Steve Barnes
From Cyberlaw
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March 21, 2006
The New England Journal of Medicine has an article about doctors participating in lethal injections NEJM. Some doctors, like "some" of every profession, have fairly simple reasons for doing such things: the prisoner was an "animal" to his victims, so put him to sleep like an animal. But read Dr. C's reasoning. Pretty much along the lines of my earlier entry in this journal. And, per Dr. C, if the death penalty is the legal equivalent of cancer, is it so wrong for an MD to make sure that that "cancer" patient isn't in agony? Perhaps those who disagree would prefer Utah's option of firing squad. Me? I'd prefer the death penalty to be outlawed so the controversy would fade away. What then, though? Is hard labor inhumane? Should a doctor treat prisoners whose prison beatings and rapes are the result of a faulty prison system? Doesn't that just patch 'em up to be tortured again? Does anyone see my point, or is this just some hard-wiring of mine leftover from the medical trenches?
I think it's too easy to say, "doctors should walk away." I think the AMA shirked its responsibility here by walking away. "It's ethical to confirm death once pronounced in a DP case, but unethical to pronounce the death first." What the?
My AMA: blocking alternative medicine, apparently preventing surgeons from enforcing a patented procedure, responsible for decreasing fees paid to procedural medicine while jacking up the fees for "thinking" (well Mrs. Jones, you have high blood pressure...we can't do jack for its long-term effects, but I thought of it--that'll be $350), spinning faulty and premature science re: the supposed inability of HIV virus to infect via saliva (it can be transmitted this way after all), mandating that health care providers risk their lives with hepatitis and HIV because "universal precautions will protect you" and thus ignoring the 5% incidence of needle-stick injuries during surgery and 30% incidence of faulty glove manufacturing that results in holes visible adn invisible to the naked eye in surgical gloves...the list goes on and on. That's not my version of an AMA.
March 5, 2006
I hope if dogs ever take over the world, and they choose a king, they don't just go by size, because I bet there are some Chihuahuas with some good ideas. Small business protection by Bayh-Dole act.
February 24, 2006
Apparently the neurotransmitters were all in alignment last night, as I actually had a good time at Bar Review. However, said NTs are sluggish today. Foiled by fermentation biotechnology! Go figure.
February 22, 2006
I've been absent from the Wiki for a while; lots of things going on in the background. I did read Jackie's entry regarding the anesthesiologists refusing to monitor a death penalty in California. This brings up my good friend (and co-intern and resident from Hopkins) Lenny Koniaris. Lenny is now an academic surgeon at Miami. He caused quite a stir last April with his article concerning the possible (if not probable) lack of anesthesia during lethal injections. I remember proof-reading this paper for him, and I so very much wanted to discuss it in my Criminal Law class at the time (but was sworn to secrecy until publication.) A reference to the Lancet article can be found here: Death Penalty, and I think I have the full paper on my desktop somewhere, if anyone is interested.
What's notable about the paper, beside the concern for awake yet chemically paralyzed lethal injection recipients, is the buttoning up of the criminal justice system regarding their LI protocols, the lack of medical input in these protocols (dosages, etc.) and the cavalier attitude of a gadfly anesthesiologist who, when commenting on this study, guarantees us that no LI recipient has ever been awake. That sort of guarantee reminds me of Barefoot v. Estelle in my Evidence casebook, where two psychiatric "experts" for the State of Texas testified, one with absolute certainty, that the defendant would kill again. This despite the fact that the leader in the field (relied upon by one of the State experts) had previously stated that shrinks are correct only 1/3 of the time when predicting future violence in a patient.
Be that as it may, I am still on the fence regarding the anesthesiologists in California. Yes, the AMA, etc. etc. states that their participation would be unethical. The AMA is also against doctor assisted suicide (certainly counter to their "duty to the patient" in a broad sense) and the AMA until recently has denigrated other health care fields such as osteopathy, chiropracty, nurse practitioners, and alternative medicine. Of course, the AMA is now on board in all of these fields since the Medical Lord recognized that money was being lost despite their attempts to squelch such practices. We're all friends now, right? So in short, don't look to the AMA for some objective eye on such matters as participation in LI. If the powers that be feel that MD participation in LI (or doctor assisted suicide) may hurt the reputation of the guild, they will of course shy away.
In my opinion, the real resolution lies beyond what certain organizations have to say. And any resolution will involve intellectual and ethical struggle. We put criminals to death by LI all the time, sans physicians. We now know that some of these criminals may be suffering even while appearing "out of it" (paralyzed). California, in response to the Lancet article, wants to have a couple of MDs come in and make sure the patient doesn't suffer. Well, do I as the MD walk away from this, leaving the criminal to suffer, or do I enter the arena and at least make sure he's properly sedated? The struggle is complicated because those not accustomed to the intricacies of LI conflate what are procedures into one procedure. It is not a lethal injection, really. It is an injection of a sedative, followed by a paralytic, followed by potassium to stop the heart.
Is it wrong for an MD to insure that the sedative portion is correct? Can't he leave thereafter, before the true "lethal" injection (potassium) takes place? Would it be wrong or unethical to give a prisoner a boat load of valium in the days leading up to LI to take the edge off of impending doom? Would you give props to a clergyman who refused to speak with a prisoner prior to execution, or administer last rights, because his "duty" is to protest tooth and nail for the prisoner? And what was with the balking over ethics if the patient "woke up" or was in pain? It would be unethical to do what...put him back to sleep? And why the sudden change of heart? If this was truly about ethics, why did this duo volunteer (they were court-appointed after defense counsel (Kenneth Starr no less) obtained the MD's OK) for the job in the first place? Conspiracy theorists may say they planned it all along--to wait until the last minute and protest, maximizing media attention. But trust me when I say that an MD under a court order is like a deer in the headlights...such a ruse isn't within the legally risk-averse MD paradigm. No, I think they balked due to a blossoming concern (media? friends? employers?) over a "bad name" or potential political damage to the Battleship Medicus.
I am attempting to describe another viewpoint to that where the MD walks away (from his patient...from his duty?) to great applause. The prisoner is now awake yet paralyzed. His heart seizes, but only after his mind and pain receptors tell him that he can't breathe, he can't cry out.... Remember that MDs are not required at an LI. I doubt that California will ask for any other MD volunteers after this episode, so we're back to Lenny's study and potential suffering. LIs will occur with or without the AMA, or anesthesiologists, or the Grand Wizard of Medicine rubber stamps. Try to understand another view: eliminate the death penalty entirely, or at the very least make sure that the alleged "humane" lethal injection is indeed "humane." And as for "duty"...what if the prisoner met the MD beforehand and said, "doc, just make sure I'm asleep." Does the MD walk away? Where does "do no harm" alight in a scenario where, inevitably, the patient will die? If you think you know the answer, try treating cancer patients as a career.
Frankly, my old cat got more of a dose of pentobarb on a pound for pound basis than some of these prisoners. And of course, Cali's alternative to the MD was a massive dose of barbiturates, a procedure that does work for cats, but alone is undesirable in a human (we pronounce death in an LI by a flatline EKG and that may take an hour or more with an overdose of barbs). Assuming that MD walk-outs will not foreclose the death penalty, I would hope that somebody with medical knowledge would at least insure that a human being has the same luxury of sedation as an animal.Doc 02:28, 22 February 2006 (EST)
