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March 4, 2007
Lots of lethal injection doings
As detailed at my main blog, there's been lots of lethal injection developments since our last class meeting. Here are links to some of my coverage at SL&P:
I plan to recap some of these developments at the start of our Wednesday class, but then we will turn to the discussion of federal death penalty issues (materials on their way).
March 4, 2007 in Execution methods | Permalink
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I think this gives Gov. Strickland a great opening to call a moratorium on the death penalty without seeming weak. With all the news going on in the country about the problems with lethal injection, Strickland can call a halt to all executions until the lethal injection mess has been sorted out either in the courts or (hopefully) the legislatures. I believe people will see this as humane instead of "soft on crime," which is the case scenario for Strickland.
Posted by: Tiffany L. | Mar 6, 2007 9:48:27 AM
Lethal Injection: Current Controversies Resolved
Dudley Sharp, Justice Matters, contact info, below
updated 5/11//07
Several issues have come up with regard to lethal injection.
Generally, they are:
1) The murderer experiencing pain during execution;
2) The ethics of medical professionals participating in executions; and
3) Proper training of execution personnel.
1) PAIN AND LETHAL INJECTION
The evidence, including the immediate autopsy of executed serial murderer/rapist Michael Ross, supports that there is no pain within the lethal injection process.
There is a concern that some inmates may be conscious, but paralyzed, during execution, because one of the three drugs used may have worn off, prior to death.
First, there is no evidence this has occurred. There is speculation.
Secondly, if properly administered, it cannot occur with the properties and amounts of the chemicals used and within the time frame of an execution.
Thirdly, no one has explained how the first drug could have worn off, within the time frame of execution. Or, how is it that the first drug was, somehow, improperly administered, but the second and third were not, when using the same lines and procedures?
An Associated Press reporter correctly stated that "there is little to support those claims except a few anecdotes of inmates gasping and convulsing and an article in the British medical journal Lancet." (AP, "Death penalty foes attack lethal-injection drug", 7/5/05)
The British Medical Journal, The Lancet, published an article critical of lethal injection (Volume 365, 4/16/05). A follow up article, by essential the same group of researchers, published a similar report in PLoS Medicine on 4/24/07.
The articles did not/could not identify one case where evidence existed than an inmate was conscious during execution.
The Lancet article identified 21 cases of execution where the level of "post mortem" (after death) sodium thiopental was below that used in surgery and, therefore, may suggest consciousness was possible.
A more accurate description would be all but impossible.
A "long after execution" post mortem measurement of sodium thiopental is very different from a moment of death measurement.
Dr. Lydia Conlay, chair of the department of anesthesiology, Baylor College of Medicine (Texas Medical Center, Houston) said the extrapolation of postmortem sodium thiopental levels in the blood to those at the time of execution is by no means a proven method. "I just don't think we can draw any conclusions from (the Lancet study) , one way or the other."
Actually, we can. The science is well known. Sodium thiopental is absorbed rapidly into the body. Long after execution blood testing of those levels means absolutely nothing with regard to the levels at the time of execution. Nothing.
The Lancet article did not dispute the obvious -- for executions, the sodium thiopental is administered in dosages roughly 10-20 times the amount necessary for sedation unconsciousness during surgical procedures.
Unconsciousness occurs within the first 30 seconds of the injection/execution process. The injection of the three drugs takes from 4-5 minutes. Death usually occurs within 6-7 minutes and is pronounced within 8-10 minutes.
The researchers also failed to note the much lower probability (impossibility?) that the murderer could be conscious, while all three drugs are coursing through the veins, concurrently.
Despite the Lancet article's presumptions and omissions, there is no scientific evidence that consciousness could occur with the amounts and methods of injecting those three chemicals within the execution period.
The AP article also stated that "They (death penalty opponents) also attack lethal injection by saying that the steps to complete it haven't been reviewed by medical professionals."
That is both deceptive and irrelevant.
