Several issues
have come up with regard to lethal injection.
Generally,
they are: 1) The murderer experiencing pain during execution; 2) The
ethics of medical professionals participating in executions; and 3)
Proper training of execution personnel.
1) PAIN AND
LETHAL INJECTION
The evidence,
including the immediate autopsy of executed serial murderer/rapist
Michael Ross, supports that there is no pain within the lethal
injection process.
There is a
concern that some inmates may be conscious, but paralyzed, during
execution, because one of the three drugs used may have worn off,
prior to death.
First, there
is no evidence this has occurred. There is speculation.
Secondly, if
properly administered, it cannot occur with the properties and
amounts of the chemicals used and within the time frame of an
execution.
Thirdly, no
one has explained how the first drug could have worn off, within the
time frame of execution. Or, how is it that the first drug was,
somehow, improperly administered, but the second and third were not,
when using the same lines and procedures?
An Associated
Press reporter correctly stated that "there is little to
support those claims except a few anecdotes of inmates gasping and
convulsing and an article in the British medical journal
Lancet." (AP, "Death penalty foes attack lethal-injection
drug", 7/5/05)
The British
Medical Journal, The Lancet, published an article critical of lethal
injection (Volume 365, 4/16/05). A follow up article, by essential
the same group of researchers, published a similar report in PLoS
Medicine on 4/24/07.
The articles
did not/could not identify one case where evidence existed than an
inmate was conscious during execution.
The Lancet
article identified 21 cases of execution where the level of
"post mortem" (after death) sodium thiopental was below
that used in surgery and, therefore, may suggest consciousness was
possible.
A more
accurate description would be all but impossible.
A "long
after execution" post mortem measurement of sodium thiopental
is very different from a moment of death measurement.
Dr. Lydia
Conlay, chair of the department of anesthesiology, Baylor College of
Medicine (Texas Medical Center, Houston) said the extrapolation of
postmortem sodium thiopental levels in the blood to those at the
time of execution is by no means a proven method. "I just don't
think we can draw any conclusions from (the Lancet study) , one way
or the other."
Actually, we
can. The science is well known. Sodium thiopental is absorbed
rapidly into the body. Long after execution blood testing of those
levels means absolutely nothing with regard to the levels at the
time of execution. Nothing.
The Lancet
article did not dispute the obvious -- for executions, the sodium
thiopental is administered in dosages roughly 10-20 times the amount
necessary for sedation unconsciousness during surgical procedures.
Unconsciousness
occurs within the first 30 seconds of the injection/execution
process. The injection of the three drugs takes from 4-5 minutes.
Death usually occurs within 6-7 minutes and is pronounced within
8-10 minutes.
The
researchers also failed to note the much lower probability
(impossibility?) that the murderer could be conscious, while all
three drugs are coursing through the veins, concurrently.
Despite the
Lancet article's presumptions and omissions, there is no scientific
evidence that consciousness could occur with the amounts and methods
of injecting those three chemicals within the execution period.
The AP article
also stated that "They (death penalty opponents) also attack
lethal injection by saying that the steps to complete it haven't
been reviewed by medical professionals."
That is both
deceptive and irrelevant.
The
unchallenged reality is that medical professionals have both
reviewed and implemented injection procedures for decades. The same
procedures are used in executions. Criminal justice professionals
have been trained in this application.
Does anyone
not know this?
The chemicals
used in lethal injection, as well as their individual and collective
results, at the dosages used, are also well known by medical and
pharmacology professionals. And this?
Dr. A. Jay
Chapman, the former Oklahoma Medical Examiner, who created the
protocol, consulted a toxicologist and two anesthesiologists. He
states the obvious " ' . . .it didn't actually require much
research because the three chemicals - a painkiller, a
muscle-paralyzing agent and a heart-stopper - are well-known to
physicians.' 'It is anesthetizing someone for a surgical procedure,
but simply carried to an extreme.' 'If it is competently
administered, there will be no question about this business of pain
and suffering.' "("Lethal Injection Father Defends
Creation", Paul Ellias, Associated Press, 5/10/07)
Further,
lethal injection is not a medical procedure, but the culmination of
a judicial sentence carried out by criminal justice professionals,
the result of which is intended as death, the outcome of every case.
