Death Row Doctoring: The Dicey Medical Ethics of Prison Executions

Medscape

Seema Yasmin

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]

 

Should American doctors participate in executions?

BioEdge

Michael Cook*

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]

Why It’s O.K. for Doctors to Participate in Executions

New York Times

Sandeep Jauhaur

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]

 

Illinois controversy about legislative overreach

 Catholic bishops withdraw opposition, others remain opposed

Confrontation centres on complicity

Sean Murphy*

 Introduction

Among American states, Illinois has the most comprehensive protection of conscience legislation, the Health Care Right of Conscience Act (HCRCA). In 2009 an attempt was made to nullify the Act with respect to abortion, contraception and related procedures by introducing HB 2354 (Reproductive Health and Access Act), but the bill died in committee two years later.1 Now it appears that the HRCA may be changed by Senate Bill 1564. Critics say the bill tramples upon physician freedom of conscience,2 while the bill’s supporters, like the American Civil Liberties Union (ACLU), claim that the bill is “about making sure no one is withholding information from the patient.”3

SB 1564 was actually drafted by the ACLU,3 but it was introduced by Illinois Senator Daniel Biss. He said that the amendments were partly in response to the case of a woman who was miscarrying over several weeks, but who was refused “diagnosis or options” in the hospital where she had sought treatment.4  Senator Bliss was apparently referring to the story of Mindy Swank, who testified before a Senate legislative panel about her experience.  The Illinois Times reported that she suffered “a dangerous, weeks-long miscarriage” because of the refusal of Catholic hospitals to provide abortions.5

Unfortunately, the Illinois Senate Judiciary Committee does not record or transcribe its hearings, and conflicting news reports make it difficult to determine exactly what happened at some critical points in her story.  Moreover, it appears that the Committee did not hear from the hospitals and physicians who were involved with Ms. Swank, so we are left with a one-sided account of what took place.6

Nonetheless, as a first step in considering the particulars of the bill and the controversy it has engendered, it is appropriate to review the evidence offered to support it.  We will begin with Mindy Swank’s testimony, even if some details are lacking, and then examine the experience of Angela Valavanis, a second case put forward by the ACLU to justify SB 1564.7  [Full Text]

Tunnel vision at the College of Physicians

National Post

Sean Murphy

The College of Physicians and Surgeons of Ontario has adopted a policy requiring physicians who have moral or ethical objections to a procedure to make an “effective referral” of patients to a colleague who will provide it, or to an agency that will arrange for it. In 2008, amidst great controversy, the Australian state of Victoria passed an abortion law with a similar provision.

After the law passed, a Melbourne physician, morally opposed to abortion, publicly announced that he had refused to provide an abortion referral for a patient. This effectively challenged the government and medical regulator to prosecute or discipline him. They did not. The law notwithstanding, no one dared prosecute him for refusing to help a woman 19 weeks pregnant obtain an abortion because she and her husband wanted a boy, not a girl.

They obtained the abortion without the assistance of the objecting physician, and they could have done the same in Ontario. College Council member Dr. Wayne Spotswood, himself an abortion provider, told Council that everyone 15 or 16 years old knows that anyone refused an abortion by one doctor “can walk down the street” to obtain the procedure elsewhere.

So why did the College working group that drafted the demand for “effective referral” urge College Council to adopt a policy that so clearly has the potential to make the College look ridiculous? . . .[Full text]

Pharmacists discouraged from providing meds for lethal injection

CNN

Debra Goldschmidt

CNN)The American Pharmacists Association is discouraging its members from participating in executions. On Monday, the group voted at its annual meeting to adopt a ban as an official policy, stating that “such activities are fundamentally contrary to the role of pharmacists as healthcare providers.”

This bolsters the association’s previous positions to oppose the use of the term “drug” for chemicals used in lethal injection and to oppose laws that require or prohibit pharmacists from participation in lethal injection cases. . . [Full text]

 

Trampled rights

Catholic Register (Editorial)

Requiring doctors to remain pillars of integrity while chipping at their moral underpinning is an odious contradiction. Yet that is what the College of Physicians and Surgeons of Ontario proposes with a draconian new policy that tramples on conscience and religious rights.

The provincial regulatory body disregarded the majority view of 16,000 public submissions, dismissed the opinion of the Ontario Medical Association and the American Medical Association, and rejected the policy of the Canadian Medical Association when it voted 21-3 to force doctors to refer patients who seek treatments that their own doctor won’t provide due to moral or religious convictions. . . [Full text]

UPDATED: Ontario doctors must refer for abortions, says College of Physicians

The Catholic Register

Michael Swan

TORONTO – Despite an overwhelmingly negative response from members of the public, physicians and organizations during a three-month online consultation, the Ontario College of Physicians and Surgeons voted 21-3 to force doctors to refer for abortions, contraception and other legal treatments or procedures even if they have moral or religious objections.

