Julian Savulescu, Janet Radcliffe-Richards
[Referring to Sinmyee et al] This seems to us to be an important, landmark paper. This is because the issues it addresses are important in their own right: how to ensure death without suffering in jurisdictions where assisted dying (including assisted suicide or euthanasia) is allowed, and also, because the technicalities are the same, in cases of capital punishment by lethal injection. Moreover, the paper shows the potential for the use of anaesthesia in contexts beyond surgery. Anaesthesia in its ordinary uses is intended to facilitate surgery designed to restore a patient to improved health and functioning. In assisted dying, however, there is no question of restoring health. The proposition is to use anaesthesia primarily to prevent suffering in a patient who is about to die and, in this sense, places anaesthesia on a new footing as a primary medical intervention, serving a purpose in its own right.
Savulescu J, Radcliffe-Richards J. A right to be unconscious. Anaesthesia. 2019 May; 74(5): 557-559
Lynn A. Jansen, Steven Wall, Franklin G. Miller
Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.
Jansen LA, Wall S, Miller FG. Drawing the line on physician-assisted death. J Med Ethics. 2019;45:190-197.
Oklahoma wants to go where no state has gone before: Executing death row inmates with nitrogen gas. Officials say nitrogen will bring quick, painless deaths, but the research is slim — and it has never been used in U.S. executions.
The case for nitrogen hypoxia sounds simple. Nitrogen is already in the air we breathe, but, as long as humans get the right mix, nitrogen is safe. The state wants to make death row inmates breathe pure nitrogen.
State Sen. Ervin Yen, R-Oklahoma City, is a cardiac anesthesiologist who signed his name to the bill that made nitrogen hypoxia a legal execution method in 2015. He says the inmates would die from “lack of oxygen,” not exposure to nitrogen. . . [Full text]
Lethal medication provisions are in a precarious state. Over the past decade, pharmaceutical companies have attempted to stamp out the use of their drugs in executions, creating several economic and regulatory hurdles for access to these medications. As a result, patients seeking physician-assisted suicide (PAS) as well as death penalty states aiming to execute their capital offenders have been forced to turn to unregulated and dangerous alternatives for these drugs. This note attempts to unpack the quality, safety, and access issues emerging from these recent changes and to explore the implications for the future of these practices.
In order to fully grasp the exact mechanisms at work, this note will first offer a brief pharmacological description of the lethal medications and detail many technical aspects of their use. The next section provides a historical account of the past decade, illustrating the emergent quality, safety, and access issues. This note then evaluates the competing notions of ‘botched’ executions and ‘complications’ in PAS while analysing the standards set forward to measure safety and efficacy for each. Finally, this note closes by exploring the future of each practice in light of our discussion.
Riley S. Navigating the new era of assisted suicide and execution drugs. Journal of Law and the Biosciences. Volume 4, Issue 2, 1 August 2017, Pages 424–434, https://doi.org/10.1093/jlb/lsx028
I had seen people die, but I had never watched a person be killed—until I moved to Texas. It was a warm day in September 2014 when my editor sent me to death row in Huntsville. I had joined the Dallas Morning News as a reporter that summer, never expecting my job to land me in a small, musty room overlooking an execution chamber.
Through green metal bars and a window, I watched Lisa Ann Coleman lying on a crucifix-shaped gurney, yellow leather straps wrapped around her arms and legs. Coleman, a 38-year-old African American woman, was scheduled to die at 6 PM for the murder of a 9-year-old boy in 2004. A microphone hung from the ceiling of the execution chamber and hovered an inch or two above her round brown face. . . [Full text]
The American state of Arkansas executed four prisoners in April. They were given a lethal injection with a three-drug cocktail, a procedure which requires some medical skills. Should doctors take part in such executions?
The consensus amongst medical ethicists is No. The American Medical Association insists that participation violates a fundamental principal of medicine: do no harm. However, many of the 31 states with capital punishment require the presence of a doctor during the execution.
In an unusual intervention in the bitter debate, cardiologist Sandeep Jauhar has written an op-ed in the New York Times arguing that the presence of doctors is ethical. . . [Full text]
New York Times
On Thursday, Arkansas executed a 51-year-old convicted murderer named Ledell Lee, the first of four prisoners the state intends to execute by the end of the month. That would set a pace rarely if ever matched in the modern history of American capital punishment. The state’s rationale for its intended spree is morbidly pragmatic: The stock of one of its three execution drugs, the sedative midazolam, will expire at the end of April.
The three drugs in Arkansas’s execution protocol — midazolam; vecuronium bromide, a paralytic used during surgery that halts breathing; and potassium chloride, which stops the heart — are administered intravenously. The execution procedure therefore requires the insertion of catheters, controlled injection of lethal drugs and monitoring of a prisoner’s vital signs to confirm death. This makes it important that a doctor be present to assist in some capacity with the killing. . . [Full text]
Study published in Liver International examined the outcomes of 564 transplantations at Zhejiang University’s First Affiliated hospital in China
A prestigious medical journal will retract a scientific paper from Chinese surgeons about liver transplantation after serious concerns were raised that the organs used in the study had come from executed prisoners of conscience.
The study was published last year in Liver International. It examined the outcomes of 564 liver transplantations performed consecutively at Zhejiang University’s First Affiliated hospital between April 2010 and October 2014.
According to the study authors, “all organs were procured from donors after cardiac death and no allografts [organs and tissue] obtained from executed prisoners were used”. . . .[Full text]
New York Times
One of the core pillars of medicine is “do no harm.” So how do the physicians who take part in the American institution of capital punishment rationalize their involvement? This film profiles Carlo Musso, a doctor who contemplates his moral compass as he participates in executions, though he personally opposes capital punishment. . . .[Full text]
Pfizer Inc. – the pharmaceutical giant – has taken a bold stance against the use of its drugs for executions, one that will please many progressive opponents of the death penalty.
The drug company announced the following policy: If a government agency wants Pfizer to supply it with drugs of kinds sometimes used in (or considered for use in) lethal injections, it will have to certify that it is buying the drugs for medical, not punitive, use, and that it won’t resell them. Pfizer also said it will “act upon findings that reveal noncompliance.”
Thus, in practical terms, the policy will function as a ban on the use of Pfizer drugs in executions. . . [Full Text]