The last humane act?

I have always had mixed feelings about capital punishment. On one hand, I think it causes unnecessary suffering to a lot of people and reflects a kind of hubris in judging people on our part. On the other hand, I find it hard to argue the value it has for deterrence; one problem in assessing deterrence is that because it necessarily involves people who might have been deterred because of possible retribution, it's always difficult to pinpoint how valuable it has been because we never get to know the wannabes who never were.

In any case, one thing which we all can agree upon is that whatever capital punishment is meted out, it needs to be humane. Electrocution, death squads, hanging, and gas chambers in my opinion always have been grotesque and cruel methods, a blot on our humaneness. I used to think that lethal injection is "better" than these methods, but somehow could not shun a dissenting thought about how humane it really is.

Now, a morbid sounding but important editorial from the freely available PLOS journal PLOS Medicine offers a critique of lethal injection that should be carefully pondered by policy makers and officials as well as by common citizens. It basically questions the use of the procedure and points out that especially the first step- considered to be the key step in making the procedure humane- may not be so foolproof and benign after all.

This first step is the induction of anesthesia by an injection of thiopental which is administered to the condemned man in order to supposedly ease the next two steps; an injection of pancuronium which paralyzes the muscles, including the respiratory ones, and then a final injection of potassium chloride that causes cardiac arrest. In the absence of anesthesia, the victim would feel an extreme asphyxiation and muscle spasms.

The PLOS editorial first points towards an article published in 2005 in the distinguished journal Lancet, whose conclusions if true are horrible and alarming to say the least. Let the abstract speak for itself:

"Anaesthesia during lethal injection is essential to minimise suffering and to maintain public acceptance of the practice. Lethal injection is usually done by sequential administration of thiopental, pancuronium, and potassium chloride. Protocol information from Texas and Virginia showed that executioners had no anaesthesia training, drugs were administered remotely with no monitoring for anaesthesia, data were not recorded and no peer-review was done. Toxicology reports from Arizona, Georgia, North Carolina, and South Carolina showed that post-mortem concentrations of thiopental in the blood were lower than that required for surgery in 43 of 49 executed inmates (88%); 21 (43%) inmates had concentrations consistent with awareness. Methods of lethal injection anaesthesia are flawed and some inmates might experience awareness and suffering during execution."

What the journal is saying is clear; the procedure seems to be administered sloppily, with basically no concern for the dying man. The fact that the concentrations of thiopental in the blood were lower even than those in surgery patients sounds outrageous, because ideally, the thiopental administered to condemned men is supposed to be at a dosage much higher than that for surgery patients, to ensure the kind of anesthesia that would be considered deadly for surgery patients. But this study shows that it is even lower than in surgery patients, which seems to indicate negligence bordering on criminal behaviour.

What is even more frightening is the second article referenced in the editorial, published in the same issue. This more clearly indicates that the level of anesthesia would depend on how long the procedure took, and if the procedure took very long because of whatever reason, the anesthesia would not be enough and the victim could actually be aware. Even more significantly and morbidly, the main thrust of this article is that the three lethal compounds do not always act in a strict sequential manner. Thus, both potassium chloride and thiopental may not have done their job before pancuronium starts acting. The implication is horribly obvious; the victim undergoes death by chemical asphyxiation, being aware of it all the time. However, because he was under anesthesia, he would not even be able to indicate his suffering.
The fact is that very little research has been done in standardising the protocols of lethal injection, and more importantly, intensive research has not been thought to be necessary. All in all, it is a great travesty if true. The whole point of lethal injection was to make the procedure humane, and such kind of negligence of simple protocols might show that in fact it's supposed to be the opposite.

However, in the end, the PLOS editorial makes a compelling point:

"As editors of a medical journal, we must ensure that research is ethical, and there is no ethical way to establish the humaneness of procedures for killing people who do not wish to die..."

That is, we have a kind of paradox here, namely that even in the absence of research, it would at the same time be considered unethical to conduct research and "standardize" the conditions for lethal injection by performing experiments, admittedly even on animals.

And this is the real heart of the matter which the PLOS editors are getting at, that no forcible killing can be humane. Admittedly, whether we believe in their stance on abolishing the death penalty or not, this is an extremely important matter, and it does not seem to be doing humanity's moral record any good. Personally, even if it might sound macabre, I think that the only possible humane way to kill a human being may be to bring him within ten meters of an atomic explosion, with instant flash incineration. The ludicrousness of this thought itself indicates how thorny and immoral the shades of this issue are.

These studies highlight the inherently oxymoronic nature of the whole matter. Humane killing? Can any method of killing someone against his or her will be considered humane? Let's face it, capital punishment can never be humane. Something to think about.