The unchallenged reality is that medical professionals have both reviewed and implemented injection procedures for decades. The same procedures are used in executions. Criminal justice professionals have been trained in this application.
Does anyone not know this?
The chemicals used in lethal injection, as well as their individual and collective results, at the dosages used, are also well known by medical and pharmacology professionals. And this?
Dr. A. Jay Chapman, the former Oklahoma Medical Examiner, who created the protocol, consulted a toxicologist and two anesthesiologists. He states the obvious " ' . . .it didn't actually require much research because the three chemicals - a painkiller, a muscle-paralyzing agent and a heart-stopper - are well-known to physicians.' 'It is anesthetizing someone for a surgical procedure, but simply carried to an extreme.' 'If it is competently administered, there will be no question about this business of pain and suffering.' "("Lethal Injection Father Defends Creation", Paul Ellias, Associated Press, 5/10/07)
Further, lethal injection is not a medical procedure, but the culmination of a judicial sentence carried out by criminal justice professionals, the result of which is intended as death, the outcome of every case.
The follow up research/article is "Lethal Injection for Execution: Chemical Asphyxiation?"(Public Library of Science (PLoS) Medicine, 4/24/07). Dr. Koniaris was an author in both this and the Lancet article.
The question mark from the title says it all.
From the Conclusion:
" . . . our findings suggest that current lethal injection protocols "may" not reliably effect death through the mechanisms intended, indicating a failure of design and implementation. "If" thiopental and potassium chloride fail to cause anesthesia and cardiac arrest, potentially aware inmates "could" die through pancuronium-induced asphyxiation." (Underline, quote and color change are mine, for emphasis)
In other words, the authors tell us they cannot prove this has ever happened. They are speculating.
Skip the speculation: Some Reality
From Hartford Courant, "Ross Autopsy Stirs Execution Debate----Results Cited To Counter Talk Of Pre-Death Pain", August 11, 2005
The below is a paraphrase of parts of that article, including some exact quotes.
Results of the autopsy done on serial killer Michael Ross are being cited by several prominent doctors to refute a highly publicized article that appeared in The Lancet, the British medical journal, in April, 2005.
Critics of the Lancet article say it does not account for postmortem redistribution of the anesthetic - thiopental. The redistribution, the critics say, accounts for the lower levels of thiopental on which Dr. Koniaris based his Lancet article conclusions that the levels of anesthetic were inadequate. The Ross autopsy results document this redistribution, bolstering the critics' assertions.
Dr. H. Wayne Carver II, Connecticut's chief medical examiner, was aware of the controversial Lancet article before performing the Ross autopsy. As a result, he took the additional step of drawing a sample of Ross's blood 20 minutes after he was pronounced dead at 2:25 a.m. May 13. Carver took a subsequent sample during the autopsy, which began about 7 hours later, at 9:40 a.m.
The 1st sample showed a concentration of 29.6 milligrams per liter of thiopental; the second sample showed a concentration of 9.4 milligrams per liter. The 1st sample was drawn from Ross' right femoral artery, and the second from his heart, which can account for some of the discrepancy. But Dr. Mark Heath, a New York anesthesiologist and one of the numerous doctors who have signed letters to The Lancet challenging the Koniaris article, said it clearly substantiates the postmortem redistribution of the thiopental.
Dr. Jonathan Groner, a pediatric surgeon from Ohio said he interviewed a number of forensic toxicologists before adopting the view that thiopental in a corpse leaves the blood and is absorbed by the fat, causing blood samples taken hours after death to be an unreliable marker of the levels of thiopental in the body at the time of death.
Groner described the Ross autopsy results as "a powerful refutation" of the Lancet-Koniaris study.
Dr. Ashraf Mozayani, a forensic toxicologist with the Harris County Medical Examiner's Office in Texas, said the level of thiopental "drops quite a bit" after death. Even in the living, Mozayani said, thiopental levels decline rapidly after administration of the drug. She cited one study in which a patient was administered 400 milligrams of thiopental intravenously. After two minutes the concentration in the blood was measured at 28 milligrams, but dropped to 3 milligrams concentration 19 minutes after the anesthetic was injected.
