Saturday, 10 February 2007

Death penalty puts 'healers' in ethical quandry

Death penalty puts 'healers' in ethical quandry

It has been 25 years since Texas became the first state in the nation to use lethal injection to execute a condemned prisoner.

And while few might remember Charlie Brooks Jr.'s death from a combination of liquid drugs in 1982, fewer still will forget the death of Angel Nieves Diaz, the Florida murderer whose December execution prompted that state's governor to halt executions.

Diaz, 55, had escaped from the Hartford Correctional Center in 1981 - two years after Florida police say he shot and killed a Miami club manager.
Diaz was convicted at trial and sentenced to death in 1986.
At 6 p.m. on Wednesday, Dec. 13, after a final meal of shredded turkey tacos, rice and beans, apple crisp, and iced tea, Diaz was strapped to a gurney inside Florida State Prison.

He was not remorseful.

"The state of Florida is killing an innocent person," the Miami Herald reports Diaz said. "I'm sorry for what is happening to me and my family who have been put through this."

With that, the execution began with the administration of the first of three chemicals flowing into his body via an intravenous line: sodium pentothal, which is designed to render an inmate unconscious before two other drugs paralyze his lungs and stop his heart.

It didn't go as planned.

According to various media reports, Diaz appeared to be in obvious pain - "grimacing," the Herald reported, while the Gainesville Sun said Diaz shuddered - throughout at least some of the execution.

It took Diaz 34 minutes to die, an autopsy showed.

According to the Associated Press, medical examiner William Hamilton said Diaz had 12-inch long chemical burns on his arms. The needles that were to deliver the toxic cocktail into Diaz's veins instead dumped the chemicals into his soft tissue, requiring a second dose of the sodium pentothal.

Two days after Diaz's execution, then-Gov. Jeb Bush suspended executions and issued an executive order creating a commission to "review the method in which the lethal injection protocols are administered by the Department of Correction."

The commission is charged with ensuring lethal injection "is consistent with the Eighth Amendment ... and its prohibition against cruel and unusual punishment."

Challenges in various states

There have been 1,062 people put to death in the U.S. since the Supreme Court reinstated the death penalty. Of those, 84 percent died by lethal injection, including triple murderer James Lewis Jackson.

Jackson, 47, was the fifth person since Jan. 1 to be executed, and the fourth to die in Texas since the New Year began. With 383 people put to death there, Texas leads the nation in the number of executions since 1976.

In contrast to Diaz's death, media representatives who attended Michael Ross' death by lethal injection on May 13, 2005 at the Carl Robinson Correctional Institution in Enfield say it was relatively peaceful.

Ross, 45, admitted killing eight young women in Connecticut and New York in the early 1980s. After two decades on death row, Ross gave up his appeals, becoming the first person to be executed in Connecticut since Joseph "Mad Dog" Taborsky in 1960.

A handful of reporters selected as witnesses said Ross gave a small gasp and a shudder before dying.

Connecticut is one of 38 states, as well as the federal government and the military, to sanction the death penalty.

But the number of states carrying out the death penalty is in flux, with various challenges to the constitutionality of execution and the required inclusion of medical personnel by some states.

In California in December, a federal judge halted executions there, declaring that the "implementation of lethal injection is broken" but "can be fixed."

That injunction came more than 10 months after another execution was halted in that state because it could not find a medically qualified person to inject the lethal drugs.

And two weeks ago, the New York Times reported, a North Carolina judge stayed the executions of three men. Judge Donald W. Stephens said state law required the presence of a doctor at executions, contrasting with that state's medical board's opinion, which says doctors cannot ethically participate.

Role of Conn. doctors debated

Whether Connecticut doctors can or should play a role in executions was debated in West Hartford this week in a seminar sponsored by the legal-medical committee of the Hartford Bar Association, in conjunction with the Hartford County Medical Association.

Among the panelists were Chief State's Attorney Kevin Kane; Karen A. Goodrow, a Tolland County public defender and co-director of Project Innocence; Harold I. Schwartz, the chief psychiatrist at Hartford's Institute of Living; and Stephen Latham, director of the Center for Health Law and Policy at Quinnipiac University.

Latham, the former director of the American Medical Association's ethics standards, said the AMA's language and stance is clear: "Don't do it," Latham said.

The AMA says that while individual opinions on the death penalty are personal, "A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution."

"Participating" can include prescribing the drugs used to end life, as well as preparing, administering, or supervising injection drugs "or their doses and types."

The state medical society has adopted the AMA rules.

But those rules can "bump into" the state's death penalty protocol - as rarely as it may be applied - because the state directive requires a physician to be summoned to certify death, Latham said.

Connecticut's execution protocol, a nine-page list created by the Correction Department, calls for the executioner to be trained "to the satisfaction of a Connecticut licensed and practicing physician."

That language "means a physician has to bless this," Goodrow said.

Goodrow questioned the role of Chief State Medical Examiner H. Wayne Carver, who took custody of Ross's body and performed the autopsy.

Although he played no role whatsoever in the execution, Carver was standing by to perform his post-execution role.

"There's something terribly wrong with that," Goodrow said.

Social policy through psychiatry

There are other considerations for doctors who treat the condemned, the panelists said, including restoring someone to competency so that they may be executed.

Ross underwent several competency evaluations, including one sought by his lawyer - at the strong prompting of a federal judge - once he decided to forego further appeals.

One doctor who did find Ross incompetent told a judge that he believed Ross wanted to be executed because he was suicidal and suffering from "death row syndrome," essentially, depression and despair brought on by years of confinement.

But Schwartz said that doctors cannot create or misuse diagnoses in an attempt to achieve a goal "that would otherwise be stymied."

"If we label these inmates' condition a mental illness, and use that to reach a finding of incompetence, what we are really doing is implementing a social policy - abolition of the death penalty - on the back of psychiatry," Schwartz said.

"If as a society we wish to abolish the death penalty, as I believe we should, we should legislate that change and not pin it on the inappropriate use of a speculative psychiatric diagnosis," Schwartz said.

Kane echoed some of what Schwartz said.

The majority of the public supports capital punishment, he said. If the public changes its feelings, it can send that message to the state legislature, which is debating four bills to abolish execution.

One doctor in the audience said physicians could be excused from any role in executions by changing the manner of capital punishment from lethal injection - to firing squad.

"These policies are obviously subject to continuing debate," Latham said.

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