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Cruel and unusual?
April 15, 2005 4:11 AM   Subscribe

The Lancet publishes a research letter that finds inadequate anaesthesia is used in executions by lethal injection
posted by magullo (40 comments total)

 
Ok. They are going to die anyway. What is the point here?
posted by pemdasi at 4:38 AM on April 15, 2005


You're going to die too so I guess you won't object to me causing that death in the most painful manner possible.
posted by substrate at 5:02 AM on April 15, 2005


We're all going to die anyway, and pain is part of life -- I say we do away with anaesthesia altogether!
posted by fairmettle at 5:03 AM on April 15, 2005


From the Seattle Times story - "Objections to lethal injection have been rising among death-row inmates, who have filed claims in many states arguing that the procedure violates the Constitution's Eighth Amendment prohibition against cruel-and-unusual punishment."
posted by Navek Rednam at 5:04 AM on April 15, 2005


Well,RTFA

I suppose you could lie them on a table a fire an advancing laser at their tender regions 'til they be dead, or is that too much like torture?
Whereas this is not enough like torture to be worthy of note against someone convicted of a crime, although not necessarily guilty of it.
Or something.

on preview: in the chorus singin' baritone
posted by NinjaPirate at 5:07 AM on April 15, 2005


substrate wins.
posted by rolypolyman at 5:24 AM on April 15, 2005


"executioners are carrying out medical procedures without training on procedures or dosages"

It is worth noticing that this is not necessarily a neglect issue. Anyone who receives medical training would in principle be barred from participating in executions.
posted by magullo at 5:28 AM on April 15, 2005


Ah! Never thought of that, magullo. True. I'd always thought that should I fall sour of one of the lovelier state's death penalty, I would try and get a firing squad. Extraordinarily cheap, and apparently, assuming you get a good solid whack to the head, shouldn't hurt to much. All of the stuff I've read about lethal injection and the chamber and whatnot make me slightly sick to my stomach.
posted by Baby_Balrog at 5:54 AM on April 15, 2005


Right or wrong, I find it hard to get worked up about the suffering of those whom society has judged so harshly that they find the only fit punishment is to end their lives. There are a lot more people suffering a lot more in the world and I have little pity to spare for those who suffer a painful execution.
posted by dg at 6:02 AM on April 15, 2005


Judged so harshly indeed.
Matters of humanity clearly mustn't come into the equation when a fallible human has been condemned to death by 13 fallible humans.

dg, I don't mean to pick on you in particular, but when the "most humane" version of capital punishment is found to be roundly inhumane and ethically horrific, does it really not prickle your sensibilities?
It doesn't make you think "well, I wonder what better way there is to kill a person" or "I wonder if there is any good way to kill a person at all"?
posted by NinjaPirate at 6:29 AM on April 15, 2005


I accept with open hands that none of this needs to apply is executioners were given full training.

Anyone who receives medical training would in principle be barred from participating in executions.
The hippocratic oath is taken before qualification as a doctor, not before medical training, isn't it? Have I got the wrong end of this black stick?
posted by NinjaPirate at 6:32 AM on April 15, 2005


Don't you do need to be a doctor to administer general anesthetic?
posted by magullo at 6:57 AM on April 15, 2005


You people who think it's perfectly okay to torture convicts t death should consider The Innocence Project ; innocent people not only go to prison, they also get executed -- and that could mean YOU. And whether you committed the crime you'd be executed for or not, would you "find it hard to get worked up about the suffering of those whom society has judged so harshly that they find the only fit punishment is to end their lives" if that person was YOU? I refer you to what Baby_Balrog said.

In any case, those who think "convicts" should not even be allowed to die like dogs should refrain from yourself Christian as if it makes you somehow morally fit: my father and grandfather were Methodist preachers and they did NOT find it hard to get worked up about suffering. Either the Golden Rule applies to you or it does not; either you enact it in your everyday lives by applying it to others -- even concerning "convicts" -- or nobody has any obligation to apply it to YOU. This might not make you any worse than a pedophile cannibal, but it sure won't make you any better -- and it will make you fair game for other predators.

