-humanity. Your certainty that it is non-human is itself based on a preconceived notion of what human means, and the rest of the reasoning you present also follows from that preconceived notion. Note that you phrase it, What human “means” rather than, What human “is.” Meanings can be subjective. Things are what they are, however, regardless of opinions.

        The death penalty, when used a means of societal self-defense, can be legitimate, just as it can be legitimate for an individual to use lethal force to stop an aggressor–if the circumstances warrant it. I support keeping the death penalty legal in that respect. Other uses of the death penalty deviate from that use, just as lethal force can deviate from legitimate self-defense depending on circumstances. Euthanasia is really about the right of the healthy to end their own suffering by killing the sick, more so than to end the suffering of the patient, because there are better ways to deal with suffering than killing. What, do we cure hypertension by getting rid of the person with hypertension? Suffering is a symptom, and to see ending suffering by ending the patient as legitimate stands as a great irony. Abortion also is more about the right of the practitioner to end the pregnancy–for a fee–than the right of women to do so.

        I mean, don’t you find it strange to advocate the killing of innocent people while opposing the death penalty for terrible, hardened criminals? You say there is a better way of dealing with criminals than killing them — well, isn’t there a better way to deal with the suffering of innocent people?

        Finally, physicians are not mere technicians who are bound to follow orders. They have their own moral compass and should be free to follow it. They should not have to perform abortions or euthanasia or assisted suicide, just because society believes the patients have a “right” to these things.

        And I would feel much more comfortable trusting my life to a doctor who would refuse to kill me even if I begged him to, than to one who doesn’t care if I want to live or die as long as there is a billable procedure he can perform at my request. Honestly, I don’t know how women can trust their pregnancies to an obstetrician who would just as soon abort as deliver and who has no moral principles aside from doing what the patient wants.

        • http://lifeinthefastlane.com CHBiscuit

          You’re misrepresenting my argument entirely.

          A large number of zygotes fail to implant, a large number develop abnormalities and spontaneously abort, entirely naturally. It has no clear developmental trajectory from a statistical point of view because nothing is mechanistic. So, no I must disagree that it is an individual, it has no choice, no will, no feeling or sensation, it isn’t a human, it’s an important distinction. One has frontal brain function which implies choice, personality etc, and the other doesn’t even  have a frontal lobe, very big distinction.

          Further, 60% + criminals have a psychiatric disorder that is not being treated, how can you hold people to ultimate account if they aren’t even in control? In Australia we have less crime and less violent crime in the US, and no death penalty. You’ll find the same correlation almost the world over. Where societies are in favour of the death penalty, you’ll almost find the same raised crime rate. I think that has more to do with a culture that violence can solve problems endemic to those regions which determine both crime and how it’s punished. You’ll also find areas with those ethics have fairly large social inequality which is a good predictive value for crime.

          Abortion and family planning have positive predictive values when it comes to reduced crime. It usually means more educated and empowered women, which has also been demonstrated have smaller families where children usually receive ideal levels of attention, are pushed into education more and thus better societal outcomes. It’s all biology, what doesn’t even have the faculties to have consciousness isn’t equivalent to a developed organism with brain function. By the same token, would it be okay to unplug a ventilator if the brain were unlikely to regenerate? If something hasn’t even developed a frontal lobe, it doesn’t matter what that mother chooses at that point in time, it has no consequences that are harming an individual. But by making the moral judgement to deny choice to the mother you increase the risk of mortality to mother by opening a market for backyard operations to terminate the foetus anyway.

          Self defence is another area entirely, but once a criminal is apprehended, I do not believe that the state has a legitimate right to terminate anyone’s life. We abolished the death penalty here, it’s abolished in much of Europe and these regions enjoy a lower violent crime rate than areas with the death penalty. It all comes down to the societal conditions that spawn both of these. Studies find more people are falsely convicted and executed than you might hope, and I am glad that they at least have legal recourse to challenge a prison sentence and not be erased from existence to satisfy false notions of the effects a lethal deterrent has.

          I also put it to you that some suffering really has no adequate treatment. Some side effects are as bad as the diseases. Some diseases leave an individual trapped in their bodies without limb movement. Other diseases require individuals be put in comas for the pain, it can’t be tolerated so they must be left unconscious (placing them at very much increased risk of secondary infections), without any sensory perception of frontal lobe function. They don’t wish to live, and the best we can do for them legally is render them unconscious, so that like death they no longer have any perception, consciousness or existence. I don’t see that as being caring or the far better outcome. That’s not to say that the patient should have no choice, the patient should have ultimate choice, depriving a patient choice stimulates cortisol suppressing dehydro-epiandosterone, lowering immunity and increasing risk of much worse and more severe (and painful) infection and disease outcome. The patient must have choice, sometimes we as a society need to intervene (like when a person’s choice isn’t their choice due to addiction for example) but their life is their life, and if they are at a hopeless juncture and no longer wish to suffer on, why should anyone push their morality on that individual? That’s what this boils down to, whether one version of someone’s absolute morality should be applied to all, regardless of the evidence against it or its origins.

          • Anonymous

            It all still seems very inconsistent to me. For instance, you want everyone to agree that euthanasia is a morally acceptable choice, to avoid making everyone accept someone else’s morality. That is what it means to legalize euthanasia: A determination in law that it is ok for anyone to choose. It is someone’s morality forced on everyone.

            Also, with euthanasia comes the ironic eventuality that the suffering person will choose euthanasia precisely because he believes he has no choice to do otherwise. Then it will become a duty. Those who want to live will be called selfish wasters of resources who prolong the suffering and burdens of their loved ones.

          • http://lifeinthefastlane.com CHBiscuit

            Which is contradicted by studies that show where people have the choice to do so it is thought out. The greater sense of choice improves who a patient perceives illness, that they have control, and subsequently more choose to fight it out longer knowing they have an exit strategy.

