For all those executed, the cause of death is homicide

On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender.

Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago.

He’s a 55-year-old African-American man with hypertension, elevated cholesterol, and a history of smoking. Florida will execute Henry with the drug midazolam, in combination with a paralyzing drug and potassium chloride. Midazolam is new for this purpose; it produces sedation, amnesia, and, in medically prescribed dosages, it lacks the ability to kill.

Florida will make deadly what is naturally not by using a dosage much larger than ever given by a physician. Scientifically, this reasoning is flawed as the drug works like a key in a lock. Once the lock is full, no additional drug increases effectiveness. Worse, midazolam is in short supply. The amount used to kill Henry could have treated 100 patients who now will have no access to midazolam.

Henry is likely plagued by coronary artery disease, common among men of his age, ethnicity, and health. Hypertension and coronary artery disease place Henry at risk of a heart attack from falling blood pressure as he is executed.

When the death warrant was signed for Henry, he was placed under constant surveillance. When he was moved within the prison, the entire prison was on lockdown. I was taken to a room within the prison where Henry was waiting.

How would I describe a professional relationship with Henry? He was not my patient. If he were, I owe him duties that I could not provide.

We chatted about his health, and he confessed the occurrence of atypical chest pain. In other circumstances I would change his medications, order tests to document coronary artery disease, advise on diet and exercise, all to enable a long life. No such follow-up would take place.

My examination also proved challenging. Privacy was ruled out immediately and he was shackled hand and foot, which proved to be a puzzling obstacle to obtaining his blood pressure. Shackled, he was unable to remove his shoes and socks. I assisted and replaced them on his feet after my exam, and tied his shoelaces. We discussed how he liked the laces tied and tucked so they would not catch and cause him to trip.

I documented a high suspicion of coronary artery disease. I thanked him for his time and was ushered away, out of the prison and outside under the cloudy Florida sky.

People wonder what is owed to Henry, a convicted double murderer, and why a doctor should treat him? Some say mercy is not owed to Mr. Henry, as long ago, he showed no mercy to those he killed. For me, a doctor’s duty is to provide impartial care. If the patient is noble or terrible, my job does not change.

I believe murder is wrong and those who murder should be punished. But the Constitution of the United States prohibits cruel punishment, and I believe the use of midazolam to execute Mr. Henry will result in a needlessly cruel death. Doctors cannot make execution less cruel by advising on a better way to execute. I am not trained in execution. The medicalization of the death penalty has occurred by the State acting in place, but not in purpose, of physicians.

The use of midazolam, a drug in short supply, to kill when it should be used to heal, is unacceptable. As a final disturbing impersonation, execution by lethal injection occurs while laying on a gurney as opposed to “old sparky” and electrocution, which occurs while sitting.

The execution of Robert Henry will be cruel punishment, in spite of constitutional objection. When he is pronounced dead, a death certificate will be issued, and a cause of death must be stated. For all those executed in this country, that cause of death so listed is always “homicide.”

Joel Zivot is an assistant professor of anesthesiology and surgery, Emory University School of Medicine, Atlanta, GA.  This article originally appeared in And Now a Word ….

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  • pmanner

    “According to trial testimony and his own statements to police, Henry
    first approached Harris after the store had closed on Nov. 2, 1987,
    telling her unknown robbers had ordered him to tie her up and blindfold
    her.

    “Henry took Harris to a restroom, tied her to a urinal, then went to
    the store’s office where he hit Thermidor repeatedly on the head with
    hammer, doused her with a flammable liquid and set her on fire. Henry
    then went back to the restroom and attacked Harris with the hammer,
    setting her ablaze as well.

    “Authorities responding to the fire found Harris dead, but Thermidor
    still alive, after she had tried to douse the flames in a second
    restroom. She lived about 12 hours, and her statement pointed to Henry.
    He was arrested the next day.”

    Robert Henry burned two people to death to steal $1300. The emergency responders wound up in therapy because of the gruesome nature of these killings. Remember that, and the suffering of his victims, when you pontificate on the “cruel” nature of execution.

    • guest

      Thank you for sharing this. When you read about what some of these inmates have done your heart breaks and your stomach turns. There is no redemption, only evil.

  • PoliticallyIncorrectMD

    I am not quite following the logic here. I would understand if Dr. Zivot objected to the death penalty in general. But to object to using midazolam on the basis of it being “needlessly cruel”? First of all, it is not midazolam that kills. It is paralyzing agent causing respiratory arrest together with potassium chloride causing cardiac arrest. Midazolam is used to humanly make the executed unaware, for which purpose it is routinely and effectively used in clinical practice.

    • JR

      Right now the states are experimenting with different death penalty drugs due to companies refusing to sell the US drugs to use for the death penalty. They aren’t switching to different drugs because the drugs are better, or cheaper, or have some other benefit.

      http://www.washingtonpost.com/news/the-watch/wp/2014/03/19/robert-henry-and-floridas-gruesome-execution-theater/

      • guest

        Correct, and I think even local compounding pharmacies are only agreeing to sell the drugs to prisons under anonymity for fear of threats or boycotts.

        • ninguem

          You know, if the anti-death-penalty people continue playing this game, we can go back to hanging and the firing squad.

          • guest

            Or wheel out ol’ sparky! Execution should not be pleasant. I don’t know how our criminal justice came to the idea that punishment for a crime should resemble a gentle nap.

          • fatherhash

            Man, it’d be nice if the victims got to choose how they wanted to die.

          • Rob Burnside

            Then there’s drawing and quartering, burning at the stake, and burial alive. Capital punishment’s role as a deterrent to capital crime has been debunked by study after study, so what is it–a custom or tradition? Revenge? Entertainment for our more bloodthirsty citizens? Biblical prophecy? I’m out of guesses Ninguem, but I’m sure you’ll have the answer.

          • guest

            There are many rational arguments for why capital punishment fails society. Like you mention, it does not deter crime, it is far more expensive than incarceration without parole and because of our dysfunctional criminal justice system an innocent can be executed.

            Yet, I like so many others, still support the death penalty. I don’t think of it as bloodthirst as much as I think of it as justice. Some may feel life imprisonment is justice enough for horrific crimes. I do not. When one decides to rob another of their humanity and liberty, one does not deserve to have theirs preserved. Mercy for the merciless is not justice.

          • Rob Burnside

            Well said, but it seems you’re equating justice with revenge, and I can’t help thinking of the old saw, “Revenge has two victims.” How does capital punishment make us a better society?

          • guest

            But how is it revenge when a punishment equivalent to the crime is handed down? In the case of torture the crime handed down is far milder than the one inflicted (please investigate the victims/perpetrators I cited above).

            Not having a DP extends a humanity and choices to those I do not feel are deserving. However, I will concede that capital punishment has shown to not be a deterrent to crime. It is also not cost effective and it is racially and financially biased. That said, not having capital punishment as an option is not something I’m ready for.

            It’s funny because I’m very pro choice, and I have struggled to understand why my scientific reasoning isn’t enough to sway anti abortionists. I no longer struggle to understand them.

          • Rob Burnside

            All good points, and I think we’d agree on many issues, but probably not this one. If justice were truly blind, and the DP had a deterrent effect, it would be easier for me to accept legal execution. In taking a murderer’s life, do we become murderers ourselves? No matter how humane the method of execution may be, do we give credence to the concept of murder as a solution and thereby encourage the very behavior we hope to prevent?
            .

          • yoosulove

            “Justice” there is a bit of a misnomer.. bloodthirst truly is more accurate.

            What the death penalty does is provide *security* and a *sense* of justice. It’s *easier* (and more safe, to be honest) for a society to get rid of an entity or problem that can not be solved or “made right” altogether than it is to attempt to reform it, and fail. For those who were directly affected by a person’s wrongdoings, they can have the “peace of mind” that that person can’t do it again to someone else, and that they “got what they deserved”. Psychologically, there is some comfort to the individual(s).. and it is a SOLUTION to the soceity as a whole – even a viable one, if a bit heartless.

            But heart doesn’t always have a place in governing a society. Someone, somewhere has to make the “tough decisions” – and that’s one of them. It’s not a decision made with heart – it’s just practical, objectively. Regardless of whether it deters crime or its expense value, eventually one also has to take into account what I’d objectively call “storage space”. Prisons and jails are already overpopulated – but at least the “worst of the worst” are eventually a non-problem in that context. Again… heartless, but logically true.

            The problem with it MORALLY speaking, however, is that the concept of “killing is wrong – so we’re killing you” doesn’t actually make sense. If it is *wrong*, it is *universally wrong*, no matter how PRACTICAL it may be. Anyone taking another’s life – or aiding/abetting it, approving it, watching it happen and doing nothing to stop it – is still doing something fundamentally WRONG. There’s a reason the term “necessary evil” exists…. but evil is evil nonetheless.

            The death penalty will always be WRONG. Nothing will ever make it “justice” – killing is killing, and there is no way possible to “break even” when death is involved. Ever.

            I would personally admit the practicality of it – the objective necessity of it, in the bigger picture. But if you’re going to support it (or even, as I, *understand* the reasoning for it) at least call it what it is – practical, and/or revenge – it’s never justice.

            If you’re going to compartmentalize it, at least be honest about it’s true nature – don’t sugar coat it, don’t *rationalize* it, and don’t make excuses for it to make it sound prettier than it is.

  • Suzi Q 38

    He was shackled because he obviously needed to be.
    The necessity of safety overcame the necessity of taking a BP.
    I understand why.
    To have to examine and treat such “slop” of the human race would be an abhorrent, task. Since he was soon to be rightfully executed, I don’t see how an elevated BP would have mattered in the scheme of things.