And by the way, those who don't feel responsible for the executions the State carries out in their names have no business supporting capital punishment. As meat-eating should be restricted to those who could kill the cow themselves, so should advocating death-dealing be restricted to those who could themselves kill. Chickenhawks are digusting.

As for the Hippocratic Oath, see (among other things) the Wikipedia article, and (from PBS Nova Online) the ancient and modernized versions. Note that I'm not agonizing over any particular provision of the(se) Oath(s), I'm only providing links to the documents.

As for my own position, I am not in principle opposed to killing people. I just ain't been moved to kill anybody yet.

On preview, magullo, I think you do have to be an MD to legally administer general anaesthetic to people. For this particular application however, if it was me I'd rather they find a good veterinarian. Generally speaking, I often wish I could convince my girlfriend's favorite veterinarian that I'm really just another exotic pet -- a big bald bonobo or something; for one thing I've seen that when she puts a cancerous ferret down she makes sure she does it right.
posted by davy at 7:09 AM on April 15, 2005


Damn, I don't know how THAT happened: the correct URL for the Innocence Project is here . I do this just to save you editing the URL in your own browsers, not because I think even your average Mefite can't figure such things out themselves. (Given this last just-corrected mistake of mine I can't claim to be SUPER-brilliant myself.)
posted by davy at 7:21 AM on April 15, 2005


I say we go back to stoning people to death. On national television. If Americans want to kill people, show'em what that means.

And while we're at it, when you're buying meat at a supermarket, you should be able to see the cows getting slaughtered in the background.

There's too much of a disconnect these days between action and consequence. (As I type this into a computer that was assembled by malnourished 4-year-olds in leg irons in Myanmar.)
posted by fungible at 7:53 AM on April 15, 2005


I thought about posting this story as well, along with links to sites discussing the Lancet's credibility. As far as I'm concerned, this so-called 'medical journal' really damages itself by giving editorial content like Capital punishment is not only an atrocity, but also a stain on the record of the world’s most powerful democracy such prominence alongside the actual research.
posted by thirteenkiller at 8:04 AM on April 15, 2005


Sure is a culture of life, innit?
posted by apis mellifera at 8:09 AM on April 15, 2005


Anyway, if you're really opposed to the death penalty, what difference does it make if they are in pain or not? They're still being executed.
posted by thirteenkiller at 8:18 AM on April 15, 2005


Extraordinarily cheap, and apparently, assuming you get a good solid whack to the head, shouldn't hurt to much.

I'm afraid they shoot you in the heart, not the head. Still better than being slowly cooked to death though.
posted by ninebelow at 8:19 AM on April 15, 2005


I thought about posting this story as well, along with links to sites discussing the Lancet's credibility.

Don't worry, we are all already aware of the Lancet's credibilty.

Anyway, if you're really opposed to the death penalty, what difference does it make if they are in pain or not?

thirteenkiller, you are some sort of genius.
posted by ninebelow at 8:27 AM on April 15, 2005


Thanks!
posted by thirteenkiller at 8:39 AM on April 15, 2005


Well done, thirteenkiller. First you shoot the messenger. Then you kick the victims.
posted by magullo at 8:50 AM on April 15, 2005


I'm not kicking anyone. I just think this isn't a very good argument against the death penalty. They can just increase the anesthesia and make sure all these people are really unconscious - then will the death penalty be okay? Is pain really the issue here, or is death the issue?
posted by thirteenkiller at 8:54 AM on April 15, 2005


Well, actually.. I am kicking the Lancet. Figuratively.
posted by thirteenkiller at 8:57 AM on April 15, 2005


thirteenkiller does have a point. Whether or not it's giving them adequate anesthesia, the state is still killing people because killing people is wrong. (Unless you're the state, in which case it's hunky dory.)
posted by graymouser at 9:18 AM on April 15, 2005


They can just increase the anesthesia and make sure all these people are really unconscious - then will the death penalty be okay?