            It’s not forcing it on anyone if there is a choice. It’s opening it to individual value judgment.

  • http://www.facebook.com/profile.php?id=1404048836 David Behar

    If saving lives is the goal of medicine then things are more complicated than the policies of the biased, left wing, abolitionist  professional societies you mentioned. The alternative to the death penalty for an extreme crime is Life Without Parole (LWOP). That sentence is  a license to kill better than that of James Bond. He has to answer for his extra-judicial executions to civil service and political officers. The prisoner with LWOP has absolute legal immunity for all crimes after the first murder.

    As a result of the coddling of such of such organized gang members, serial killers, contract killers, and ultra-violent prisoners, Jihadist terrorists, hundreds of innocent people are murdered inside prisons each year, many times more than are executed.  These murder victims include other prisoners, visitors, and staff, including doctors and nurses. Thank the lawyer.

    Why does the lawyer and its running dog left wing collaborators, like the AMA, and the Anesthesiology Board,  protect such vicious prisoners from the death penalty? These generate massive government worker sinecures. The murder victims generate nothing for the left, and may rot. So the abolitionist policies come from bad faith, and economic conflict of interest. They are immoral.

    I would like to see the estates of the murder victims killed by prisoners on LWOP sue these professional societies for their wrongful guidelines, and the resulting damage. These doctor societies have taken an oath to do no harm. So they should be held accountable when their guidelines harm people, while the Societies have knowledge of the consequences. If the loss of a board certificate interferes with the earning ability of a doctor, he should sue the Anesthesia Board.

    • http://profiles.google.com/molly.ciliberti Molly Ciliberti

      YIKES! How do you really feel about it. You are flaming.

  • Hexanchus t

    Two comments:

    1. The only reason the death penalty is not an effective deterrent in the US is that it is so rarely actually carried out. Those that commit capital crimes know that even if they are convicted & sentenced to die, there will be years  (often decades) of appeals process, and the chance they will actually be executed is extremely remote. In those countries where it is actually carried out in a timely manner, the rate of capital crime is much lower.

    2. Even if it is not a deterrent, it most certainly stops repeat offenders.

    Nomex on….flame away!

    • http://lifeinthefastlane.com CHBiscuit

      Actually, it’s because the altered risk calculus that leads to crime also means that the individual does not believe they will be caught. No “tough” measure acts as a deterrent. The impulses for crime are more or less based on either insanity, and going on crime stats and studies, difficult childhoods. Crime can only be effectively dealt with trough societal level preventative measures, not harder penalties, studies keep showing this.

    • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

       Nobody who commits a crime plans to be caught. If they were, they’d not have committed a crime in the first place. As to the penalty, I’d imagine in many cases a life prison sentence is a whole lot more of a deterrent. Death is far easier.

  • http://twitter.com/katellington Katherine Ellington

    The most intriguing aspect of the comments is that most of the conversation has not been specifically about my post. I do welcome the dialogue on health care professionals role in execution by lethal injection this method has replaced hanging, firing squad, gas chamber and the electric chair.

    • Anonymous

      That’s because your original post was so clearly an anti-death penalty point-of-view disguised as a discussion of medical ethics, as is the postion of the ABA.  To be consistent, if you feel participation in the death penalty is wrong, how can you justify abortion, especally late-term abortion? Shold not ACOG revoke the certification of any Obstetrician who engages in that practice?  That’s certainly doing harm to a human being ….

      • http://twitter.com/katellington Katherine Ellington

        This reading of my piece is intriguing.  I will take some time with abortion on its own merits at another time.  These issues may be interrelated legislatively they are separate. From a professional standpoint, to use the tools of medicine and healing for the purpose of state-sponsored executions does real harm.   

        • Anonymous

          State sponsored execution has the virtue of having been determined not by the the choice of a single individual, as abortion is, but by at LEAST 12 independent citizens, and (almost always) a legion of independent judges and attorneys. Those lives are not taken based on the emotional reaction of a single person; they are carefully reviewed and examined multiple times before action is taken. I noticed a lot of protestors outside Davis’ execution, but not so many (if any) outside Brewers’. I heard NO death penalty foes arguing that Brewers’ life should be spared, nor do I think it should have been. BUt for the liberal left, it all depends on whose ox is being gored ….

      • http://profiles.google.com/molly.ciliberti Molly Ciliberti

        No, the fetus is not living outside of the uterus.

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    Funny how many people don’t have a problem with a physician killing someone with a series of injections, but object to physician assisted death at the request of a suffering, dying patient.

  • Anonymous

    One does not have to go beyond the title of this article to understand that the author has a bias. I personally believe that while death is the result of executions, euthanasia and abortion, the arguments pro and con are mutually exclusive. That is my personal belief. Others have a different value system and would take umbrage that I equate abortion with death of a fetus. Others see no difference between the three.

    The author, by taking a position, is saying “my values are right and yours are wrong.” It’s no wonder that she has brought out the best and worst of us. If she really wanted to have an intellectual discussion, she should have framed her comments in a different manner. She didn’t. Emotions flair.

    As far as executing criminals for capital offenses each state has made that decision. There is no provisions in any state constitution for a medical veto by the state board of whatever. If you are in a state that has the death penalty it’s up to each individual physician if they want to participate or not. I think that lethal injection is more humane considering the alternatives. Firing squads, electrocution and hanging do not need a doc to accomplish the desired result.

  • http://www.facebook.com/people/Robert-Jones/100000513871710 Robert Jones

    I agree…lethal injection is a waste of perfectly good meat.
    Organ harvest and feeding the carcass to OTHER ANIMALS is a much better idea.
    Remember To Recycle…

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