BUL4602 Fall-2011 Lecture 2, Reading 6

BUL4602 Fall-2011 Lecture 2, Reading 6 - T he N EW ENGLA ND...

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The NEW ENGLAND JOURNAL of MEDICINE march 23, 2006 n engl j med 354;12 www.nejm.org march 23 , 2006 1221 have a physician, specifically an anesthesiologist, personally super- vise the execution, or else drasti- cally change the standard proto- col for lethal injections. 1 Under the protocol, the anesthetic sodi- um thiopental is given at massive doses that are expected to stop breathing and extinguish con- sciousness within one minute af- ter administration; then the par- alytic agent pancuronium is given, followed by a fatal dose of potas- sium chloride. The judge found, however, that evidence from execution logs showed that six of the last eight prisoners executed in California had not stopped breathing before technicians gave the paralytic agent, raising a serious possibil- ity that prisoners experienced suf- focation from the paralytic, a feel- ing much like being buried alive, and felt intense pain from the potassium bolus. This experience would be unacceptable under the Constitution’s Eighth Amendment protections against cruel and un- usual punishment. So the judge ordered the state to have an an- esthesiologist present in the death chamber to determine when the prisoner was unconscious enough for the second and third injections to be given — or to perform the execution with sodium thiopen- tal alone. The California Medical Associ- ation, the American Medical Asso- ciation (AMA), and the American Society of Anesthesiologists (ASA) immediately and loudly opposed such physician participation as a clear violation of medical ethics codes. “Physicians are healers, not executioners,” the ASA’s president told reporters. Nonetheless, in just two days, prison officials announced that they had found two willing anesthesiologists. The court agreed to maintain their anonymity and to allow them to shield their identities from wit- nesses. Both withdrew the day be- fore the execution, however, after the Court of Appeals for the Ninth Circuit added a further stipulation requiring them personally to ad- minister additional medication if the prisoner remained conscious or was in pain. 2 This they would not accept. The execution was then postponed until at least May, but the court has continued to require that medical profession- als assist with the administration of any lethal injection given to Morales. When Law and Ethics Collide — Why Physicians Participate in Executions Atul Gawande, M.D., M.P.H. O n February 14, 2006, a U.S. District Court is- sued an unprecedented ruling concerning the California execution by lethal injection of murderer Michael Morales. The ruling ordered that the state The New England Journal of Medicine Downloaded from nejm.org on August 22, 2011. For personal use only. No other uses without permission. Copyright © 2006 Massachusetts Medical Society. All rights reserved.
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BUL4602 Fall-2011 Lecture 2, Reading 6 - T he N EW ENGLA ND...

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