No, but you might consider it a (very small) step in the right direction. By your logic, if you're opposed to abortion, then you should have no opinion on curtailing late term abortions.
posted by Armitage Shanks at 9:25 AM on April 15, 2005


I just think this isn't a very good argument against the death penalty.

It isn't an argument against the death penalty. Rather it is pointing out that the US Government engages in torture. Guess what: people who are against state murder tend to be against that as well.
posted by ninebelow at 9:51 AM on April 15, 2005


Rather it is pointing out that the US Government engages in torture.

In this particular instance, you're attributing to malice what is most likely a result of gross incompetence.
posted by Cyrano at 10:27 AM on April 15, 2005


Besides the fact that the Bill of Rights (or tattered remnants of same) is to be preserved at all costs (unless you hate America!) and that execution itself has often been a subject of debate
vis-a-vis the good ole 8th "cruel and unusual" clause (the Hunter S. Thompson clause, I like to call it, although he might have said "vicious and savage") we as human beings are called either by God or the furtherance of civilization to be good to each other and where we cannot, to be minimally cruel.

Ok. They are going to die anyway. What is the point here?

And so on (flippant or not) on a website or not implies that you are content to be a worthless jackal rooting around in the rotten bowels of our (human) common history, which by any standard is in large part bloody and cruel and downright evil , instead of participating in some small way to transcend the unbelievable horrors of which the human animal is capable. So fuck you. Opt out of the best of the human race, but don't come whining to me when some other atavistic little shit gouges out your eyeball. The whole point of our debased and mortally wounded country was to be better than we had to be, there is simply no need to twist the knife.

Cryano: In this particular instance, you're attributing to malice what is most likely a result of gross incompetence.

The problem here (and I suspect you are right) is that repeated
gross incompetence is malicious.
posted by Divine_Wino at 10:41 AM on April 15, 2005


I have a number of thoughts regarding this post and associated comments. First of all, the Lancet editorial really just uses the Koniaris study as a jumping off point for criticism of the death penalty in general and raises a number of issues that are not directly related to the study itself, and so it is entirely possible to criticize the editorial stance of The Lancet without addressing the specific problems brought up in the study. This editorial stance is not surprising given that The Lancet is a British publication. I wonder if the authors tried to get published in an American journal first and were rejected.

As far as the participation of health care providers in executions is concerned, there is no legal prohibition against physicians or nurses participating in them, but the American Medical Association and American Nurses Association condemn the practice and the majority of physicians in this country feel that it is ethically wrong. On the other hand, 19% of the physicians in this country would be willing to administer the drugs themselves and 41% would be willing to help in other ways; this is all mentioned in the editorial and I fear speaks poorly for the character of physicians in this country. Some people wondered who can legally administer anesthesia; in the US it can be adminstered by as physician or by a nurse anesthetist or anesthesia assistant (a physician's assistant with additional training in anesthesia) under the supervision of a physician. The physician involved does not have to have any training in anesthesia legally, but hospital credentialling committees and malpractice insurers can insist upon it. Specifics of the law vary from state to state.

As far as the study itself goes, I fear it is a bit of a straw man. I am a death penalty opponent, but I am also an anesthesiologist and the study did not convince me that inadequate anesthesia is being given before lethal injections. The problem is that blood levels of anesthetics are less important than brain levels, which were not measured. Furthermore, plasma levels of drugs are most reliable when a patient is at "steady state", i.e. when the drug is being given continuously and the concentration has reached equilibrium throughout the body. In contrast, the scenario given reults in blood concentrations that vary rapidly not only with time but with location in the body. After a single injection of thiopental, the blood concentration reaches an immediate peak. The drug then reaches a high concentration in the brain, heart, liver, and kidneys. These organs get about 75% of the blood pumped by the heart and so are affected first. The patient is usually unconscious within 1-2 minutes after this single injection, and then will wake up in 5-10 minutes as the drug redistributes to the rest of the body. A normal induction dose of thiopental in an adult is 250-500 mg (the drug comes in 500 mg vials), so the dose used in capital punishment is 4-8 times what is used for anesthesia. This should be easily sufficient to make the prisoner unconscious and keep him that way while the other drugs are administered. In other words, the authors conclusions do not agree with what is seen every day in clinical practice.

