Doctors Demand Restrictions On Another Execution Drug

PANCURONIUM_BROMIDE lethal injection drug death penaltyOver the past year numerous pharmaceutical companies have tried to distance themselves from lethal injections (sometimes voluntarily, sometimes under pressure).  Until now, all these efforts involved the use of an anesthetic, the first drug in 3-drug execution protocols, or the only drug in one-drug protocols.  First Hospira, then Novartis, Lundbeck, Kayem and Naari have all objected to the use of their anesthetic products in U.S. executions.

Now, Hospira is under fire for pancuronium bromide, which is the second drug in all 3-drug execution protocols in the U.S.  Hospira is the sole provider of this drug for executions; it’s a muscle-relaxant that in executions is used to induce paralysis.  Paralysis during executions makes the condemned look like he’s peacefully falling asleep even if he’s in excruciating pain.  This makes the witnesses to the execution feel better.  Ironically, this masking of possible pain is why pancuronium bromide is widely banned in the euthanizing of animals.

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Forcible Medication Now, Lethal Injection Next

The medical profession, whose prime directive is “do no harm,” gets dragged into the mud when health care providers are required, or choose, to get involved in executions.  Back in January, Ty Alper, associate director of Berkeley Law School’s Death Penalty Clinic, wrote an important paper on the participation of doctors in executions, or rather the widespread failure to exclude their participation.  “Nearly all capital punishment states specifically call for doctors to be involved in some way,” he told Canada Views, which was reporting on an award he has received this week for his work.

But there are also ways outside of the execution chamber that health care professionals can contribute to the execution of a prisoner, in violation of their basic oath.  One area where the medical profession and the death penalty collide is in the execution of the mentally ill, a distressingly regular practice of our capital punishment system.  Tennessee, for example, is still scheduled to execute a seriously mentally ill man, Stephen West, on Nov. 9.  A similar execution in Texas has been postponed, as Lone Star State authorities try to forcibly medicate a severely mentally ill manSteven Kenneth Staley – so he can become temporarily competent enough to be put to death. 

Texas capital punishment and science have always had an uneasy relationship.  From trying to quash an investigation into bad forensic science, to paying psychiatrists (including Dr. James Grigson, aka “Dr. Death”) to convince juries of someone’s “future dangerousness”, to seeking to hide basic information about the drugs used for executions, to attempting to revive the scientifically invalid practice of scent lineups, Texas capital punishment enthusiasts have never had a problem taking steps that undermine the respectability of the medical and scientific professions. 

But even by these standards, if the state is calling on doctors, or other medical professionals, to forcibly medicate a man for the sole purpose of killing him, that is pretty low.

Doctors Detained for Strike Action, at Risk of Torture in Sudan

This posting is part of our Urgent Action Series. For more information visit www.amnestyusa.org/uan

Officers of Sudan’s National Intelligence and Security Services (NISS) have arrested six doctors and attacked protesting medical students and doctors in the last two weeks.  This is worrisome for several reasons, including that the arrests are warranted by Sudan’s 2010 National Security Act.

NISS officers are arresting doctors simply for participating in the Doctors’ Strike Committee, which has been pressuring authorities to keep their promises to improve the working conditions and salaries of Sudanese doctors.  The government has neglected its promises to doctors, and instead is using an unjust law to arrest, detain, and intimidate protesting doctors.

Amnesty International is calling on the Sudanese government to reform its unjust laws and to protect the rights of its citizens.  The government has granted itself the power to detain without charge for up to four and a half months, and NISS agents are essentially free to violate human rights as long as they do it as part of their work.  This means that the government can arrest people like Dr. Bahkit and Dr. Aldin, who, as prisoners of conscience, are simply advocating peacefully for better treatment from the government.  Even worse, NISS officers can beat and torture those they arrest without a single worry of future prosecution.

Take action to get the Sudanese government to respect the rights of its citizens. It is deeply disturbing that peaceful doctors are being mistreated and detained without charge.  Sudanese authorities need to grant these doctors the freedom of expression and improved working conditions.

Anna Westlund, Individuals at Risk Campaign, contributed to this blog post.

Join the Urgent Action Network!

Members of the Urgent Action Network provide an effective and rapid response by sending letters, e-mails, and faxes directly to those who have the power to stop the violations. For more information visit: www.amnestyusa.org/uan

Medical Ethics and Executions: A New Development

lineedleThis weekend, the Washington Post reported that the American Board of Anesthesiology (ABA) decided in February to censure any of its members who participate in executions.  As the document outlining the policy states, bluntly: 

 “… anesthesiologists may not participate in capital punishment if they wish to be certified by the ABA.”

As members of the medical profession, anesthesiologists are bound by the oath to “do no harm,” and of course helping the state kill a prisoner violates that oath in the most fundamental and basic way.  According to the Post, anesthesiologists have been employed by executioners to “consult prison officials on dosages,” or “insert catheters and infuse the three-drug cocktails.”

