Since 1977, the method of execution in the United States has increasingly become by lethal injection, hailed by proponents as a “humane” methodology.  We now know that this is not the case (Liptak, NYT, 10/7/2003).  We also know that lethal injection causes severe ethical issues for medical personnel necessarily involved with the process.

Chemical Problems

In most states three chemicals are used for lethal injection: Sodium thiopental, pancuronium bromide, and potassium chloride.  The first of these is  considered an ultra-short-acting bromide which is effective as an anesthesia for just a few minutes.  The second, pancuronium bromide, marketed as Pavulon, paralyzes the skeletal muscles without affecting the nerves or brain.  The individual injected with Pavulon is conscious without being able to move or speak, thus giving the impression of serenity or tranquility.  In the state of Tennessee, it is a crime for veterinarians to use this drug in euthanizing pets.  The final injection, potassium chloride, stops the heart while causing excruciating pain.  The effect of this “cocktail,” according to testimony by Dr. Mark J.S. Heath who teaches anesthesiology at Columbia, is “that the sodium thiopental can be inadequate or wear off”…leaving “the prisoner conscious, paralyzed, suffocating and subject to extreme pain from the potassium chloride” (Liptak, NYT, 10/7/2003).

According to Judge Ellen Hobbs Lyle, “The subject gives all the appearances of a serene expiration when actually the subject is feeling and perceiving the excruciatingly painful ordeal of death by lethal injection…the Pavulon gives a false impression of serenity to viewers, making punishment by death more palatable and acceptable to society” (Liptak, NYT, 10/7/2003).

Ethical Problems

In addition to the chemical problems, there are medical ethics problems with lethal injection.  According to the AMA, physicians “should not be a participant in a legally authorized execution.”  This includes injecting drugs, inspecting injection devices, supervising staff who perform injections, ordering lethal drugs, selecting intravenous sites and placing intravenous lines (particularly necessary in inmates who have been drug abusers and thus have poor veins), monitoring vital signs and pronouncing the prisoner dead (Groner, BMJ, 11/2/2002).  In addition to the AMA, the American Nurses Association is “strongly opposed” to participation in executions because it is “contrary to the fundamental goals and ethical traditions of the profession (press release, 12/8/1994 ).

References

www.ama-assn.org Policy files E-2.06 Capital Punishment

Goner, Jonathan I, bmj.com, Volume 325, November 2, 2002 or gronerj@chi.osu.edu

Liptak, Adam, The New York Times, October 7, 2003