Editorial
The
Lancet, Volume 365, Number 9468, 16 April 2005
Medical
collusion in the death penalty: an American atrocity Lethal
injection is the most common way people are legally put to death
in the USA. To be exact, this method has been used to kill 788 of
the 956 men and women who have been executed in the USA since 1976,
when the death penalty was reinstated by the Supreme Court.
Lethal
injection is supposed to be humane, and thus not in violation of
the US Constitution's Eighth Amendment proscription against "cruel
and unusual" punishment. Indeed, compared with electrocution,
gas, gunfire, or hanging, killing people with drugs seems almost
humane.
Typically,
the condemned man or woman is strapped to a chair or trolley. Two
intravenous lines are inserted, one as a back up. The lines are
kept open with saline solution. Then, at the warden's signal, the
injection team administers: first, sodium thiopental to induce anaesthesia,
then pancuronium bromide to cause paralysis, and finally a bolus
of potassium chloride to bring about cardiac arrest.
It
seems so clinical and clean. However, in a fast-track Research Letter
in this week's Lancet,
Leonidas Koniaris and co-workers report that these killings may
not be as free from cruelty as death-penalty proponents claim. The
research team obtained information from Virginia and Texas, where
since 1976 nearly half of the executions in the USA have been done.
Among the facts they learned were that neither state has a record
of how they developed their execution protocol, that the injection
teams were made up of medical technicians or individuals from medical
corps with no training in administering anaesthesia, and that there
was no assessment of the depth of anaesthesia before the paralysing
agent and potassium chloride were injected.
The
researchers also obtained toxicological reports from four other
states which indicate that post-mortem thiopental concentrations
in the blood of 43 of 49 executed inmates (88%) were lower than
those needed for surgical anaesthesia, and 21 (43%) episodes were
consistent with awareness. That is: those being executed may have
been awake. Of course, because they were paralysed, no one could
tell. It would be a cruel way to die: awake, paralysed, unable to
move, to breathe, while potassium burned through your veins.
That
is why, as Koniaris and his co-authors point out, the American Veterinary
Medical Association and 19 states, including Texas, prohibit the
use of neuromuscular blocking agents to kill animals. The authors
call for a halt to executions by lethal injection and a public review.
They also argue that because "participation of doctors in protocol
design and execution is ethically prohibited", a more effective,
humane protocol cannot be developed.
But,
ethically prohibited or not, many doctors are willing to participate
in putting people to death. 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.
Clearly,
for a substantial number of physicians, the putting to death of
condemned people is not considered contrary to the precept "first,
do no harm". What justification can there be for capital punishment
at all? The two main arguments for the death penalty are deterrence
and retribution. Few experts believe that the threat of capital
punishment is an effective deterrent. That leaves retribution. But
to justify capital punishment, the retribution must be meted out
fairly, and that is clearly not the case. In only 1% of murders
do prosecutors seek the death penalty.
Whether
you receive the death penalty depends not on what you have done,
but where you committed your crime, what colour your skin is, and
how much money you have. The use of the death penalty not only varies
from state to state (12 US states have no death penalty) but from
jurisdiction to jurisdiction within a state. Repeated studies have
shown a pattern of racial discrimination in the administration of
the death penalty.
Of
the 205 people executed for inter-racial murders in the USA, for
example, 193 were black defendants charged with killing a white
person, while only 12 were white defendants charged with killing
a black individual. 90% of defendants are too poor to hire their
own
lawyer--most rely on overworked court-appointed lawyers.
Capital
punishment is not only an atrocity, but also a stain on the record
of the world's most powerful democracy. Doctors should not be in
the job of killing. Those who do participate in this barbaric act
are shameful examples of how a profession has allowed its values
to
be corrupted by state violence.
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