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Ethics clash with justice in executions

By CHRIS TISCH
Published December 28, 2006

STARKE - The execution chamber is so white it looks clinical.

The eggshell walls. The bright ceiling lights. The sheet pulled over the inmate who is about to die.

The chemicals start to flow. The prisoner goes still. Then a person in purple medical scrubs and a blue mask - it appears to be a man but there is no way to tell for sure - emerges from a back room.

The person shines a light in the inmate's eyes and places a stethoscope over the heart. Eventually, he signals that the inmate is dead.

Florida closely guards the identities of the people involved in executions, but perhaps none more so than the person in purple.

He's a doctor.

Medical groups would likely ostracize him if they knew who he was. The American Medical Association forbids doctors from almost any involvement in executions because it violates the tenet that doctors will not knowingly harm a patient.

"If you sent your wife or child to a doctor you wouldn't want them washing their hands from their last execution," said Dr. William G. Plested III, president of the American Medical Association. "You might have some questions about how precious they think life is."

After a botched Florida execution earlier this month in which an inmate took 34 minutes to die, DOC officials revealed that the doctor in purple made some important decisions after the execution went awry. The doctor made the call to skip one drug as a second dose of the state's lethal three-drug cocktail was released into the inmate's body.

DOC Secretary James McDonough said the doctor did this to quicken the death of Angel Diaz, who was taking so long to die because the needles carrying the lethal chemicals to his body had broken through the veins in his arms and into his flesh.

It troubles many doctors and medical groups that a doctor would be calling any shots during an execution. Still, several state governments and courts nationwide are trying to draw doctors closer to executions, often to ensure that procedures are medically sound and that they are carried out humanely.

"It's a role we're not wanting to be in, but it's kind of being thrust upon us by the legal system," said Dr. David Varlotta, a Tampa anesthesiologist. "And we have a problem with that."

Varlotta admits there is a bit of a Catch-22.

Doctors may be more likely to ensure that an execution goes smoothly, which could prevent an inmate from suffering if something goes wrong. But ethics prevent the doctor from getting involved in the first place.

He asks: How would nervous patients getting ready for anesthesia for surgery feel if they knew the last procedure their doctor performed was an execution?

"The people who have the most experience with these kinds of drugs are anesthesiologists, but ... it's against the Hippocratic Oath," said Varlotta, who is on the board of directors of the Florida Society of Anesthesiologists. "I wouldn't want any of my patients to think it was me under that shroud. I think for us to be cast in that role, it would be terrible for patients to have to face going into surgery."

DOC officials won't say how they found the doctor in purple, whether he came to them or vice versa.

"The doctor who did it came to terms with his own ethical code," McDonough said.

If the doctor's identity was revealed, he would become "highly stigmatized in the medical community," said Dr. Steven Miles, a bioethics professor at the University of Minnesota.

Miles said the fact that doctors shield their faces "suggests essentially the medical ethics argument that physicians should not participate in executions has been won."

Some bioethicists think states should better train their own execution teams in the medical procedures needed for executions and leave doctors out of it.

"If the goal is to minimize suffering, then you don't need doctors, you don't need nurses," said Art Caplan, bioethics professor at the University of Pennsylvania. "You need trained executioners who practice."

Death penalty defense attorneys tend to disagree, saying prison officials can't be relied on.

"This is a medical procedure, and we don't have medical people doing it," said Martin McClain, who has defended more than 100 death row inmates in Florida.

In California, defense attorneys have suggested to the courts that doctors need to be involved in capital punishment to ensure executions are carried out properly.

The state filed a response saying that scenario would effectively end the death penalty because no doctors would participate.

Plested, the AMA president, said the future of the death penalty should not hinge on whether doctors can get involved. He said lethal injection procedures do not require a doctor.

But defense attorneys believe the Diaz execution shows how badly things can go wrong. Witnesses saw Diaz wince, grimace and cough, though members of the execution team reported no signs that Diaz suffered during the 34 minutes it took him to die.

A preliminary autopsy found two foot-long burn marks on his arms where chemicals drained from his veins into his flesh. The doctor who performed the autopsy has held off on saying if Diaz felt pain until more tests are complete.

But doctors interviewed by the St. Petersburg Times said these chemicals likely would cause severe pain, which would violate the Eighth Amendment ban on cruel and unusual punishment.

Gov. Jeb Bush halted executions while a commission reviews the state's lethal injection procedures. A preliminary report is due from that group in two months. Caplan said history also has taught us - in Nazi Germany, China and Turkey - that doctors should not be used by the state to harm people.

"If the state wants to execute people then ... it should not have doctors using medicine in that role," he said. "Medicine is not to be used as the punishment arm of the government."

[Last modified December 28, 2006, 01:45:29]