Fritzroy Sterling

NEW YORK, Jul 31 2006 (IPS) — When Stanley “Tookie” Williams was strapped to a gurney awaiting his execution last December, things did not go as planned. California executioners had trouble finding a suitable vein in which to inject a lethal combination of drugs.

What happened next, medical professionals say, was probably a botched job that ultimately resulted in excessive and unnecessary pain for an additional 12 minutes.

Williams’ probable inhumane death, which would be in violation of the U.S. constitution, was not the only one, according to doctors’ groups and rights organisations that have studied executions.

Death row inmates this year have challenged the humaneness of the lethal series of drugs meant to kill them. Courts in California and Missouri have ruled that without the presence and participation of a qualified medical professional, the executions cannot proceed.

Doctors and anesthesiologists, however, increasingly are refusing to help on the grounds that they have signed an oath prohibiting them from doing harm.

“Much of medical science is guided by a principle to first do no harm,” Dr. Jonathan I. Groner, a clinical associate professor of surgery at Ohio State University’s College of Medicine and Public Health, told IPS. “Physicians have an obligation to heal when they can and to comfort when they cannot.”

The Hippocratic Oath, signed by all medical professionals in the U.S., reads, “I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel.” Without their help, however, the state must find another way to humanely kill prisoners – or abolish capital punishment.

“Lethal injection procedures cannot survive without the intervention of medical professionals,” said Dr. Groner, who has written extensively about capital punishment and medical ethics. “It requires vascular access – someone to infuse chemicals into the veins, which is a medical procedure.”

Groner said doctors dedicated to the basic tenets of the Hippocratic Oath are thrust into an ethical and moral dilemma: Can the professional sworn to protect patients now work to ensure a painless death of those same patients? Is it not in the best interest of the patient to die without severe suffering?

Medical science is ethically bound to distance itself from lethal injections and capital punishment in general, but it is the only establishment qualified to come up with a way to execute criminals that is not cruel. Under the Constitution’s Eight Amendment, cruel and unusual punishment is illegal.

The Code of Ethics of the American Medical Association (AMA), the American Nursing Association (ANA), and the American Society of Anesthesiologists (ASA) strictly forbids members from participating in executions.

In 1977, an Oklahoma medical examiner with no expertise in pharmacology or anesthesia developed the current procedure for executing prisoners in the U.S. Some 35 other states quickly adopted the method. Only Nevada, whose protocol remains secret, has not, according to an April report by Human Rights Watch.

That group found that none of the states has consulted medical experts to determine if another way could be found to reduce the pain and suffering of the condemned. The report, titled “So Long as They Die: Lethal Injections in the United States,” found that the mistakes of poorly trained execution officials have caused some lethal injection procedures to exceed 30 minutes.

Logs from recent executions in California, and toxicology reports from North Carolina, suggest prisoners may have been inadequately anesthetised before being put to death, the report said. Prisoners executed by the current three-drug sequence sometimes are not knocked out with the first injection, but actually are conscious when the second medication, a paralysing agent, is administered and slowly starts to suffocate them.

They also feel “fiery pain” as the last medicine – potassium chloride – courses through their veins and kills them, the report says.

One reason corrections officials have chosen not to execute prisoners with a single massive overdose of barbiturates – even though that should provide a painless death – was because of time. Such a method would take about 30 minutes longer for the prisoner’s heart to stop beating, the report charged.

Further, it added, prison officials also have resisted eliminating the pancuronium bromide – the paralysing agent – even though using it makes it harder to tell if a prisoner is sufficiently anesthetised.

“The drug is not needed to kill the prisoner, nor does it protect him from pain. It merely is intended to keep his body from twitching or convulsing while dying. It also masks any pain the prisoner might be feeling, since he cannot move, cry out, or even blink his eyes,” the report said.

Medical professionals are not legally forbidden to participate in executions and some have indeed participated in executions beyond the basic requirement to determine or pronounce death. But professional associations forbid it.

“The ethical opinion explicitly prohibits selecting injection sites for executions by lethal injection, starting intravenous lines, prescribing, administering, or supervising the use of lethal drugs, monitoring vital signs, on site or remotely, and declaring death,” according to a July 2006 statement by AMA president Dr. William G. Plested, III.

Still, according to the Human Rights Watch report, 28 states require a physician to determine or declare death after the lethal injection procedure. Nine other states require a physician’s presence without stating the physician’s exact purpose.

As more medical professionals refuse to participate in the killing, more prisoners’ death sentences are being repealed. A California judge recently granted Michael Morales, a prisoner convicted of raping and killing a teenage girl in 1981, an indefinite stay of execution by default. Morales was scheduled to die in February, but prison officials postponed his execution after two anesthesiologists refused to participate.

U.S. District Judge Jeremy Fogel ruled that officials either had to find a qualified doctor who would participate in the execution, or execute Morales by administering an overdose of sedatives rather than infusing the usual series of three lethal drugs. When prison officials chose the overdose option, the judge required the injection to be administered by a qualified medical professional.

A similar ruling by U.S. District Judge Fernando Gaitan Jr. halted executions by lethal injections in Missouri this spring. Judge Gaitan’s ruling requires an anesthesiologist to mix the lethal drugs, administer them or oversee their administering, and monitor the inmate’s level of consciousness.

The Missouri ruling prompted the ASA to issue a statement reminding members of their ethical obligations, Dr. Orin F. Guidry, president of the ASA, told IPS.

“Once it became clear that Missouri was going to search for anesthesiologists, I wanted to make it known to all our members,” he said.

His statement read, in part, “Lethal injection was not anesthesiology’s idea… The legal system has painted itself into this corner and it is not our obligation to get it out. This is a complex subject and anesthesiology is being reluctantly thrust into the middle of it.”

The recent challenges have raised the question of whether lethal injections are at all possible without the aid of medical professionals.

Still, some death penalty opponents argue that the debate about whether doctors and medical professionals have a professional obligation to make lethal injections humane should include further scrutiny of the death penalty itself.

“There is a level of ambivalence about capital punishment,” Dr. Groner said. “As long as it looks clean and like a clinical, sanitary procedure, the American public is more than willing to accept it.”