On the other hand, the questions raised about the qualifications of the executioners to start IVs, administer drugs, and determine adequacy of anesthesia are valid (although not addressed in this article). A bad IV could result in the prisoner not getting the entire dose of thiopental, and it can be difficult to tell how deeply anesthetised a patient is even to a trained observer; I routinely see patients who seem deeply asleep jerk their arms away when I try to start an IV. Of course, do we want trained medical professionals using their skills to kill unwilling prisoners? To me this one of the many serious questions raised by this countries insistence on capital punishment. Think about how many people express outrage that physicians should assist in the death of willing patients with terminal illnesses.

All in all, this article has some serious flaws but raises some interesting questions. It will be interesting to see what letters are written to The Lancet in response to the article and editorial. Sorry if this post is too long, but the subject hits kind of close to home for me.
posted by TedW at 10:55 AM on April 15, 2005


Speaking as an ex-pharmacist, making execution by lethal injection painless is a no-brainer. We have a substance to hand that will kill 100% of subjects when administered in overdose, but which is also the best pain-killer known to medicine. It's a respiratory depressant a sedative, and it's also a very potent anxiolytic -- a tranquiliser. It's also dirt-cheap -- a gram of the pharmaceutical product, enough to kill anybody within a minute if administered as an i/v bolus injection, costs under $5. I am talking about diacetyl morphine, better known by the trademark Bayer AG acquired for it -- heroin™.

Enough folks have been brought back from heroin o/d for us to know that it's totally painless and anxiety-free. If the proponents of capital punishment by lethal injection were serious about not inflicting pain, they'd use it. Hell, using it for executions could even be sold to the drug warriors as anti-drug propaganda -- "look how dangerous this stuff is, we use it to execute people!"

So why don't they?
posted by cstross at 10:57 AM on April 15, 2005


That is not a bad idea at all cstross; a couple of potential drawbacks are that any narcotics abusers would be resistant to the effects of heroin (and the fact that heroin is a trademark of Bayer is one of my favorite bits of medical trivia). It can be truly amazing to see someone who chronically takes narcotics and is given 50 or 100 times a typical dose of morphine or fentanyl with little or no effect. The other problem with using a large bolus dose of narcotic in this way is that these drugs can cause chest wall rgidity in large doses, making it impossible to breathe and very unpleasant for the recipient. Of course, it might be possible to use a combination of sedatives to minimize these problems. On the other hand, changing the drug regimen does nothing to address the qualifications of the people administering the drugs.

In answer to your last question, the comments of some presumed death penalty supporters above lead me to believe that they simply don't care whether the person being put to death suffers or not.
posted by TedW at 11:09 AM on April 15, 2005


No, but you might consider it a (very small) step in the right direction. By your logic, if you're opposed to abortion, then you should have no opinion on curtailing late term abortions.

Rather, by my logic, if one is opposed to abortion he should not participate in movements to make late term abortion less painful for a fetus. A ban on late term abortions, however, would indeed further the cause of eliminating abortions altogether, so if one truly believes abortion is inherently wrong it is perfectly logical to support such a ban. In the same way, if one believes the death penalty is inherently wrong it is reasonable for him to support a ban on the execution of minors because it saves people from execution. Making the execution process less painful doesn't save anyone, it just increases the social acceptability of the death penalty.

Unless the only reason this person doesn't like the death penalty is because it's painful.

It isn't an argument against the death penalty. Rather it is pointing out that the US Government engages in torture. Guess what: people who are against state murder tend to be against that as well.