Mozayani said the declining concentration of thiopental cited in the Ross autopsy report "make sense."
On The Lancet article, she said, "I don't think they have the whole story - the postmortem redistribution and all the other things they have to consider for postmortem testing."
NOTE: I think that had and knew the whole story. They just didn't include it in their report(s).
The Veterinary sidetrack
Opponents of the death penalty, as well as other uninformed or deceptive sources, have been stating that even vets do not use the paralytic agent in the euthanasia of animals. This is a perversion of the veterinary position, which actually provides support, however unintended, for the human execution process.
Some fact checking is in order -- www(dot)avma.org/issues/animal_welfare/euthanasia.pdf
2. THE MEDICAL/ETHICAL DILEMMA
Medical groups cite that there is an ethical conflict for participation in the lethal injection process, because medical professionals have a requirement to "do no harm".
Those ethical codes pertain to the medical profession, only, and to patients, only. Judicial execution is not part of the medical profession and death row inmates are not patients.
Doctors and nurses can be police and soldiers and can kill, when deemed appropriate, within those lines of duty and without violating the ethical codes of their medical profession. Similarly, medical professionals do not violate their codes of ethics, when acting as technical experts, for executions, in a criminal justice procedure.
Physicians are often part of double or triple blind studies where there is hope that the tested drugs may, someday, prove beneficial. The physicians and other researchers know that many patients, taking placebos or less effective drugs, will suffer more additional harm or death because they are not taking the subject drug or that the subject drug will actually harm or kill more patients than the placebo of other drugs used in the study.
Physicians knowingly harm individual patients, in direct contradiction to their "do no harm" oath.
For the greater good, those physicians sacrifice innocent, willing and brave patients. Of course, there have been medical experiments without consent and, even, today, they continue ("Critical Care Without Consent", Washington Post, May 27, 2007; Page A01).
The greater good is irrelevant, from an ethical standpoint, if "Do no harm" means "do no harm". Physicians knowingly make exceptions to their "do no harm" requirement, every day, within their profession, where that code actually does apply. And, they should.
The "do no harm" has no ethical effect in a non medical context, because this ethical requirement is for medical treatments, only, and for patients, only.
The acknowledged anti death penalty editors of The Public Library of Science (PLoS) Medicine agree. They write:
"Execution by lethal injection, even if it uses tools of intensive care such as intravenous tubing and beeping heart monitors, has the same relationship to medicine that an executioner's axe has to surgery." ("Lethal Injection Is Not Humane", PLoS, 4/24/07)
The PLoS Medicine editors have made the same point many of us have been making - similar acts and similar equipment do not establish any equivalence or connection.
There is no connection between medicine and lethal injection, therefore there is no ethical prohibition for medical professionals to participate in executions.
To put it clearly: The execution of death row inmates is not equivalent or connected to the treatment of patients.
Is this a mystery?
Obviously, execution is not a medical treatment, but a criminal justice sanction. The basis for medical treatment is to improve the plight of the patient, for which the medical profession provides obvious and daily exceptions. The basis for execution is to carry out a criminal justice sentence where death is the sanction.
Justice, deterrence, retribution, just punishments, upholding the social contract, saving innocent life, etc., are all recognized as aspects of the death penalty, all dealing with the greater good.
Are murderers on death row willing participants? Of course. They willingly committed the crime and, therefore, willingly exposed themselves to the social contract of that jurisdiction.
Lethal injection is not a medical procedure. It is a criminal justice sanction authorized by law. Therefore, there is no ethical conflict with medical codes of conduct and medical personal participating in executions.
40,000 to 100,000 innocents die, every year, in the US because of medical misadventure or improper medical treatment. (1)
Do no harm? The doctor doth protest too much, methinks.
There is no proof of an innocent executed in the US since 1900.
3. PROPER TRAINING
In every state, there are hundreds or thousands of people trained for IV application of drugs or the taking of blood. Even many hard core drug addicts are proficient in IV application.