The follow up
research/article is "Lethal Injection for Execution: Chemical
Asphyxiation?"(Public Library of Science (PLoS) Medicine,
4/24/07). Dr. Koniaris was an author in both this and the Lancet
article.
The question
mark from the title says it all.
From the
Conclusion:
" . . .
our findings suggest that current lethal injection protocols
"may" not reliably effect death through the mechanisms
intended, indicating a failure of design and implementation.
"If" thiopental and potassium chloride fail to cause
anesthesia and cardiac arrest, potentially aware inmates
"could" die through pancuronium-induced
asphyxiation." (Underline, quote and color change are mine, for
emphasis)
In other
words, the authors tell us they cannot prove this has ever happened.
They are speculating.
Skip the
speculation: Some Reality
From Hartford
Courant, "Ross Autopsy Stirs Execution Debate----Results Cited
To Counter Talk Of Pre-Death Pain", August 11, 2005
The below is a
paraphrase of parts of that article, including some exact quotes.
Results of the
autopsy done on serial killer Michael Ross are being cited by
several prominent doctors to refute a highly publicized article that
appeared in The Lancet, the British medical journal, in April, 2005.
Critics of the
Lancet article say it does not account for postmortem redistribution
of the anesthetic - thiopental. The redistribution, the critics say,
accounts for the lower levels of thiopental on which Dr. Koniaris
based his Lancet article conclusions that the levels of anesthetic
were inadequate. The Ross autopsy results document this
redistribution, bolstering the critics' assertions.
Dr. H. Wayne
Carver II, Connecticut's chief medical examiner, was aware of the
controversial Lancet article before performing the Ross autopsy. As
a result, he took the additional step of drawing a sample of Ross's
blood 20 minutes after he was pronounced dead at 2:25 a.m. May 13.
Carver took a subsequent sample during the autopsy, which began
about 7 hours later, at 9:40 a.m.
The 1st sample
showed a concentration of 29.6 milligrams per liter of thiopental;
the second sample showed a concentration of 9.4 milligrams per
liter. The 1st sample was drawn from Ross' right femoral artery, and
the second from his heart, which can account for some of the
discrepancy. But Dr. Mark Heath, a New York anesthesiologist and one
of the numerous doctors who have signed letters to The Lancet
challenging the Koniaris article, said it clearly substantiates the
postmortem redistribution of the thiopental.
Dr. Jonathan
Groner, a pediatric surgeon from Ohio said he interviewed a number
of forensic toxicologists before adopting the view that thiopental
in a corpse leaves the blood and is absorbed by the fat, causing
blood samples taken hours after death to be an unreliable marker of
the levels of thiopental in the body at the time of death.
Groner
described the Ross autopsy results as "a powerful
refutation" of the Lancet-Koniaris study.
Dr. Ashraf
Mozayani, a forensic toxicologist with the Harris County Medical
Examiner's Office in Texas, said the level of thiopental "drops
quite a bit" after death. Even in the living, Mozayani said,
thiopental levels decline rapidly after administration of the drug.
She cited one study in which a patient was administered 400
milligrams of thiopental intravenously. After two minutes the
concentration in the blood was measured at 28 milligrams, but
dropped to 3 milligrams concentration 19 minutes after the
anesthetic was injected.
Mozayani said
the declining concentration of thiopental cited in the Ross autopsy
report "make sense."
On The Lancet
article, she said, "I don't think they have the whole story -
the postmortem redistribution and all the other things they have to
consider for postmortem testing."
NOTE: I think
that had and knew the whole story. They just didn't include it in
their report(s).
The
Veterinary sidetrack
Opponents of
the death penalty, as well as other uninformed or deceptive sources,
have been stating that even vets do not use the paralytic agent in
the euthanasia of animals. This is a perversion of the veterinary
position, which actually provides support, however unintended, for
the human execution process. Some fact checking is in order --
www(dot)avma.org/issues/animal_welfare/euthanasia.pdf
2. THE
MEDICAL/ETHICAL DILEMMA
Medical groups
cite that there is an ethical conflict for participation in the
lethal injection process, because medical professionals have a
requirement to "do no harm".
Those ethical
codes pertain to their medical profession, only.