A last-minute submission from the Ontario Medical Association urging the college not to force doctors to act directly against their moral or religious convictions failed to sway the governing council of the college to reconsider wording that demands doctors provide “an effective referral to another health-care provider” despite personal convictions, whether religious or moral.

The college did not provide a statistical breakdown of the 16,000 submissions it received online, other than to say that 90 per cent were from members of the public and most were against the policy. . . [Full text]

American Medical Association provides details of new freedom of conscience policy

AMA submission to Ontario College of Physicians an improvement on quality of briefing by College working group

Sean Murphy*

The American Medical Association has made a submission to the public consultation on physician freedom of conscience being conducted by the College of Physicians and Surgeons of Ontario (CPSO).  The AMA letter provides important details about a policy on physician freedom of conscience adopted by the AMA House of Delegates in November, 2014, but not due to be formally published until June of this year.

The current consultation on a controversial draft policy, Professional Obligations and Human Rights (POHR), was approved by College Council in December, 2014.  Briefing materials provided to Council members by the College working group at that time included the American Medical Association as one of the organizations selected for international comparison of policies.

However, the single sentence offered by the working group as representative of AMA policy was taken from an on-line source of short essays about medical ethics, not an authoritative source of information about AMA policy. In fact, the article was about conscientious objection among pharmacists, not about the policies of the American Medical Association concerning freedom of conscience in health care.

The letter from the AMA is a substantial improvement upon what the Protection of Conscience Project submission characterizes as the “deficient and superficial” briefing materials concerning the United States supplied to College Council in December.

. . .In the Council’s view, an account of the nature and scope of a physician’s duty to inform or to refer when a patient seeks treatment that is in tension with the physician’s deeply held personal beliefs must address in a nuanced way the question of moral complicity. The Council concurs that physicians must provide information a patient needs to make a well-considered decision about care, including informing the patient about options the physician sincerely believes are morally objectionable. However, the Council sought to clarify that requirement, holding that before initiating a patient-physician relationship the physician should “make clear any specific interventions or services the physician cannot in good conscience provide because they are contrary to the physician’s deeply held personal beliefs, focusing on interventions or services that a patient might otherwise reasonably expect the practice to offer.”

The Council also reached a somewhat different conclusion than the College with respect to a duty to refer.

The College’s draft policy provides that, when a physician is “unwilling to provide certain elements of care on moral or religious grounds,” the physician must provide “an effective referral” to “a nonobjecting, available, and accessible physician or other health care provider.”

This seems to us to overstate a duty to refer, risk making the physician morally complicit in violation of deeply held personal beliefs, and falls short of according appropriate respect to the physician as a moral agent. On our view, a somewhat less stringent formulation of a duty to refer better serves the goals of non-abandonment, continuity of care, and respect for physicians’ moral agency. The council concluded that:

In general, physicians should refer a patient to another physician or institution to provide treatment the physician declines to offer. When a deeply held, well-considered personal belief leads a physician also to decline to refer, the physician should offer impartial guidance to patients about how to inform themselves regarding access to desired services.

On the Council’s analysis, the degree or depth of moral complicity is defined in part by ones “‘moral distance’ from the wrongdoer or the act, including the degree to which one shares the wrongful intent.”

Other factors also influence complicity, including “the severity of the immoral act, whether one was  under duress in participating in the immoral act, the likelihood that one’s conduct will induce others to act immorally, and the extent to which one’s participation is needed to facilitate the wrongdoing.” . . .

Pediatrician won’t treat baby with 2 moms

 USA Today

Tresa Baldas, Detroit Free Press

DETROIT  –  Sitting in the pediatrician’s office with their 6-day-old daughter, the two moms couldn’t wait to meet the doctor they had picked out months before.

The Roseville, Mich., pediatrician  –  one of many they had interviewed  –  seemed the perfect fit: She took a holistic approach to treating children. She used natural oils and probiotics. And she knew they were lesbians.

But as Jami and Krista Contreras sat in the exam room, waiting to be seen for their newborn’s first checkup, another pediatrician entered the room and delivered a major blow: The doctor they were hoping for had a change of heart. After “much prayer,” she decided that she couldn’t treat their baby because they are lesbians. [Full text]