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May 2, 2010

"Group to censure physicians who play role in lethal injections"

The title of this post is the headline of this notable article from today's Washington Post, which reviews the latest effort by a group of doctors to prevent physician involvement in lethal injections.  Here are excerpts:

A national physicians organization has quietly decided to revoke the certification of any member who participates in executing a prisoner by lethal injection.

The mandate from the American Board of Anesthesiologists reflects its leaders' belief that "we are healers, not executioners," board secretary Mark A. Rockoff said. Although the American Medical Association has long opposed doctor involvement, the anesthesiologists' group is the first to say it will harshly penalize a health-care worker for abetting lethal injections. The loss of certification would prevent an anesthesiologist from working in most hospitals.

About half of the 35 states performing executions, including Virginia and North Carolina, require a doctor to be present. Other states have also recruited doctors, including anesthesiologists, to play a role in executions involving lethal injections. In some jurisdictions, anesthesiologists consult prison officials on dosages. In others, they insert catheters and infuse the three-drug cocktails.

While death penalty opponents welcome the move because it raises yet more questions about lethal injections, capital punishment supporters contend that doctors are not needed during the procedures, which can be administered by prison employees. But as questions mount about the types and combinations of drugs used and whether they cause undue suffering, states have been turning to doctors for advice and assistance. With 3,200 prisoners now on death rows across the country, most of the 50 executions performed each year since 2008 have used lethal injections....

Under the policy, which the group's 40,000 members learned about in February, any of these activities could lead to a loss of certification. Anesthesiologists can get state medical licenses without certification, but most hospitals require it.

Thus far, no doctors have been disciplined, Rockoff said, but several anesthesiologists, including some who have worked as execution consultants or testified in capital punishment litigation, said the step has had a chilling effect. "They are clearly drawing a line in the sand and saying, 'If you cross this, we'll come after you,' " said Bryan A. Liang, a law professor at California Western School of Law and a professor of anesthesiology at the University of California at San Diego.

"It sure will deter me. For the ABA to threaten to pull your board certification is a big deal," said one anesthesiologist who has consulted for prison officials in his state about drug dosages. Arguing that the decision should be left up to individual doctors' consciences, none of those who criticized the policy agreed to be named, saying they feared repercussions....

Some death penalty supporters said nurses or emergency medical technicians are well-equipped to perform executions.  "Some think it's an effective argument to say you need a doctor to do this," said Michael Rushford, president of the Criminal Justice Legal Foundation, which supports the death penalty.  "You don't need a doctor to do this.  It's a counterfeit argument."

This story further convinces me that it will only be a matter of time before most states that want to continue using the death penalty in a serious way will turn to the one-drug lethal injection protocol that has proved successful so far in Ohio.  The need for doctor involvement seems further diminished by the one-drug approach, and Ohio was able to engineer and has now been regularly utilizing this method of execution with only very limited help from medical authorities.

May 2, 2010 at 04:27 PM | Permalink

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Comments

The anesthesiologists should see their attorney review the possibility of suing their pro-criminal, left wing organization. First enjoin their interference with contract. Then, get a class declaration, and wrack them with a class tortious interference claim, with enough punitive damages to deter them. Make an example of them. If the AMA does not change its ethics ruling, sue them.

Posted by: Supremacy Claus | May 2, 2010 6:00:24 PM

These guys are self-righteous pricks.

Posted by: federalist | May 2, 2010 6:25:41 PM

I agree with both federalists sentiment and SC's tactics.

Posted by: Daniel | May 2, 2010 8:23:30 PM

Hopefully they'll have some good things for us. By the way, this group of medical research assistants might interest and help you in some ways. More power!

Posted by: Mitch | May 3, 2010 12:22:52 AM

hmm sorry but i disagree. last time i looked one of the main parts of the old oath a doctor took was to

"DO NO HARM"

so this activity wold be a direct violation

Posted by: rodsmith | May 3, 2010 1:02:07 AM

The doctor is not doing harm, but good. It is like good clinical management of end of life care. The patient has cancer throughout the body, and is in pain. Is the doctor who provides adequate pain control collaborating with death? No, but acting in the best interest of the patient. There is a doctor patient relation likely formed. But others are doing any harm, not the doctor, acting in the interest of the patient.

