Doctors in the Death Chamber

Hippocratic Oath—Modern Version I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Hippocratic Oath -- Classical Version I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Before proceeding note that there are a variety of Oaths similar to the Hippocratic Oath (which, note says nowhere: First, do no harm).

Feb 14, 2006: California courts rule that an anesthesiologist has to be present at the lethal injection of Michael Morales.  High on PCP, strangled, raped, stabbed, and hit a 17 girl in the head with a hammer, Confessed

Lethal injection 1st: Massive dose of Sodium Thiopental should stop breathing and consciousness after 1 min. This alone will kill in ~ 15 min. 2nd: pancuronium is given to paralyze muscles. 3rd: a fatal dose of potassium chloride is given, causes rapid cardiac arrest Remember the Na/K pump’s work in neurons. Kevorkian used 1st and 3rd steps

In 6 of the last 8 prisoners to get L. I In 6 of the last 8 prisoners to get L.I. the 1st step hadn’t stopped their breathing yet and they probably suffocated along with intense pain from the 3rd step. This would be cruel and unusual If Pancuronium works, and you’re paralyzed, but the pain killers don’t work, you wouldn’t cry out, you’d just have to sit there and take the pain.

Side note Serial killer Efren Saldivar was a respiratory therapist who used pancuronium to kill people in hospitals.

Medical associations opposed this as a violation of medical ethics. Doctors are not executioners Still the jail found 2 doctors who agreed, as long as they could remain anonymous. Then the court said they’d have to treat Morales if it didn’t work and they withdrew

Morales is still on death row Judge who sentenced him, has since had a change of heart Morales has found God and regrets the crime. (victim also regrets it.) California has had a moratorium on executions since then.

Courts have made execution a medical procedure in the US. Doctors have to choose between codes of profession v. dictates of society.

1977 Utah, Gilmore executed by firing squad 1976, Gregg v. Georgia, Supreme courts bring captial punishment back after a decade 1977 Utah, Gilmore executed by firing squad Heart didn’t stop for 2 minutes Riflemen sometimes pull off target at last min.

Since 76; 2 firing squads, 3 hangings, 11 gas chambers Hanging: at best spine breaks at 2nd vertebrae, diaphragm is paralyzed, and prisoner suffocates over a couple of min. Gas chamber: cyanide prevents cells from using O2 took longer, people didn’t like to watch the guy struggle 92, triple murderer Harding took 11 min to die Witnesses cried, A. gen. vomitted, warden threatened to quit. Since 76; 2 firing squads, 3 hangings, 11 gas chambers

Since 76; 153 electrocutions Sometimes the electricity arcs out, cooks flesh, ignited prisoners 79 Alabama, Evans III took 3 tries at 2,600 volts. About 20 min to die. Today its all L. I. in the 38 states that use the D.P.

L.I. looks medical, controlled, humane Having doctors around can help with technical difficulties, they can tell you how painless it is, they make it professional. But in 80, the AMA passed a resolution against physician participation. It’s very general A survey in 99 found on 3% of Drs aware of the resolution

1992 Article 2.06: “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.” Prescribing or administering meds Monitoring vital signs Giving tech. advice Choosing injection sites on the body Starting, supervising IV placement Pronouncing death Society of Correctional Physicians is even stricter ANA: has similar codes

What’s okay? Giving the prisoner a requested sedative Signing death certificates after someone else has pronounced death.

What happens when Drs are there? Jails say, come in to pronounce death, Almost inevitably: Things go wrong and only Drs know how to fix it. They become more involved. Slippery slope States have promised anonymity, but produced Drs in court to testify about the L.I.

If Drs are allowed to not do it, then who does and why? Both Drs for and against D.P. go Help out a friend in the prison system The need of the community If you don’t do it they’ll just find someone else to do it poorly. Some view it like treating a terminally ill patient But the Dr aren’t there working for the patient, they’re there working for the state. Otherwise they’d not kill the patient. The gentle hand the places the IV is still the hand of death Still the conflict exists when they medically know how to save the person they are helping kill

If your name gets out protestors can show up at your clinic, Challenges to your medical license can be filed Though no one’s had their license taken

What do we do? PA would hang people publicly until 1834 when hangings moved inside jails 1913, we switched to the electric chair Used it on ~350 people until 60’s when hippies ruined everything. Since 76 we’ve executed 3 people, Since 1973, at least 123 death row inmates have been released after evidence showed innocence.

Do we follow the rules blindly? There are many conflicts over what is right and best. Do your best to act intelligently and wisely.

What message does this cartoon send?

2 ways the media portrays D.P.