This is not too big of a deal, since most states do not now use anesthesiologists, but the new policy is significant in that it has teeth.  Instead of being just another resolution decrying participation in executions (almost every association of medical professionals has already passed a resolution like that),  this one promises actual punishment and de-certification for anesthesiologists who chose to help the state put someone to death.   It will be interesting to see if other medical professions which have passed resolutions – physicians, emergency medical technicians (EMTs), nurses  – will follow suit and implement policies with some real consequences.

Ultimately, any states that still use anesthesiologists can simply stop using them, or alter their execution protocol, so this decision is likely to have little effect on executions.  But the American Board of Anesthesiology’s stand is symbolic of a growing recognition that the death penalty not only contradicts the ethics of one of our nation’s most prominent professions, but directly conflicts with one of our society’s most basic values:  the preservation of life.

Docs Won’t Help Ohio Kill

Health professionals confirm death in 1998 Guatemala execution. (c) Jorge Uzon

Health professionals confirm death in 1998 Guatemala execution. (c) Jorge Uzon

Ohio’s botched and failed execution of Romell Broom, which has led to the postponement of all the Buckeye State’s execution plans – at least for this year – has created another problem for the state.  It seems that when you are doing something morally repugnant, like putting a human being to death with lethal chemicals, those with ethics don’t want to help you.  So, as Ohio looks for ways to improve its ability to kill prisoners without embarrassing mishaps, it is not surprising that they are having a hard time finding a respectable member of the medical profession who is willing to help them.  Killing someone, it seems, is somewhat of a violation of the whole “do no harm” code of ethics to which health professionals are bound.

According to an AP report, on Friday, Ohio’s Attorney General Richard Cordray filed a brief with a federal District Court explaining that “ethical and professional considerations are deterring doctors and others from offering advice about lethal injection.”

Apparently, due to this difficulty, Ohio now has judges, police and lawmakers helping to find some medical professionals who are willing to take their ethical obligations less seriously and give the state the help it needs to resume killing.

Meanwhile, there is nothing to prevent us from continuing to offer our own – albeit unsolicited – advice, that the best way for Ohio to avoid these moral quandaries it to simply stop executions.

Sri Lankan doctors at risk of torture

Amnesty International today issued an urgent action appeal on the five Sri Lankan doctors currently being held by the government under emergency regulations.  We are concerned that they are at risk of torture or other ill-treatment.  The doctors had provided medical services to civilians trapped in the war zone, during the last stages of the war earlier this year between the government and the opposition Tamil Tigers.  Before they were detained by the government on May 15, the doctors had provided eyewitness accounts to the media of the suffering experienced by the trapped civilians.  On July 8, while still under detention, the doctors appeared at a press conference organized by the government and retracted their earlier reports.  AI is concerned about how genuine their later statments were.  The doctors remain in detention without charge.

Amnesty is calling on the Sri Lankan government to release the doctors immediately, unless they are to be promptly charged with a recognizable criminal offense.  Please join our appeal and write the government on their behalf.  Write to:  President Mahinda Rajapaksa, Presidential Secretariat, Colombo 1, Sri Lanka; email:  prsec@presidentsoffice.lk.

Sri Lankan doctors "recant" prior testimony

A group of Sri Lankan doctors currently in detention were produced by the Sri Lankan government before the media today in order to recant their prior reports of civilian deaths during the last stages of the war between the Sri Lankan military and the opposition Tamil Tigers.  I’d written about three of these doctors in an earlier entry on this blog, expressing concern that their arrest by the government shortly after leaving the war zone was in reprisal for their earlier reports.  The doctors had provided eyewitness accounts from the war zone detailing the extent of civilian suffering earlier this year.

Since January, an intense military offensive by the government gradually reconquered all the territory once held by the Tigers.  In mid-May, the government announced that it had defeated the Tigers and recaptured all their territory.  Trapped in the war zone with the Tigers had been thousands of civilians who were prevented by the Tigers from leaving; some civilians who did flee were shot by the Tigers as they did so.  The government forces repeatedly shelled the war zone, despite the heavy concentration of civilians in an increasingly shrinking area.  The government denied that it had caused any civilian casualties.  Since the government barred independent observers and the media from the war zone, the doctors’ reports were one of the few eyewitness accounts available as to what was actually happening in the war zone.

Despite U.N figures of more than 7,000 civilian deaths this year, the doctors today said only 650-750 civilians were killed this year.  Their estimate also happens to be far below the Sri Lankan government’s own estimate – a Sri Lankan government official last month estimated 3,000 – 5,000 civilians had been killed.

The Sri Lankan government had said, and the doctors today asserted, that their earlier reports from the war zone had been given under pressure from the Tigers who then controlled the area they were in.  Consider this:  the doctors have been in detention by the government since mid-May and have yet to be charged.  At today’s press conference, they expressed hope that they might now be released.

Also consider that last week, Sri Lankan President Rajapaksa had said in an interview with the Indian newspaper, The Hindu, when asked why the doctors couldn’t be released now, “I told them to organize a press conference.  Let the doctors come and say what they have to say.”  You might think that that would mean that the doctors have now done what the President wanted, so they’d now be released.  But note that in the same interview, Lalith Weeratunga, Secretary to President Rajapaksa, had said about the doctors, “If they go scot-free, it will set a very bad precedent.”

