Lethal injection debate
Jan 13th, 2008 by Terry
In the news this week, the Supreme Court began hearing arguments over the inhumanity of lethal injection as a modality for the death penalty. Presently, 36 out of 37 states that advocate the use of the death penalty utilize lethal injection (the 37th state utilizes the electric chair - Nebraska).
As an anesthesia provider, I am intimately familiar with the present drug trilogy (sodium pentothal, pancuronium bromide, & potassium chloride) that is currently administered for the death penalty. We actually use two classes of these drugs everyday in general anesthesia. All three of the drugs are given in “mega-doses” for an execution, i.e., in much much larger doses than is safe and compatible with life.
Sodium pentothal, the first drug, is a powerful barbiturate, and, when used to induce general anesthesia, causes unconsciousness and apnea (cessation of breathing). Its onset of action is 30-40 seconds, and its duration of action is about 10-15 minutes. Pancuronium bromide is a long-acting muscle relaxant causing total paralysis of all voluntary muscles, with an onset of action of 3 to 5 minutes and duration of 60 minutes or more. Potassium chloride will cause cessation of all electrical activity in the heart - it will stop the heart from beating. Medically, it is given in very small doses for low serum potassium levels, and in high doses directly into the heart during open heart surgery to stop the heart from beating.
This trilogy of drugs was concocted to ensure a humane end to a life. When administered in the proper sequence and through a patent vessel, the person condemned to die should first become unconscious and stop breathing, then stay apneic, while concurrently, the heart will stop beating. When blood no longer circulates and ventilation and oxygenation no longer take place, cell death begins within 2 minutes. This is well-documented. Brain death and permanent death occur within 4 to 6 minutes after cardiac arrest. Drugs sitting on receptors cannot be washed away or redistributed by non-circulating blood. Consciousness cannot be regained after 10 minutes of anoxia. A heart arrested with a mammoth dose of potassium chloride will not decide to spontaneously beat 5 - 10 minutes after its administration.
While it is not the purpose nor the message of this blog entry to weigh in pro or con about the death penalty, the lethal cocktail that is currently the standard for death by injection, when administered according to protocol, should be a painless passageway to death. The ASA (American Society of Anesthesiologists) has weighed in about their stance against physician participation in execution.
But an interesting counterpoint can be found at California Medicine Man’s blog. While I am not about to reveal to you what my opinions are about the death penalty, I think that California Medicine Man’s point is well taken that if, as a society, we condone public executions, then it is incumbent upon us as a society to ensure that they are carried out in a humane and painless manner, “with compassion and decency.”
Good post. Obviously there is no room for political discussion here, but I agree that as medical professionals, we ought to be making every effort to ensure that this type of death is painless and fast.
Didn’t realize those drugs were also used in anesthesia but it makes sense now that you mention it…
All I have to say is that I am glad I do not possess the skills to do perform lethal injections.
Politics alone is not the only reason why someone would not want to perform lethal injection–religion and personal morality also play a part in it, which is why I will not work in a few areas. I just do not want to have to make ethical decisions against my personal belief system. Certain areas of practice, while interesting, would cause that to happen, and we as practictioners should be aware of those issues and choose our practice areas accordingly.
Political and humane arguments apart, I can’t help but wonder what effect facilitating an unwanted death, even a gentle one, would have on a health care practitioner whose professional code rests on the mandate - Do No Harm. Yes, one can argue that providing a humane death in a government mandated execution is doing the best in a harmful situation. But how much would a practitioner committed to healing need to twist her foundation to force death upon the unwilling?
It is indeed a very volatile and touchy subject. While doing no harm is a pillar of practice, can we as a society condemn individuals to die and then torture them in the process? There are many documentations of lethal injections (and electrocutions) gone awry. What does this say about all of us?
I could never imagine a health care provider in a position as executioner, but who is properly skilled to adminster lethal drugs for death? Do we train people especially for this job?
Barbara, I think you brought two key words into the equation - unwanted death. But this also brings to mind Dr. Kevorkian - he facilitated wanted deaths, and served time for it, too.
I have no answers here, as you can tell. Just more questions. . .
This is a tough question. I know social workers face similar issues, though we don’t have the knowledge and skiills to influence anything with medications, we do have the ability to advocate one position or person over the other. TIt’s good to hear about another group of practitioners and these ethical challenges.
Now, if we could just get the attention of our lawmakers. . .
You bring up an excellent point. It only makes sense that people of our profession would be against this procedure, considering we got into this line of work because we are “caring and compassionate.” However, supporters of the death penalty might argue, “How much compassion did the convicted killer have for his victims.”
Still, I certainly wouldn’t want to make that decision. I think there was an episode of Law and order about this recently.