Retired Consultant Anaesthetist
Editor - Dr Groner's horrific vignette of a recently botched and hence inhumane execution by lethal injection in the state of Georgia U.S.A appals as much by the time taken in the 'preliminaries (30 min) as by the ethics of employing a doctor to insert a central venous line .The report of the Royal Commission on Capital Punishment (RCCP) may be of some help to Dr Groner. The Commission was asked by the Prime Minister of the day to look at methods of execution. Was there a more humane method than hanging? There was a choice of four methods: hanging, and in other countries electrocution, lethal gas [cyanide] and the guillotine. Execution by lethal injection had lapsed since the Nazi euthanasia programme. Zyklon B (cyanide) killed millions in the Holocaust.
As to methods of execution, "We shall take as our postulate that the requisites are humanity, certainty and decency, and those alone….The requirements of humanity are essentially two. One is that the preliminaries to the act of execution should be as quick and as simple as possible, and free from anything that unnecessarily sharpens the poignancy of the prisoner's apprehension. The other is that the act of execution should produce immediate unconsciousness passing quickly into death." The Commission at once rejected the guillotine as producing a mutilation 'shocking to public opinion in this country' and rejected also the firing squad, 'which does not possess even the first requisite of an efficient method, the certainty of causing immediate death.' 'The figures in our table leave no room for doubt that in the time taken by the preliminaries, hanging is superior to either of the other methods (gas, electrocution).'
Lethal injection. (Chairman) What are the objections that you see to a lethal injection? (Dr Landers) We do not think it would be any more humane (than hanging), and we think the main objection is its impracticability.(Chairman) Would you enlarge on that -? - It raises the question as to who is to do it, and how they are to do it. We cannot suggest who is to do it… (Dr Landers represented prison medical officers.)
The British Medical Association (BMA) said: 'If it were practicable, the intravenous injection of a lethal dose of a narcotic drug would be a speedy and merciful procedure…But the practical difficulties encountered in many cases  are such as to render the method quite unsuitable for the purpose of execution'. The Association of Anaesthetists (of Great Britain and Ireland) AAGBI agreed. There were three reasons why the method was impracticable. First it was impossible to give an intravenous injection to anyone with certain physical abnormalities. Secondly it was never easy to give one except with the co-operation of the subject. Thirdly, the operation demanded professional skill, which the medical profession would be unwilling to use for such a purpose.
The BMA was as explicit about the third reason as today's, American Medical Association (AMA). 'No medical practitioner should be asked to take part in bringing about the death of a convicted murderer. The BMA would be strongly opposed to any proposal to introduce, in place of judicial hanging, a method of execution which would require the services of a medical practitioner either in carrying out the actual process of killing or in instructing others in the technique of the process.' Such absolutist ethics were shared by Dr Frankis Evans, President of the then Faculty of Anaesthetists of the Royal College of Surgeons of England.
Perhaps fortunately British doctors were never put to the test. To intense public disapproval, some years after publication of the Commission's report  Parliament abolished capital punishment. Dr Groner might take heart from that.
Peter Scott, Retired Consultant Anaesthetist, Bromsgrove.
 GRONER J. Lethal injection: a stain on the face of medicine. BMJ, 2002;325:1026-1028 (November 2)
 Report f the Royal Commission on Capital Punishment 1949-1953. London: Her Majesty's Stationery Office, 1953.