Execution dilemma for supervising doctors

WHEN Clayton Lockett was executed by lethal injection in Oklahoma in 2014, nothing went according to plan.

The 38-year-old – sentenced to death for a brutal murder and rape committed in 1999 – took 43 minutes to die, while repeatedly struggling, moaning and apparently trying to speak, witnesses revealed.

That was after the administering paramedic and the doctor who took over from her had spent almost an hour trying to insert an IV line to deliver the lethal drugs, causing at least 16 puncture marks in the condemned man, according to media reports.

“I said … you’ve hit the artery,” the paramedic revealed in court documents reported in the Guardian.

“[The doctor said:] ‘Well, it’ll be all right. We’ll go ahead and get the drugs.’ [And I said:] ‘No. We can’t do that. It doesn’t work that way’... I mean I wasn’t trying to countermand his authority but he was a little anxious … I don’t think he realised that he hit the artery and I remember saying, ‘You’ve got the artery’. We’ve got blood everywhere.”

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The corrections director called off the botched execution about 30 minutes after the injection of the sedative midazolam, the first of three drugs used in the execution.

No attempt was made to revive the, by then, unconscious Lockett, who died 10 minutes later.

Lockett’s is one of a string of botched executions in the US in recent years. In part, that’s due to the increasing difficulty authorities face in getting the drugs required.

With the European Union banning export of drugs for use in capital punishment, and many pharmaceutical companies also seeking to distance themselves from the practice, American authorities have been forced to use whatever drugs they can get, from whatever sources.

As The Atlantic spells out, drugs have been substituted without proper evidence of efficacy and have often been obtained from unorthodox sources, including illegal imports.

In Oklahoma, authorities paid for more than US$50 000 worth of drugs from petty cash to avoid leaving a paper trail, reporter Katie Fretland discovered.

If all that is not shady enough, high-profile reversals of death sentences – such as that of Anthony Ray Hinton released last year after 30 years on death row – are also contributing to increased debate about capital punishment in the US.

The participation of doctors in executions has long been controversial.

Some argue that, as long as capital punishment exists, the participation of doctors is essential to minimise suffering.

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Boston anaesthetist Dr David Waisel, for example, has written: “I argue that it is honourable for physicians to minimize the harm to these condemned individuals and that organised medicine has an obligation to permit physician participation in legal execution.”

The American Medical Association disagrees, stating in its code of ethics: “A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.”

North Carolina is one of 31 US states to still impose the death penalty, but it has not actually executed anyone since its medical board ruled in 2007 that participating doctors could be subject to disciplinary action.

With doctors refusing to supervise executions, the state legislative bodies last year passed a “Restoring Proper Justice Act”, removing the requirement for physician involvement.

Executions in the state can now be supervised by a range of other health professionals, including nurses, physician assistants, paramedics and emergency medical technicians.

A doctor is still required to certify death, a role that is not prohibited by the American Medical Association.

Supervising executions may, of course, put those other health professionals in conflict with their own professional codes of ethics, as the Journal of Medical Ethics points out.

It remains to be seen how authorities in North Carolina will deal with that if it happens.

Jane McCredie is a Sydney-based science and medicine writer.