As to the single drug protocol, at some point some licensed person must have reviewed it for dose, injection advice. Medical methods should include offers of voluntary overdoses by mouth.

The problem is that the court wants the appearance of virtue to be above criticism by the pro-criminal forces of rent seeking. The Court should grow up, allow non-medical methods, and take the heat from the hypocrites. These hypocrites have zero tolerance for any twinge of pain in serial killers. Meanwhile, the murder victims, all 17,000 of them, went rough, by butchery methods. The lawyers do not care because the victims did not generate lawyer fees.

Electrocution may disturb the audience, but dispatches the person at the speed of electricity through the brain.

Posted by: Supremacy Claus | May 3, 2010 5:49:05 AM

The ABA could hardly be more in error or irresponsible.

The Hippocratic Oath and “Do No Harm” have nothing to do with executions.

What this is about is turning a personal bias against the death penalty into a created ethical prohibition by the ABA. It's unethical.

“Physicians & The State Execution of Murderers: No Ethical/Medical Dilemma”
http://prodpinnc.blogspot.com/2009/10/physicians-state-execution-of-murderers.html

Posted by: Dudley Sharp | May 3, 2010 8:54:03 AM

It's understandable that some death-penalty zealots would be upset by the association's position, but shouldn't professional organizations be permitted to set and police their own ethical standards?

They're no more "self-righteous pricks," federalist, than you are a blood-thirsty sadist.

Posted by: John K | May 3, 2010 10:54:08 AM

Posted by: John K,

If those organizations did not hold licensing power (or at least a negative licensing power, you don't join or aren't a member you can't get licensed) I would agree with you. It would be similar to a rule saying that lawyers must remain members of the ABA in order to ply their trade. To the extent that licensing choices turn on political disagreements I would say that is an illegitimate use of authority.

On the other hand I could see this move backfiring if they do attempt to implement it. The death penalty remains extremely popular in the general public and I could see a state legislature ditching a requirement that someone be a member of a national organization over something like this. And I don't think such a move would have a lot of political downside back home.

Posted by: Soronel Haetir | May 3, 2010 11:59:08 AM

Soronel, unless I misunderstood, the sanction of pulling certification would be considerably less debilitating than revoking licenses.

Posted by: John K | May 3, 2010 12:41:20 PM

John. I agree with SH. The question isn't a matter of degree. It's a question of why should they have they any power to pull at all over what is in essence a policy disagreement. To me it's an abuse of power. They cannot change the law, so they abuse their members. That's just wrong.

Posted by: Daniel | May 3, 2010 1:43:37 PM

John K --

"It's understandable that some death-penalty zealots would be upset by the association's position, but shouldn't professional organizations be permitted to set and police their own ethical standards?"

Not when inconsistent with the law.

Suppose this association proposed to expel members who joined the armed forces, on the theory that its members were supposed "to be healers, not warriors." Think that would hold up in court?

If I were a member of ABA and participated in an execution, I would notify the organization in writing that I had done so and was planning on doing it again. I would then tell them that if they revoked my license or took any action against me whatever, I would sue them in the court that had ordered the execution and take everything they own.

If these guys want to go the "chilling effect" route, I'll play.

Posted by: Bill Otis | May 3, 2010 3:41:27 PM

The professional organizations do police their members, are relied upon by licensing boards, and by courts to define standards. They are also quasi-governmental organizations. For example, they can put a member on trial, with attorneys representing both sides. It they expel a member, the licensing board wants to hear about it, and employers will have to satisfy themselves with an explanation of the expulsion. As quasi-governmental organizations, they have a duty to obey the law and regulations, and cannot express themselves limitlessly as a private entity might. I would challenge whatever charter or exclusivity agreement in addition to the remedies mentioned already, injunction and class action tort litigation.

Posted by: Supremacy Claus | May 3, 2010 4:57:05 PM

Bill--

(shouldn't the organizations be allowed to set and police their own ethical standards?)..."Not when inconsistent with the law."

The law is what you must do. Ethics are what you should (or shouldn't) do.

And contrary to what SC suggests, I don't quite see a professional association of anesthetists (who by and large train to put people to sleep without killing them) as a quasi-governmental law-enforcement agency.

Posted by: John K | May 3, 2010 8:06:59 PM

John K, they're still self-righteous pricks.

Posted by: federalist | May 3, 2010 9:03:43 PM

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