There may be only 1 or 2 times where personnel error may have led to problems in the lethal injection process. That is out of nearly 900 lethal injections in the US.
It appears that some 500-1000 innocent patients die, every year, in the US, due to some type of medical misadventure, with anesthesia. (1)
Do no harm? Glass house. Stones.
I am unaware of evidence that shows criminal justice professionals are more likely to commit some error in the lethal injection process than are medical professionals in IV application.
Furthermore, even with errors in lethal injection, those cases resulted in the death of the inmate - the intended outcome for the guilty murderer.
In the errors of medical professionals, we are speaking of a large number of deaths and injuries to innocent patients - the opposite of the intended outcome.
1) see "Deaths from Medical Misadventure"at
www(dot)wrongdiagnosis.com/m/medical_misadventure/deaths.htm
and
"Health Grades Quality Study: Patient Safety in American Hospitals, July 2004"
www.(dot)healthgrades.com/media/english/pdf/HG_Patient_Safety_Study_Final.pdf
originally written May, 2005. Updated as merited.
copyright 2005-2007
Dudley Sharp, Justice Matters
e-mail sharpjfa(at)aol.com, 713-622-5491
Houston, Texas
Mr. Sharp has appeared on ABC, BBC, CBS, CNN, C-SPAN, FOX, NBC, NPR, PBS and many other TV and radio networks, on such programs as Nightline, The News Hour with Jim Lehrer, The O'Reilly Factor, etc., has been quoted in newspapers throughout the world and is a published author.
A former opponent of capital punishment, he has written and granted interviews about, testified on and debated the subject of the death penalty, extensively and internationally.
Pro death penalty sites
homicidesurvivors(dot)com/categories/Dudley%20Sharp%20-%20Justice%20Matters.aspx
www(dot)dpinfo.com
www(dot)cjlf.org/deathpenalty/DPinformation.htm
www(dot)clarkprosecutor.org/html/links/dplinks.htm
joshmarquis(dot)blogspot.com/
www(dot)lexingtonprosecutor.com/death_penalty_debate.htm
www(dot)prodeathpenalty.com
www(dot)yesdeathpenalty.com/deathpenalty_contents.htm (Sweden)
www(dot)wesleylowe.com/cp.html
Permission for distribution of this document is approved as long as it is distributed in its entirety, without changes, inclusive of this statement.
Posted by: Dudley Sharp | Sep 6, 2007 8:35:34 PM
What is perverse here is Mr. Sharp's convoluted logic. From the physician's oath "do no harm" he argues that means patients only. Never mind that the oath of Hippocrates makes no such distinction, by that standard Dr. Mengele violated no medical ethical rules by lending his professional talents to the Nazi government in determining who would be a fit person to survive and who should be exterminated at Auschwitz. Nor did the German doctors who were employed in administering the necessary amount of cyanide in the shower rooms or the so-called medical experiments on live human beings. By Mr. Sharp's logic, no problema, these were not patients of the doctors, so they could have their way with them . Mr. Sharp would probably argue with equal facility that a priest or nun could ethically accept employment in a brothel, as the their oath is to their church, not to the brothel owners of the world. If intravenous tubing and heart monitors have the same relationship to medicine as an executioners axe has to surgery in Mr. Sharp's rather discombobulated way of thinking, God forbid he tell us what he thinks the relationship between human kindness and beastiality might be. None at all perhaps?
For all his thirst for blood, Mr. Sharp overlooks one simple historical fact. Capital punishment was never intended for the enjoyment of people like him; it was intended to terrify the citizens by a graphic example of what awaited them for offending the majesty of the Sovereign and the State.
Posted by: RFM | Nov 6, 2007 3:27:06 PM
The Hippocratic oath is absolutely specific to medecine.
The Oath
By Hippocrates
Written 400 B.C.E
I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
Posted by: Dudley Sharp | Jan 17, 2008 5:34:25 AM
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