For example,
both doctors and nurses can be police and soldiers and can kill,
when deemed appropriate, within those lines of duty and without
violating the ethical codes of their medical profession. Similarly,
medical professionals do not violate their codes of ethics, when
acting as technical experts, for executions, in a criminal justice
procedure.
Physicians are
often part of double or triple blind studies where there is hope
that the tested drugs may, someday, prove beneficial. The physicians
and other researchers know that many patients, taking placebos or
less effective drugs, will suffer more additional harm or death
because they are not taking the subject drug or that the subject
drug will actually harm or kill more patients than the placebo of
other drugs used in the study.
Physicians
knowingly harm individual patients, in direct contradiction to their
"do no harm" oath.
For the
greater good, those physicians sacrifice innocent, willing and brave
patients. Of course, there have been medical experiments without
consent and, even, today, they continue ("Critical Care Without
Consent", Washington Post, May 27, 2007; Page A01).
The greater
good is irrelevant, from an ethical standpoint, if "Do no
harm" means "do no harm". Physicians knowingly make
exceptions to their "do no harm" requirement, every day,
within their profession, where that code actually does apply. And,
they should.
The "do
no harm" has no ethical effect in a non medical context,
because this ethical requirement is for medical treatments, only,
and for patients, only.
The
acknowledged anti death penalty editors of The Public Library of
Science (PLoS) Medicine agree. They write:
"Execution
by lethal injection, even if it uses tools of intensive care such as
intravenous tubing and beeping heart monitors, has the same
relationship to medicine that an executioner's axe has to
surgery." ("Lethal Injection Is Not Humane", PLoS,
4/24/07)
The PLoS
Medicine editors have made the same point many of us have been
making - similar acts and similar equipment do not establish any
equivalence or connection.
There is no
connection between medicine and lethal injection, therefore there is
no ethical prohibition for medical professionals to participate in
executions.
To put it
clearly: The execution of death row inmates is not equivalent or
connected to the treatment of patients.
Is this a
mystery?
Obviously,
execution is not a medical treatment, but a criminal justice
sanction. The basis for medical treatment is to improve the plight
of the patient, for which the medical profession provides obvious
and daily exceptions. The basis for execution is to carry out a
criminal justice sentence where death is the sanction.
Justice,
deterrence, retribution, just punishments, upholding the social
contract, saving innocent life, etc., are all recognized as aspects
of the death penalty, all dealing with the greater good.
Are murderers
on death row willing participants? Of course. They willingly
committed the crime and, therefore, willingly exposed themselves to
the social contract of that jurisdiction.
Lethal
injection is not a medical procedure. It is a criminal justice
sanction authorized by law. Therefore, there is no ethical conflict
with medical codes of conduct and medical personal participating in
executions.
40,000 to
100,000 innocents die, every year, in the US because of medical
misadventure or improper medical treatment. (1)
Do no harm?
The doctor doth protest too much, methinks.
There is no
proof of an innocent executed in the US since 1900.
3. PROPER
TRAINING
In every
state, there are hundreds or thousands of people trained for IV
application of drugs or the taking of blood. Even many hard core
drug addicts are proficient in IV application.
There may be
only 1 or 2 times where personnel error may have led to problems in
the lethal injection process. That is out of nearly 900 lethal
injections in the US.
It appears
that some 500-1000 innocent patients die, every year, in the US, due
to some type of medical misadventure, with anesthesia. (1)
Do no harm?
Glass house. Stones.
I am unaware
of evidence that shows criminal justice professionals are more
likely to commit some error in the lethal injection process than are
medical professionals in IV application.
Furthermore,
even with errors in lethal injection, those cases resulted in the
death of the inmate - the intended outcome for the guilty murderer.
In the errors
of medical professionals, we are speaking of a large number of
deaths and injuries to innocent patients - the opposite of the
intended outcome.
Mr. Sharp has
appeared on ABC, BBC, CBS, CNN, C-SPAN, FOX, NBC, NPR, PBS and many other
TV and radio networks, on such programs as Nightline, The News Hour with
Jim Lehrer, The O'Reilly Factor, etc., has been quoted in newspapers
throughout the world and is a published author.
A former opponent
of capital punishment, he has written and granted interviews about,
testified on and debated the subject of the death penalty, extensively and
internationally.