The Lancet says: Capital punishment is not only an atrocity, but also a stain on the record of the world’s most powerful democracy. Clearly they intend for this report to be an argument against capital punishment and not a plea for a softer, gentler capital punishment. I really just don't think they're going about it right way.
posted by thirteenkiller at 11:19 AM on April 15, 2005


Making the execution process less painful doesn't save anyone, it just increases the social acceptability of the death penalty.

Partially true, however there is much anecdotal evidence to suggest that abolitionists of all stripes have had success with first creating conditions where the victims of whatever they want to abolish are viewed as human and deserving of basic consideration.

In other words, making an execution less painful doesn't mean that execution is a fine thing, rather it means that willfully killing a fellow human is a decision that must be weighed very carefully and approached with respect and gravity and therefore that perhaps state sanctioned execution is too sticky and fraught with gray areas to be practiced in an enlightened society.

Personally I'm fine with capital punishment, I think there are people that need killing, however I don't think we should be in the practice of putting people to death if there is ever a shred of doubt that they might be innocent, no perfect world, no executions.

cstross: We can't be killing people with Heroin otherwise the depraved junkies will be killing people to get a fix.
posted by Divine_Wino at 11:34 AM on April 15, 2005


thirteenkiller, simply put: punishing people to death by torture is flat-out illegal, immoral, unethical and, in a fallible system, also a supreme idiocy. If for some reason the death penalty were to become the death by torture penalty, there'd be a boatload of extra reasons to oppose it with increased ferocity.

TedW and cstross, thank you. I posted hoping to get some interpretation of the scientific data presented by the study. I am an opponent of the death penalty for many reasons, the least of which is not the fallibility mentioned above. I just can't see how killing a few innocent citizens here and there can contribute to a "greater good".
posted by magullo at 12:14 PM on April 15, 2005


I'm opposed to the death penalty too; luckily I live in a country where it's illegal and unconstitutional. I merely offered the observation about non-painful means of execution in order to demonstrate that a painless execution is in actual fact achievable if that was seen as a desirable objective.

(I hold to the fallability argument. I also hold to the no-recidivism argument: when the dealth penalty was applied in the UK, a subsequent false-positive rate of around 15% occured. After the UK switched to life imprisonment, the level of re-offense by released prisoners convicted of murder was found to be around 0.2%. By a utilitarian argument, executing murderers therefore kills more innocent people than incarceration. Finally there's the libertarian argument -- I believe that the rights of the individual come before those of the state, except to the extent necessary to protect those individual rights -- and if you start from that premise, why on earth would you be willing to give the state the ultimate power over the individual, the right to inflict death on its own citizens?)
posted by cstross at 12:29 PM on April 15, 2005


I'm glad TedW's around; that was good.
posted by NinjaPirate at 12:34 PM on April 15, 2005


...killing people is wrong. (Unless you're the state, in which case it's hunky dory.)

We are the state -- right?!

(Unless they slipped in that change in one of those omnibus bills...)
posted by fairmettle at 2:16 PM on April 15, 2005


Just to set this straight a bit, I am not in favor of the death penalty. That being said, if the government is going to execute those whom it deems have forfeited the right to life, I see no reason why it should care if they feel pain as they die.

Think about it, it doesn't make sense.
posted by pemdasi at 9:43 PM on April 15, 2005


Think about it, it doesn't make sense.

Oh yes, it's self-evident! You know I remember a time when it was uncontroverstial that torture was wrong, in the dim and distant past like, oh, 10th September 2001.

you're attributing to malice what is most likely a result of gross incompetence.

cyrano, I wasn't concerned with the intent, just the outcome.

Clearly they intend for this report to be an argument against capital punishment and not a plea for a softer, gentler capital punishment.

thirteenkiller, the Lancet report criticises the current process of capital punishment. The Lancet editorial criticises the concept of capital punishment. They don't need to argue against it using scienctific research because the arguments against it are well known and it is obvious to anyone who doesn't have the moral sense of a chimp why it is wrong.
posted by ninebelow at 2:31 AM on April 16, 2005


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