Sunday, October 28, 2007

Editorial by Mr. Hood

Mr John Hood, writing for the John Locke Society, is too big for his breeches. Judge Stephens ignores reality is stating that an execution is not a “medical event”. A medical gurney is used—or an operating table: it is designed for no other purpose. Medical tubing is used; it has no other purpose. Drugs are used; they have no other non-medical purpose. The execution chamber is decorated like a surgical suite, and the killing team wears hospital associated clothing (scrub suits) except in Disneyland, where the doctor wears a purple moon suit, and colored goggles The honorable judge is jumping into an area of which he has no knowledge, and he pretends to be able to dictate the ethics of my profession.
The North Carolina Medical Board—formally called the “Board of Medical Examiners”, was specifically set up by the legislature to regulate the practice of medicine in the 1830s. Those salons then realized that doctors should regulate medicine, and not people who did not go through a medical education, of which some traditions and ethical standards go back 2500 years or more. Stare decisis.
Judge Stephens, and the legislatures of today are laboring under the delusion that: (1) a machine, monitored by doctors, can determine if an execution causes “excessive pain”. Typically, the legislature and the Judge do not define “too much “ pain, nor can doctors—pain is too subjective-- and no machine, watched by a physician or not, can make that medical distinction. The act of dying is frequently accompanied by erratic brain waves and a hypoxic and then anoxic pattern develops, overlapping any other patterns. So much for the monitor.
If this is a not a medical procedure, what is the doctor doing there? Can he intervene and stop the killing if things go awry, can he do an impromptu cut down if needed, or otherwise modify the procedure in midstream. He is present to give the killing a degree of respectability to an inherently evil and ugly procedure. That is the only reason.
The physicians who did turn killer in the Nazi T-34 program started out merely getting rid of “ballastexistenz” and this eventually led to mass murder. Let the image of Karl Brandt, a gifted neurosurgeon, and one of the designers of T-34, dangling from a gallows be a reminder of what can happen to a good physician gone bad.
There are better combinations of poison that can be used, better gas than cyanide, but those developing them are prevented from divulging these poisons. It is pure stubbornness to keep the three drug cocktail today, considered too cruel to kill Fido and Tabby.
The analogy made by Hood is equally specious. A doctor’s mission on the battlefield is not to better kill, but to preserve life and to alleviate suffering as much as possible. It is the intent that distinguishes the physician from the medical monster. Doctors have evolved a body of ethics that, at least in a civilized world, prevent the use of medical knowledge to kill. There is no comparison between the battlefield and he death chamber. It is so easy to use the word “war” in a sense not intended.
I would not tell a lawyer, or an accountant what is ethical in his profession, and it is presumptuous of a lawyer to dictate to doctors. Ethics is too serious a matter to leave to the lawyers. The legislature’s intent might sound noble, but its effect is just the opposite—it perverts medicine’s most cherished rule—PRIMAM NON NOCERE --- first do no harm
G M Larkin MD/Charlotte NC
a North Carolina physician for 40 years

1 comment:

dudleysharp said...


Medical groups cite that there is an ethical conflict for participation in the lethal injection process, because medical professionals have a requirement to "do no harm".

Those ethical codes pertain to the medical profession, only, and to patients, only. Judicial execution is not part of the medical profession and death row inmates are not patients.

Doctors and nurses can be police and soldiers and can kill, when deemed appropriate, within those lines of duty and without violating the ethical codes of their medical profession. Similarly, medical professionals do not violate their codes of ethics, when acting as technical experts, for executions, in a criminal justice procedure.

Physicians are often part of double or triple blind studies where there is hope that the tested drugs may, someday, prove beneficial. The physicians and other researchers know that many patients, taking placebos or less effective drugs, will suffer more additional harm or death because they are not taking the subject drug or that the subject drug will actually harm or kill more patients than the placebo of other drugs used in the study.

Physicians knowingly harm individual patients, in direct contradiction to their "do no harm" oath.

For the greater good, those physicians sacrifice innocent, willing and brave patients. Of course, there have been medical experiments without consent and, even, today, they continue ("Critical Care Without Consent", Washington Post, May 27, 2007; Page A01).

The greater good is irrelevant, from an ethical standpoint, if "Do no harm" means "do no harm". Physicians knowingly make exceptions to their "do no harm" requirement, every day, within their profession, where that code actually does apply. And, they should. There are obvious moral and ethical nuances and we should consider and pay attention to them, as is done within the medical profession.

The "do no harm" has no ethical effect in a non medical context, because this ethical requirement is for medical treatments, only, and for patients, only.

The acknowledged anti death penalty editors of The Public Library of Science (PLoS) Medicine agree. They write:

"Execution by lethal injection, even if it uses tools of intensive care such as intravenous tubing and beeping heart monitors, has the same relationship to medicine that an executioner's axe has to surgery." ("Lethal Injection Is Not Humane", PLoS, 4/24/07)

The PLoS Medicine editors have made the same point many of us have been making - similar acts and similar equipment do not establish any equivalence or connection.

There is no ethical connection between medicine and lethal injection. Therefore, there is no ethical prohibition for medical professionals to participate in executions.

To put it clearly: The execution of death row inmates is not equivalent or connected to the treatment of patients.

Is this a mystery?

Obviously, execution is not a medical treatment, but a criminal justice sanction. The basis for medical treatment is to improve the plight of the patient, for which the medical profession provides obvious and daily exceptions. The basis for execution is to carry out a criminal justice sentence where death is the sanction.

Justice, deterrence, retribution, just punishments, upholding the social contract, saving innocent life, etc., are all recognized as aspects of the death penalty, all dealing with the greater good.

Are murderers on death row willing participants? Of course. They willingly committed the crime and, therefore, willingly exposed themselves to the social contract of that jurisdiction.

Lethal injection is not a medical procedure. It is a criminal justice sanction authorized by law. Therefore, there is no ethical conflict with medical codes of conduct and medical personal participating in executions.

Any participation in executions by medical professionals should be a matter for their own personal conscience.

A side note:

40,000 to 100,000 innocents die, every year, in the US because of medical misadventure or improper medical treatment. (1)

Do no harm? The doctor doth protest too much, methinks.

There is no proof of an innocent executed in the US since 1900.