Monday, April 18, 2005
The April 16, 2005 issue of The Lancet contains a fast-track Research Letter entitled Inadequate anaesthesia in lethal injection for execution, and an editorial entitled Medical collusion in the death penalty: an American atrocity. It was the latter title that really got my attention. Although it is not unusual for the leading British medical journal editorials to be critical of American policy, it is not common for them to use so strong of a word as atrocity. It turns out, though, that their choice of words is no mere attention-getting gimmick; what they report really is an atrocity. It this post, I review the Research Letter and the Editorial, to explain why it really is an atrocity. Indeed, it is an embarrassment to our nation.
From the Research Letter:
Toxicology reports from Arizona, Georgia, North Carolina, and South Carolina showed that post-mortem concentrations of thiopental in the blood were lower than that required for surgery in 43 of 49 executed inmates (88%); 21 (43%) inmates had concentrations consistent with awareness. Methods of lethal injection anaesthesia are flawed and some inmates might experience awareness and suffering during execution.The authors go through much technical detail explaining why the protocols are inadequate, particularly with regard to the dosage of thiopental. The other two agents used are pancuronium, and potassium chloride. The pancuronium is a neuromuscular blocking agent (a paralyzing agent), which makes it impossible to breathe; the potassium chloride stops the heartbeat. It is the thiopental that is supposed to render the convict unconscious.
Then the authors inform us of this tidbit:
With little public dialogue about protocols for killing human beings, it is pertinent to consider recommendations from animal euthanasia protocols. The American Veterinary Medical Association (AVMA) panel on euthanasia specifically prohibits the use of pentobarbital with a neuromuscular blocking agent to kill animals, and 19 states, including Texas, have expressly or implicitly prohibited the use of neuromuscular blocking agents in animal euthanasia because of the risk of unrecognised consciousness.This sort of thing does have some precedent in our legal system. After all, in our country, it was illegal to beat your dog before it was illegal to beat your spouse. Now we learn that the standards for euthanasia of animals are more stringent and humane than those for executing humans.
In the corresponding editorial, we are informed that, although the AMA Code of Medical Ethics forbids physicians from participating in execution, a substantial number would be willing to do so:
A survey of US physicians found that although the American Medical Association (AMA) ethical guidelines forbid physicians to participate in executions, 19% said they would inject lethal drugs and 41% said they would perform at least one action prohibited by the AMA guidelines, such as starting intravenous lines. In fact, only 3% of those asked were aware that there were guidelines.One irony of these articles is that, by pointing out the technical deficiencies of the existing execution protocols, the authors provide information that could be used to improve those protocols. If that actually happens, it would mean that the authors unwittingly contributed to the very practice they are protesting, which would, I suppose, be an ethical violation. I hasten to add that I do not fault the authors for this. There probably isn't any way for them to influence policy without providing such detail; without it, the articles would not be persuasive.
Another irony is this: Texas is preparing to execute two convicts by lethal injections on Wednesday (4/20/2005).
I will be curious to see if the Lancet articles have any influence here in the USA.
Yesterday and today, I spoke about this subject with several people. A common response was to say that perhaps it is not such a bad thing, for such criminals to suffer before they die. I don't agree, but even if I did, I still would consider it an atrocity. Our Constitution forbids cruel punishment. I suppose that if, as a result of an honest political process, the constitution were changed; and if, through a well-reasoned political process, it became standard protocol to torture persons before putting them to death; and if a protocol were designed with that express purpose in mind, and properly legislated, then I could accept it as a political reality. But I still wouldn't agree with it.
Of course, none of that is the case. The convicts are being tortured before they die, only because someone who didn't understand what he or she was doing designed a bad protocol and did not do any follow-up testing. The torture is not being administered as the result of due process; it is being done by mistake. There just isn't any sense to that.
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