Friday, July 14, 2006

Execution and the Medical Professional

Having just watched Now on PBS with David Brancaccio, I was moved to write about tonight's story which discussed the role of doctors and nurses in the executions of condemned prisoners. The Now reporter presented what I felt was a relatively dispassionate airing of the various sides of this very controversial issue, the website providing further facts and figures for the curious.

Whether one opposes or supports capital punishment, the myriad questions raised in its discussion are thought-provoking and quite worthy of consideration. The media has recently focused a fair amount of attention on the various court decisions which have ruled lethal injection as a flawed form of execution which is in dire need of readdressing. Many opponents have stated that the cocktails used for the euthanization of animals in the United States are far more effective in producing a soporific effect with no apparent experience of pain than those used in our prison system today. Horrific stories have been published of condemned prisoners complaining of pain while undergoing injection, one particularly gruesome account detailing that technicians needed 90 minutes to complete the execution of a man who kept raising his head from the gurney to say "It ain't workin'!" These stories send chills down my spine and underscore the next questions that I will raise.

In these times, we have come to understand that execution has become "medicalized", in that it no longer involves a firing squad or hangman---it now involves IV access, the administration of sedatives and narcotics, and the need for medical oversight of such an undertaking (no pun intended). During tonight's show on PBS, a nurse from Georgia who participates in executions was interviewed about her experience. In her descriptions of the executions in which she takes part, she carefully stated that she does not see herself---nor the anesthesiologists who actually push the plungers---as executioners. She sees the execution team as a group of professionals carrying out orders, the "executioner" actually being "The State". This Kafkaesque denial of responsibility was difficult for me to swallow, as was a doctor's statement that by solely overseeing the heart monitor and vitals of the "patient", he was not actually participating in the execution, rather, he was advocating for the prisoner and assuring that no undue suffering was occuring.

To wit, the AMA states clearly that a doctor "should not be a participant in a legally authorized execution. Physician participation in execution is defined generally as actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner." Additionally, the American Nurses Association states that "participation in executions is considered contrary to the fundamental goals and ethical traditions of the [nursing] profession."

Taking into consideration the Hippocratic Oath of "do no harm", as well as the many pledges taken by (and professional standards imposed upon) nurses, takng active part in the carrying out of executions seems to be a contradiction of any medical code of ethics with which I am even vaguely familiar. Reading the AMA position statement, even consulting with the administering personnel would be a violation of the physician's role as healer. That said, some doctors' defense of the practice---and continued participation in such---has led to proceedings and investigations, although whether licenses have actually been revoked is unknown to this writer.

This article by Atul Gawande, MD, is certainly worthy of perusal. Dr. Gawande is firmly against the participation of any medical professionals in state-sanctioned executions of any kind, and his article was published in the March 23rd edition of NEJM earlier this year.

When considering "non-traditional" roles for doctors and nurses and other medical professionals---whether it be participation and medical oversight of interrogations at Guantanamo Bay, oversight of medical experiments on those unable to defend themselves (remember the institutions for the mentally retarded in the 20th century?), or the doctors who colluded in the Nazi experiments in the 1940s---one must bear in mind the ethical and moral issues underscored when such acts are committed by said indivduals. While there are some stellar prison healthcare facilities which offer state of the art compassionate care to the incarcerated, there are those in the shadows who, rather than contributing to the health and recuperation of the imprisoned, actually are complicit in the extinguishing of those lives.

Whether we can truthfully say that "The State"---a faceless entity---is the true executioner or not, many of our brethren and colleagues are taking part in the ending of life for reasons other than the relieving of suffering. One might argue that execution provides "closure" and relief from suffering for the loved ones of the victims of violent crime. That said, it is still a stretch---in my mind---that there is any precedent for a medical professional to take part in such an act and still truly call him- or herself a healer.


Anonymous said...

Thanks Keith,
Very thought provoking and stimulating piece. I must say I agree completely with you, and I was quite suprised that it was a nurse participating. I always assumed it was some sort of prison technician.
Reading the PBS interview with "nurse Karen" is fascinating.
It all sounds like good material to present before the next grand rounds methinks.

Anonymous said...

Hi Keith,
I was surprized too, to find out that a nurse would participate. I always thought it must be some sort of tech. So, where I work, high school educated people are trained to administer meds to menatall ill children (because they don't really see a need for only nurses to do it), but in a prison, a nurse participates (o matter how indirect) in executions.
Interesting and disturbing.

Anonymous said...

I realized that with the exception of the administration of Potassium Chloride to stop the heart, the procedure for lethal injection mimics the procedure for rapid sequence intubation, albeit with higher doses of medication.

Sedation, paralyization and then intubation.


Sedation,, paralyzation and then heart stoppage with KCL.

Took my breath away when I read it.

And I'm for the death penalty.

Talk about a mental conflict.

But I can't believe a medical/nursing professional could participate in this and was stunned to think that they do.
Makes my skin crawl, it just FEELS so wrong and against everything we work so hard to do everyday.