The killing was the best part. It was the dying I couldn't take
-Craig Volk-

There has been a trend to 'medicalize' the capital punishment since the French Revolution according to Dr. Guillotin's proposal about decapitation should be carried out by a machine (the guillotine) as a more humane method of performing death penalty. Details concerning such a project were referred to a committee, conducted by the secretary to the Academy of Surgeons. Furthermore doctors got involved again in designing more state-of-the art methods like that of electrocution for the same reason in the United States: Harold P. Brown and his assistant Dr. Fred Peterson showed experimental results at Columbia University by administering a series of DC shocks to a dog. By 1,000 V DC, the dog agonized but not died. Eventually, Brown finished the dog off with an additional charge of 330 V AC. On a follow-up demonstration, a second dog became the first creature ever publicly reprieved from execution by electrocution.

The most recent example is the case of Michael Angelo Morales, convicted of raping and murdering the teenage girl Terri Winchell in 1981.

At the appointed time (February 22, 2006), the warden of the San Quentin State Prison should give the final order. A trained technician would press the plunger on a syringe connected to a catheter in a convict’s arm, allowing a bolus of sodium thiopental to rush into its vein. Morales should render unconscious in 5 to 10 seconds. After the catheter was flushed with saline, the technician would inject pancuronium bromide.

Pancuronium-muscle relaxation effects, at a correct dosage, last around 45 minutes and it is currently used with general anaesthesia in surgery as an aid to intubation or ventilation. It has no sedative or analgesic effects.

Within 30 seconds Morales should be fully unable to move. At this point breathing stops, as the muscles of the chest and diaphragm have been paralyzed. He should be still alive but, if left in this condition, would expire in approximately three minutes from hypoxia.

Finally, the technician would be ready to inject a large amount of potassium chloride which interferes with the heart’s capability to contract. Within minutes, the inmate's heart reaches asystole in which its activity ceases. It is at this time that a doctor not present for any of the proceedings, upon listening to the convict’s heart, should pronounce the prisoner dead.

According to the above facts it is possible, while unlikely, for convicts executed by lethal injection to be conscious, paralyzed and under unendurable pain during the last minutes of their lives.

Faced with this possibility and the Amendment VIII implications of it, the United States Court of Appeals for the Ninth Circuit judge ordered the state of California to bring in two anesthesiologists to ensure that Morales was fully sedated and unconscious prior to the lethal dose of potassium.

The AMA have long opposed doctors having any role in executions, including monitoring a prisoner's vital signs or giving technical advice except in certifying death. In accordance, the two anesthesiologists designed to oversee the Morales execution refused to participate after learning they would be expected to tell prison officials whether Morales needed more medication, thereby allowing the execution to proceed.

Then the judge gave officials two ways: find a doctor who wanted being involved, or kill Morales with an overdose of thiopental instead of the three-drug protocol. As no such individual willing to participate in an execution could be found, prison officials chose the second option, but drug administration can only be performed by a professional legally authorized to inject intravenously.

Thus the Morales penalty is now on hold indefinitely.

There is a controversy over whether this is actually an ethical dilemma for anesthisiologists. It has been argued that it does not 'since doctors participating in the death penalty are not damning in and of itself any more than Navy doctors are Hippocratic hypocrites for participating in war. The doctors who drug Morales will be helping him and not doing harm, so long as they do not do the lethal injection. Of course, some doctors are performing euthanasia and assisted suicide, which are explicitly prohibited by the Hippocratic oath, so whatever' (1). And the same can be said about the doctors' participation in developing modern execution techniques.

Some things are simply beyond our purview. Decisions of life and death should be made above our pay grade. The state, no matter how careful the protocols or how due the process, should not be in the deal of killing people in cold blood.