If the doctors had been under pressure earlier from the Tigers while the fighting was going on, have they since been under pressure from the government to “recant” their earlier reports?  AI said today that the doctors’ statements were “expected and predicted,” since we feared that their detention by the government was intended to produce exactly the result we saw today.

I’ll repeat the request I made in my earlier entry about the doctors:  please write to President Mahinda Rajapaksa (Presidential Secretariat, Colombo 1, Sri Lanka, email:  priu@presidentsoffice.lk) and to the Sri Lankan Ambassador to the U.S. Jaliya Wickramasuriya (email:  slembassy@slembassyusa.org).  Please ask that the doctors be released immediately from detention unless they’re promptly charged with a recognizable crime.  They should be given all the medical care they may need, especially Dr. Varatharajah, as well as access to their relatives and lawyers of their choice.  Thanks for your help.

Sri Lanka arrests three doctors

I’m very worried.  In the final days of the war between the Sri Lankan government and the opposition Tamil Tigers, it had been hard to get reliable information as to what was happening in the war zone, since the government had barred access to the area to independent observers.  One of the few sources of information were the reports from three government-employed doctors (Drs. T. Sathiyamoorthy, Varatharajah and Shanmugarajah) who were working in the  war zone.  They provided eyewitness accounts to reporters detailing the suffering of the civilians trapped in the area, many of whom died from war-related injuries.  Their reports highlighted continuous shelling of areas in which civilians were concentrated.

The three doctors were reported to have left the war zone on May 15 with about 5,000 other civilians.  They were last seen at a holding area at the Omanthai checking point.  Amnesty International has gotten reports that Dr. Varatharajah was seriously injured and was airlifted by the Sri Lankan Air Force to an unknown destination.  We also understand that Drs. Sathiyamoorthy and Shanmugarajah were arrested and are now in the custody of the Terrorist Investigation Division, a police unit, in the capital, Colombo.  However, no detention order has been issued so their relatives don’t know where they are or what their status is.

I’m very concerned that the doctors may have been detained in reprisal for the reporting they had done from the war zone.  A Sri Lankan health official has been quoted as saying that they were detained on accusations that they gave false information about civilian casualties to the media.  A top UN official yesterday said that the doctors had “performed absolutely heroically” and expressed concern about their fate.

Please write to President Mahinda Rajapaksa (Presidential Secretariat, Colombo 1, Sri Lanka, email:  priu@presidentsoffice.lk) and to the Sri Lankan Ambassador to the U.S., Jaliya Wickramasuriya (email:  slembassy@slembassyusa.org).  Please ask that the doctors be released immediately from detention unless they’re promptly charged with a recognizable crime.  They should be given all the medical care they need, especially Dr. Varatharajah, as well as access to their relatives and lawyers of their choice.  Thanks for your help.

Doctors who torture

Torture can’t happen without doctors.

The point of torture is not to kill. As a former CIA lawyer once said, “If a detainee dies, you’re doing it wrong.”

The point of torture is to inflict pain. And only doctors can determine how to suffocate without drowning, how to beat without doing too much damage, how to torment without killing.

How horrifying to read “Health Provision and Role of Medical Staff” in the recently leaked International Committee of the Red Cross report (PDF) on the U.S. torture program:

For certain methods, notably suffocation by water, the health personnel were allegedly directly participating in the infliction of the ill-treatment. In one case, it was alleged that health personnel actively monitored a detainee’s oxygen saturation using what, from the description of the detainee of a device placed over the finger, appeared to be a pulse oxymeter. For example, Mr Khaled Shaik Mohammed alleged that on several occasion the suffocation method was stopped on the intervention of a health person who was present in the room each time this procedure was used.

Other detainees who were shackled in a stress standing position for prolonged periods in their cells were monitored by health personnel who in some instances recommended stopping the method of ill-treatment, or recommended its continuation, but with adjustments.

and

As well as the monitoring of specific methods of ill-treatment, other health personnel were alleged to have directly participated in the interrogation process. One detainee, who did not wish his name to be transmitted to the authorities, alleged that a health person threatened that medical care would be conditional upon cooperation with the interrogators.

The report goes on to explain the medical ethics all physicians must follow:

Medical ethics are based on a number of principles which include the principle of beneficence (a medical practitioner should act in the best interest of the patient – salus aegroti suprema lex), non-malefiance (first do no harm – primum non nocere) and dignity (the patient and the person treating the patient have the right to dignity).

So much for those medical vows the doctors at Guantanamo took.

And this report didn’t come from left wing partisans, but rather from one of the most neutral, objective and meticulous watchdogs in the world, the Red Cross. The report was never meant to be leaked. It was intended only for a few individuals within the U.S. government. There was no reason to fabricate, exaggerate or misstate any of the facts.

The details uncovered in the report rely on the testimony of 14 “high value detainees”. Shouldn’t we uncover all of it, interview more than just 14 detainees, but all detainees and U.S. government employees and other staff involved?

Don’t you want to find out how doctors allowed themselves to partake in torture? Don’t we have a duty to make sure this never happens again?