Issue 4 / 8 February 2016

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.”

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.

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.

3 thoughts on “Execution dilemma for supervising doctors

  1. dr roger burgess says:

    Apalling incompetence. Haven’t these people ever heard of percutaneous femoral vein puncture? Easy as falling off a log!!!!!!!!!!!!!

  2. Lee says:

    With a spin of the meaning – there are parts touting for euthanasia to be legalized– families are pressured by staff at nursing facilities & backed by the medical counterpart –for a loved one to be “medicated” to the end or medical intervention e.g.dialysis be stopped & be placed into palliative care – even when it is not their wish on their End of Life Plan thats on file. Yet it is pushed,considered their time of life to be “up” “done”not worthy of any more treatment  because it costs $$$$. Funny, isn’t it? Yet we should waste more money & time fighting for a person’s life because they’re on death row? Don’t get me wrong here , I know there have been wrongfully accused.To say these people having been convicted of the most heinous of crimes should be spared life and supported until they die naturally is just as wrong, if we continue to fight to euthanize those that truly need our protection –when health care industries name them a burden on society for taking up space or hospital beds etc. I believe we need to look at our moral reasoning when we start saying something is wrong in one area and trying to enforce it in others.Funny too, we can euthanize our pets in any county,yet for those condemned on death row,it is being botched–makes you wonder what really is going on doesn’t it.

  3. Natalie MacCormick says:

    Incidents like these botched executions are horrific and very confronting for the medical profession, and it is unsurprising that the majority of doctors would avoid any involvement. Whilst there appears to be an indication for doctors to be involved to ensure that harm and suffering are minimised during proceedings by providing appropriate technical skills and medical expertise; an execution is in direct conflict with the core ethical principles that the medical profession adhere to. We have been trained and taken oaths to uphold the doctor-patient relationship with respect to autonomy, beneficence, nonmalificence and justice; and being involved in the proceeding of an execution where the needs of the state are placed over the needs of the individual patient raises multiple ethical dilemmas. I can not see how these dilemmas can possibly be resolved. Indeed, shouldn’t we be acting as the patient’s advocate irrespective of their crimes. Our role is not to pass judgement, nor to hand out and deliver penalties.

    It appears to me that the purpose of a doctor in these circumstances is not only to minimise the suffering of the ‘patient’, but more to the point, to sanitise the experience for the witnesses.  

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