Execution Archives - Protection of Conscience Project Library

(Editorial) A right to be unconscious

Julian Savulescu, Janet Radcliffe-Richards

Extract
[Referring to Sinmyee et al] This seems to us to be an important, landmark paper. This is because the issues it addresses are important in their own right: how to ensure death without suffering in jurisdictions where assisted dying (including assisted suicide or euthanasia) is allowed, and also, because the technicalities are the same, in cases of capital punishment by lethal injection. Moreover, the paper shows the potential for the use of anaesthesia in contexts beyond surgery. Anaesthesia in its ordinary uses is intended to facilitate surgery designed to restore a patient to improved health and functioning. In assisted dying, however, there is no question of restoring health. The proposition is to use anaesthesia primarily to prevent suffering in a patient who is about to die and, in this sense, places anaesthesia on a new footing as a primary medical intervention, serving a purpose in its own right. . .

Savulescu J, Radcliffe-Richards J. A right to be unconscious. Anaesthesia. 2019 May; 74(5): 557-559

Drawing the line on physician-assisted death

Lynn A Jansen, Steven Wall, Franklin G Miller

Abstract
Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.

Jansen LA, Wall S, Miller FG. Drawing the line on physician-assisted death. J Med Ethics. 2019;45:190-197.

Hippocrates’ Oath and Asclepius’ Snake:The Birth of the Medical Profession

Thomas A Cavanaugh

Thomas A. Cavanagh. Hippocrates’ Oath and Asclepius’ Snake:The Birth of the Medical Profession. New York: Oxford University Press, 2018. 177 pp.

Publisher’s Description
T. A. Cavanaugh’s Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession’s unique internal medical ethic – in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem – injury caused by a physician – and argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections.

Navigating the new era of assisted suicide and execution drugs

Sean Riley

Extract
I. Introduction
Lethal medication provisions are in a precarious state. Over the past decade, pharmaceutical companies have attempted to stamp out the use of their drugs in executions, creating several economic and regulatory hurdles for access to these medications. As a result, patients seeking physician-assisted suicide (PAS) as well as death penalty states aiming to execute their capital offenders have been forced to turn to unregulated and dangerous alternatives for these drugs. This note attempts to unpack the quality, safety, and access issues emerging from these recent changes and to explore the implications for the future of these practices.

In order to fully grasp the exact mechanisms at work, this note will first offer a brief pharmacological description of the lethal medications and detail many technical aspects of their use. The next section provides a historical account of the past decade, illustrating the emergent quality, safety, and access issues. This note then evaluates the competing notions of ‘botched’ executions and ‘complications’ in PAS while analysing the standards set forward to measure safety and efficacy for each. Finally, this note closes by exploring the future of each practice in light of our discussion.

Riley S. Navigating the new era of assisted suicide and execution drugs. Journal of Law and the Biosciences. Volume 4, Issue 2, 1 August 2017, Pages 424–434, https://doi.org/10.1093/jlb/lsx028

Clinicians’ Involvement in Capital Punishment – Constitutional Implications

Nadia N. Sawicki

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
If capital punishment is constitutional, as it has long been held to be, then it “necessarily follows that there must be a means of carrying it out.”1 So the Supreme Court concluded in Baze v. Rees, a 2008 challenge to Kentucky’s lethal-injection protocol . . .

Lethal injection, the primary execution method used in all death-penalty states, was adopted precisely because its sanitized, quasi-clinical procedures were intended to ensure humane deaths consistent with the Eighth Amendment. But experiences like Clayton Lockett’s . . .demonstrate the dearth of safeguards for ensuring that this goal is actually achieved. . . Nevertheless, states have demonstrated their willingness to continue with lethal injections, and most federal courts have allowed executions to proceed in the face of constitutional challenges. The time is therefore ripe for the medical and scientific communities to consider, once again, their role in this process.

Sawicki NN. Clinicians’ Involvement in Capital Punishment – Constitutional Implications. N Engl J Med 371;2 nejm.org july 10, 2014

Physicians, Medical Ethics, and Execution by Lethal Injection

Robert D. Truog, I. Glenn Cohen, Mark A. Rockoff

Journal of the American Medical Association

Extract
In an opinion dissenting from a Supreme Court decision to deny review in a death penalty case, Supreme Court Justice Harry Blackmun famously wrote, “From this day forward, I no longer shall tinker with the machinery of death.” In the wake of the recent botched execution by lethal injection in Oklahoma, however, a group of eminent legal professionals known as the Death Penalty Committee of The Constitution Project has published a sweeping set of 39 recommendations that not only tinker with, but hope to fix, the multitude of problems that affect this method of capital punishment.

Truog RD, Cohen IG, Rockoff MA. Physicians, Medical Ethics, and Execution by Lethal Injection. JAMA. 2014;311(23):2375-2376. doi:10.1001/jama.2014.6425

What makes killing wrong?

Walter Sinnott-Armstrong, Franklin G Miller

Abstract
What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

Sinnott-Armstrong W, Miller FG. What makes killing wrong? J Medical Ethics 2013;39:3-7.

Toxic Tinkering – Lethal Injection Execution and the Constitution

George J Annas

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Physicians should not lend their medical expertise to the state to make executions more palatable to the public, even by advising on drug protocols, doses, and routes of administration. Even physicians who support the death penalty should stay out of its execution, because the problem that the state seeks to solve by using physicians is one of the state’s own making by its refusal to abolish capital punishment and its insistence on execution by lethal injection.

Annas GJ. Toxic Tinkering – Lethal Injection Execution and the Constitution. N Engl J Med. 2008;359(14):1512-1518.

Anesthetizing the public conscience: lethal injection and animal euthanasia

(The Lethal Injection Debate: Law and Science)

Ty Alper

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People are never executed using the anesthetic-only procedure that veterinarians and shelter workers use on animals. And animals are never euthanized by the three-drug formula prison officials use on human beings. As detailed in this Article, the veterinary and animal welfare communities widely condemn the use of neuromuscular blocking agents such as pancuronium. Particularly given the popular assumption that execution of humans by lethal injection is no different than “putting an animal to sleep,” the condemnation of the use of curariform drugs in the euthanasia context should give courts pause when assessing the risks of the three-drug formula under the Eighth Amendment. . . The Humane Society mandates a method of euthanasia the primary benefit of which is that it is actually humane. At a time when the public’s trust in the administration of capital punishment in this country appears to be eroding, the states, on the other hand, have clung to a method whose primary benefit is that it looks humane- but that in reality risks the unnecessary infliction of excruciating pain and suffering.

Alper T. Anesthetizing the public conscience: lethal injection and animal euthanasia (The Lethal Injection Debate: Law and Science). Fordham Urban Law J. 2008;35(4):817-856.

Physicians and Execution

Gregory D Curfman, Stephen Morrissey, Jeffrey M Drazen

Extract
Physicians and other health care providers should not be involved in capital punishment, even in an advisory capacity. A profession dedicated to healing the sick has no place in the process of execution.

Curfman GD, Morrissey S, Drazen JM. Physicians and Execution. N Engl J Med. 2008 Jan 24;358(4):403-404.