The New England Journal of Medicine recently conducted a panel discussion on the issue of Physicians and Execution. The panel members consisted of a general surgeon as the moderator (Dr. Atul Gawande from the Brigham and Women’s Hospital in Boston, a notable author)1, a law professor (Deborah W. Denno, Ph.D., J.D.), and two anesthesiologists (Dr. Robert Truog and Dr. David Waisel). As individuals who know the science and have researched the ethics behind the topic of execution, one should duly consider their opinions.

Dr. Waisel outlined that the typical lethal concoction consists of 3 drugs. The first drug, sodium thiopental, is a barbituate whose aim is “to put you to sleep, create amnesia and anesthesia.” The second drug, pancuronium bromide, causes muscle paralysis. While anesthesiologists often use both of these drugs to sedate patients in the operating room, the lethal injection doses are necessarily much larger. The third and final drug, however, is not part of a doctor’s toolbox. Potassium chloride “rapidly stop[s] the heart,” and it represents the proverbial nail-in-the-coffin, ensuring a speedy death.

The experts mentioned that the paralytic agent raises ethical concerns, because it may mask the true state of comfort of the inmate during the execution, and it may be painful, itself. In fact, Professor Denno notes that the primary purpose of the pancuronium bromide is “to enhance the dignity of the inmate who’s dying, because without pancuronium, there might be some jerking or involuntary movements that would disturb some of the witnesses.” Both Professor Denno and Dr. Truog voiced objections to the paralyzing agent because, while it may render the spectacle of death more tolerable for witnesses, it may introduce unnecessary pain for the prisoner, as it is not a vital component of the lethal injection.

The discussion shifted to the role of physicians in the execution process. Dr. Gawande cited the fact that only phlebotomists and EMTs carry out executions in Kentucky, because physicians in that state objected to the life-taking role. Consequently, Dr. Gawande noted that the failure rate of executions — when something goes wrong — in Kentucky could be as unthinkably high as 5%. Accordingly, there was a consensus that the act of administering the lethal injection is actually a rather difficult maneuver, requiring high precision and extensive medical experience — the unique skills of the physician.

Although Dr. Truog objects to capital punishment, he offered one of the most compelling statements, with which I will conclude this summary:

If I think of the kind of a hypothetical where you have an inmate who is about to be executed and knows that this execution may involve excruciating suffering, that inmate requests the involvement of a physician, because he knows that the physician can prevent that suffering from occurring, and if there is a physician who is willing to do that, and we know from surveys that many are, I honestly can’t think of any principle of medical ethics that would say that that is an unethical thing for the physician to do.

Footnotes:
(1) Dr. Gawande is also involved in the breast carcinoma research I do at the MGH.