Wednesday, April 26, 2006

'Hippocratic Paradox'

Earlier this week, Human Rights Watch issued a marvelous report on the problems with lethal injection executions. You can read the report here; we recommend it.

However, there is an interesting conundrum that comes out of the report. Human Rights Watch recommended abolishing the death penalty. However, should the death penalty not be abolished, the organization recommended convening a panel of experts (including medical doctors) to examine lethal injection protocols. Which, of course, would be a violation of medical ethics, because doctors inherently can't be in the business of recommending ways to kindly and nicely execute people. Here's a letter from one of the leading experts in the field that addresses this paradox. Because of the importance (and timeliness) of this issue, we present the letter in its entirety:

April 24, 2006
Executive Director
Human Rights Watch

Dear Sir or Madam:
I am writing in response to the report on lethal injection ("So long as they die: Lethal injections in the United States") recently released by Human Rights Watch.

This report is a thorough account of the vast array of problems plaguing lethal injection executions in the United States. I applaud Human Rights Watch for the enormous effort researching this report.

I must, however, take issue with the report's recommendations. While I enthusiastically support the recommendation to abolish the death penalty, I am quite concerned with the other recommendations in the statements below:

"Review lethal injection protocols by soliciting input from medical and scientific experts, and by holding public hearings and seeking public comment"

"If the death penalty is not abolished, suspend all lethal injection executions until each state convenes a blue ribbon panel of medical, scientific, legal, judicial, and correctional experts authorized to review and recommend changes to lethal injection execution protocols as necessary to ensure the protocol adopted causes the inmate the least possible pain and suffering."

problem with these recommendations. The American Medical Association's opinion on capital punishment (opinion E-2.06) clearly states that:

"Physician participation in an execution includes, but is not limited to, the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution."

While I do not claim to represent the AMA, I am quite confident that holding public hearings in which physicians testify about how to perform lethal injection properly, or creating a blue ribbon panel of physician experts to "recommend changes" in lethal injection procedures, would clearly constitute "rendering technical advice" and would be a violation of the AMA ethics guidelines.

To illustrate this point, on March 26, 2006, in a Richmond, Virginia newspaper story about lethal injection, I was quoted as saying, "Everybody agrees on every side of the execution issue that 5 grams of the sodium thiopental properly administered is fatal." The following day, I received a phone call from gentleman at the AMA in which he admonished me for making this statement, since rendering technical advice regarding executions violated AMA ethical guidelines.

It is my contention that the writers of the Human Right Watch report were trapped by what has been called the "Hippocratic Paradox," meaning that lethal injection is structured so that physicians must violate their fundamental ethical principles in order to "help" make the execution "humane." Thus, it becomes ethically impossible for physicians to become involved in lethal injection in any capacity, including endeavoring to make the protocols "better."

It is possible that the only way out of this dilemma is to abolish the death penalty, which is, after all, the HRW's strongest recommendation.

Jonathan I. Groner MD
Associate Professor of Surgery,
The OSU College of Medicine and Public Health
Trauma Medical Director
Children's Hospital

No comments: