Lethal Injections

Here's the ethical conundrum. There have been some instances where people being executed under the death penalty suffered unnecessarily due to problems with the lethal injection. IV placement and administration of the medications is usually done by personnel who have no medical training at all. When something goes wrong - from something as simple as IV infiltration to miscalculation of doses to a lack of understanding of the drug mechanics - people die in awful, agonizing, and unconscionable conditions. This problem has been compounded by the fact that a lot of drugs have had shortages or been restricted from use for executions; some manufacturers won't allow prisons to purchase their drugs (in my opinion, rightly so).

Executions could potentially be much less likely to go wrong if a medical professional were involved. In particular, anesthesiologists have a deep understanding of drugs commonly used for this instance: benzodiazepines, barbiturates, muscle relaxants, potassium. As I read articles about lethal injections, I am shocked by the lack of nuance and understanding of dosing. One protocol uses 10mg of midazolam and pancuronium. That does of midazolam may be sufficient for a drug-naive person, but for a heavy drinker or drug user, that would not guarantee amnesia. That cocktail doesn't even incorporate a quick and painless death. How can we put someone to death under our legal system in a fashion where they may feel paralyzed, suffocating, pain, and misery?

The American Medical Assocation and American Society of Anesthesiologists are very clear on this matter. As physicians and with the Hippocratic oath, there are no circumstances in which we should involve ourselves in the execution of people. Even if we could relieve suffering in those last moments of a inmate's life, we would be going against our oaths. There is no place for medicine on death row.

For me, this is an ethical quandary. I would not feel comfortable standing by if someone were suffering and I had the knowledge and means to alleviate their pain. But in looking at this issue, I think that if we were to involve ourselves with lethal injections, we would be missing the bigger picture. Involving ourselves in this matter is to become passive tools of a justice system that puts people to death. We may be helping an individual inmate, but we would be relinquishing our autonomy as physicians. Instead, we need to influence things at a systems level, in the political arena. If we feel that death penalties are unethical, we need to work on changing it. If we feel that death penalties have a place, we need to argue for systems changes to prevent unnecessary suffering and pain.