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Post date: Mar 28, 2013 4:36:46 AM


Take the pain out of the death penalty

Andy Ho Senior Writer

28 March 2013

The Straits Times

AS LONG as there is going to be capital punishment in Singapore, make it more humane, a retired doctor friend said to me recently, advocating death by lethal injection as used in the United States instead of hanging, which is used here.

The US Supreme Court in Furman v Georgia (1971) found death by hanging, gas chamber, electric chair, firing squad or decapitation to be "cruel and unusual" punishment.

By contrast, lethal injection would be more humane as it causes less pain and suffering. In the US, all 35 states with the death penalty use lethal injection as their primary mode of execution.

First practised in Texas in 1982, according to Jean Kellaway in The History Of Torture And Execution (2003), it is usually a cocktail of three different drugs delivered sequentially through two separate intravenous lines.

The first drug to be injected is sodium thiopental, a barbiturate that acts as an anaesthetic to eliminate all pain. The second is pancuronium bromide, an agent that paralyses all skeletal muscles, so the person stops breathing. The final agent to be injected is potassium chloride, a drug to stop cardiac function by disrupting electrical activity in the heart.

The first injection will knock out the prisoner for enough time to complete the execution. Once he is unconscious, he will not suffer the terror of suffocation, which the second drug causes, or the chest pain the third drug leads to.

Two different veins have to be used because the first drug will cause a precipitation reaction with the second drug if they were mixed together in a single syringe, or even if delivered one after another through the same intravenous line.

It is true that there is a risk of extreme suffering and excruciating pain if the anaesthetic has not taken effect before the second and third drugs are administered. But properly administered and monitored by appropriately trained physicians, the process would be efficient and virtually painless.

Sadly, the US experience has been tainted by the fact that doctors and nurses are not usually involved in executions by lethal injection.

The Code of Ethics of the American Medical Association (AMA), of which only 20 per cent of US physicians are members, does not permit physicians to administer lethal injections.

It is common to say that the AMA "prohibits" physicians from participating in lethal injections. But the US Department of Justice has declared that "the pronouncements of the AMA and other associations do not themselves bind physicians".

In the US, physicians are licensed by the medical boards of each state, not the AMA, which thus has no legal authority to enforce its guidelines. It can urge physicians not to participate but the decision is the individual physician's to make.

A 2008 study published in the Journal of American Association of Nurse Anesthetists recounts botched executions because of the use of non-medical personnel called "lethal-injection technicians" who may struggle to set up intravenous lines.

For this reason, some executions have gone on for 90 minutes. In cases where the condemned was a former drug addict who had used most of his veins to inject heroin - so that most of his visible veins had hardened - establishing the necessary intravenous lines became a very difficult task, even if skilled doctors and nurses had tried.

A physician's participation would prevent such farces. But some contend that the physician must only heal, not harm. They say that the ancient Hippocratic Oath requires the physician "not to give a lethal drug to anyone if... asked, nor... advise such a plan", but few physicians the world over take this archaic oath. Thus, the Singapore Medical Council (SMC) Physician's Pledge omits this clause.

In the context of administering the lethal injection to a legally condemned prisoner, the physician's role is neither one of healing nor harming.

The person has been legally sentenced to death by properly constituted courts, so he will die with or without the involvement of a physician, who can't legally preserve his life anyway.

So in this context, the physician has only one role - to alleviate the condemned person's suffering.

The SMC Ethical Code and Guidelines require the physician to "use (his) medical knowledge in accordance with the laws of humanity" and ensure his patients are "treated with courtesy, consideration, compassion and respect".

All this is quite consistent with a physician being involved to alleviate the condemned person's suffering and minimise his physical pain during the execution.

In this setting, the physician is not a tool of the state but is there simply to make sure the condemned person is treated as humanely as possible up to and at the very last moment of life.

Some physicians might indeed be quite willing to give such succour.