    • guest

      There are 2 great documentary series on this topic. One is Werner Herzog’s series called “On Death Row.” There are about 6 episodes. The other is Sir Trevor McDonald’s series called “Inside Death Row.” In Werner Herzog’s series an amusing comment is made that they use an alcohol wipe before starting the IV on a prisoner’s arm. This was to prevent infection on a man they were set to execute.

  • guest

    I find that most physicians, myself included, are very much in favor of the death penalty. I am not sure why but maybe it is because we see or have seen how rotten some humans are.

    I would invite you to read about the cases of Amora Carson (13 months old, brutally raped and tortured), Tesslyn O Cull (2.4 years old, raped and tortured) and Teghan Skiba (4 years old, raped and tortured) before declaring the death penalty to be cruel or unusual. These victims were all under the age of 4 and suffered horrifically at the hands of their rapists/torturers (Blaine Milam, Jesse Compton and Jonathon Richardson). Being euthanized is too kind for these barbarians.

    I do believe the death penalty in the US is racially and financially biased. Also, the state supported appeals process makes it more expensive than life in prison. Nonetheless, I think in extreme cases an “eye for an eye” is appropriate and really no lesser penalty is appropriate.

    • Patient Kit

      Is that really true? Are most doctors very much in favor of the death penalty?

      • guest

        The physicians I know and have communicated with (both online and in person) discuss capital punishment with the same emotion as the anti-abortion crowd. Sure, there may be rational reasons why we shouldn’t have capital punishment. But, my guess is physicians have seen both enough offenders and enough victims to feel that some people are just plain evil and do not deserve to live.

        For me, I remember one instance being told as a med student I could “practice” central lines on a brain dead patient. The reason he was brain dead was he was caught raping a woman and vigilantes beat him with a baseball bat. He wasn’t going to wake up. There is a lot of emotional experience in medicine that influences opinion among physicians, especially when it comes to DP.

        • ninguem

          I’d go with Occam’s Razor and say that physicians are citizens of their respective State, and the USA, and they have the same variety of opinion as anyone else.

          • guest

            Yeah, I realized I generalized a bit with my first statement.

  • buzzkillerjsmith

    I have an idea. Instead of limiting this thread to capital punishment, I suggest that we also bring in abortion, gun control, immigration, gay marriage, the theory of evolution, man-woman conflict, why group you name it is so irritating and offensive, the pros and cons of hip hop music, why my religion is better than yours, why yours is better than mine, whether we should re-introduce wolves to western wild lands or just shoot them all on sight, and perhaps the doctor-nurse practitioner cage match for good measure.

    • guest

      Oh come on, don’t fear a good debate about a controversial topic! It’s topics like these that keep us reconsidering and re-evaluating our positions, and I think that’s a good thing.

      • buzzkillerjsmith

        Nicely done, I almost took the bait. But I’m the button-pusher around these parts, mister, and don’t you forget it!

        • guest

          Ha, I’ll try harder next time!

    • ninguem

      I’ll bring the popcorn and beer.

      Taking bets on who invokes Godwin’s Law first.

      • buzzkillerjsmith

        I’m not taking that bet.

        • ninguem

          That’s because you’re as bad as Hitler

          DING DING DING DING DING DING
          We have a winnah!

    • Rob Burnside

      “Half of what I say is meaningless….” J.Lennon

  • Eric Thompson

    Personally I believe the cruel punishment clause should be modified. There are too many of this type of criminal who don’t receive the death penalty, serve 20 years or so and are let out; long after the memory of their crime fades. Sitting in a rather comfortable prison continually challenging their conviction.

    • ninguem

      The Founders anticipated capital punishment in the Fifth Amendment to the US Constitution, which is then followed by the “cruel and unusual punishments” clause in the Eighth Amendment.

      As such, to my reading at least, the Founders anticipated that capital punishment was not “cruel and unusual”, at least in some cases.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        They also anticipated slavery to be just fine…

        • ninguem

          No, they anticipated slavery…..which was brought to America by loyal servants of the crowned heads of Europe, long before the term “American” was coined…….would be tolerated as a compromise to hold the Union together.

          Fight it at the Constitutional Convention, and there would never have been a United States.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Sure…. just saying that something should not be immune from scrutiny in the 21st century just because it made its way into the Constitution in the 18th century.
            Things do change and “cruel and unusual” are relative terms.

          • ninguem

            Sure, it’s all relative.

            Israel snatched Eichmann and hanged him.

            Which is fine with me.

            As far as I know, they’ve executed no one since.

            But they could have jailed him for life.

            Some crimes deserve death.

            I guess it’s all relative.

            The country that you have chosen to live, is the oldest continuously existing Constitutional Republic on the planet. The pedants sometimes cluck about San Marino, maybe older, except it’s about the size of my garage, and not sure if you want to call it a constitution or a municipal code.

            Be that as it may, this country has existed since the Holy Roman Empire. I for one am loathe to change the operating system of this computer.

            So I will give that 18th century concept a great deal of respect.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            …and they executed no one before that, and they never will again, since capital punishment is reserved for genocide, and BTW, I did not agree with that sentence either….

            As to the country I choose to live in, as does everybody else in said country, I have nothing but the deepest respect for the Constitution, which was envisioned by the Founders to be a living document, which came complete with a mechanism for amendment. Saying that it should not be amended is contrary to what the Founders believed in, and contrary to what they actually did.
            I think the biggest surprise for all of them would be not that the country is holding together, but that we have such an abject lack of leadership and statesmanship these days, and that their document has so few amendments to reflect the threats posed by changing times to individual freedoms and proper governance. I wouldn’t be surprised if Jefferson would proclaim our times as overdue for a patriotic revolution…

  • ninguem

    The Fifth Amendment to the Constitution.

    “No person shall be held to answer for a CAPITAL [emphasis mine], or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.”

    The Founders anticipated the death penalty.

    Whether it’s appropriate for today is a fit subject for debate, but spare me the cheap moralizing. If anyone had it coming, it was the guy you describe here.

  • leslie fay

    As a charter member of what I refer to as the “Clint Eastwood school of law enforcement” I really do not care if Henry has an unpleasant death. Actually I have always thought that the appropriate way to execute a murderer is exactly how he killed his victims, which in this case would be decidedly worse than what whatever drugs will be used.

    • guest

      I’ve thought that too, but who on earth could inflict the penalty?

      • leslie fay

        that is a problem, however I think you would probably get volunteers from the victim’s families.

  • ninguem

    “First do no harm”, always a good idea, is not in any physician oath.

    And actually, prohibition against abortion and abetting suicide ARE in the classical Hippocratic Oath.

  • guest

    The moral argument is a valid one. I contend though that showing mercy to the merciless is not justice. When an individual robs another of their humanity why do they get the luxury of having theirs preserved?

    Obviously no right or wrong answer here but a worthy debate.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      They don’t. Those who administered justice do.

  • Patient Kit

    I’m against the death penalty, primarily, because of the inequity in our law enforcement and legal systems. Until our justice system is more equal and fair, I can’t even consider the death penalty even though I don’t disagree that some people do things to others that are so horrendous that they do deserve to die.

  • fatherhash

    i agree, the cause of death in the death penalty is “homicide”…..the homicide that the murderer(in the eyes of the legal system) committed to begin with. without that homicide, there would’ve been no death penalty.

    • ninguem

      Actually, now I wonder. Those executed, how do they classify the cause of death.

      Homicide? “Execution”? Do they use the actual mechanism of death, hanging, “lethal injection”, electrocution, cyanide poisoning?

      I don’t know.

      • EmilyAnon

        Here is Timothy McVeigh’s death certificate. Do you notice that occupation at time of death is listed as “soldier”.

        • ninguem

          Now I know……

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Yes, it does depend on how many you kill….and how much money you have….and whether you win the war or not…. hence I oppose the whole notion of state sanctioned murder, no matter the crime.

    Yes, they were all aware of bad leadership, but there were always some good ones sprinkled here and there. We seem to have run out of sprinkles…

    It’s not easy to amend the Constitution, and that’s by design, and that’s as it should be. Considering our shortage of sprinkles, we should probably not even try, because I seriously doubt that anybody “leading” today can improve on the original. It is an option for better days to come…. I hope….

    • ninguem

      Works for me.

      My aunt and uncle, who really did have a son killed on a contract murder, both the hit man and the purchaser of hit man’s services are in jail.

      Death penalty proceedings in progress, the hit man died in jail. Good riddance. The man who hired him, is still alive in jail. Actually the parents of slain boy, don’t have a strong opinion one way or another, death of killers won’t bring back son and all that. Life in prison acceptable. So they let the process work its way through multiple appeals.

      What DOES bother them, is the anti-death-penalty organizations, especially the Europeans, who make off like these killers are victims.

  • Thomas D Guastavino

    First, I have become convinced that the death penalty does not work as a deterrent because many, if not most, of the criminals are suicidal so there is no fear of death. Second, the purpose of punishment is to send a clear cut message to the next person that may be considering committing such evil crimes. Therefore, what punishment would criminals fear the most? The answer: bring back the penal colony. Find an isolated area or island and provide nothing. These criminals may have to fear of death but the idea of trying to survive and find you own food, water, shelter, or protection and surrounded by those who trying to do the same and have the same mindset as you would scare anyone. Would cost a whole lot less as well. The only remaining death penalty? Trying to escape.

    • fatherhash

      Brilliant!