"When a convicted murderer is
executed, newspapers often quote the victim's family as
saying they now have a sense of closure, implying that
mourning could not be completed so long as the murderer
lived. Psychologically this is not valid. Mourning requires
the acceptance of the loss and it's working through.
Vengeance is not a part of mourning; it is a part of
feuding."
-Moisy Shopper, The
American Psychoanalyst, Volume 35, No.1
A federal killing --
Q&A with Dr. Edward Brunner
(source: Chicago Tribune, 4/22/2001)
It's only a painless
death if you're the one watching
Timothy McVeigh is sentenced to die by
lethal injection in Terre Haute, Ind., on May 16 at 7 a.m.
for the role he played in the Oklahoma City federal building
bombing. Edward Brunner, M.D., Ph.D., is the Eckenhoff
professor and chairman emeritus of anesthesia at
Northwestern University Medical School and at Northwestern
Memorial Hospital. A death penalty opponent, he was a
practicing anesthesiologist for 4 decades.
Q. Is lethal injection a painless way to
die?
A. Not necessarily. It may be, but more often than not it is
messed up. It is misused in its application because the
people who use the drugs for lethal injection don't
understand the mode of action or the time course over which
the drugs act.
Q. Describe what happens during a lethal
injection.
A. Three drugs are used. The first one is sodium thiopental,
an ultrashort-acting drug. It acts within a minute to make
the brain unconscious. From that point on it begins to wear
off. Depending on the dosage, the individual may wake up
within 3 or 4 minutes. The 2nd drug is called
succinylcholine. It acts at the point where the nerves
enervate the muscles, and it causes an overstimulation of
the muscle so you get muscle twitching all over the body.
The muscles are then completely flaccid and unable to move.
This drug will act for about 10 minutes, but if given in
much larger doses it can act longer. The final drug that is
used is called potassium chloride. We use that drug to stop
the heart beating when we are doing heart surgery and in
lethal injection it is used to stop the heart beating, never
to start again.
Q. What can go wrong in lethal injections?
A. In misuse of the drugs, the thiopental will cause the
patient to look like he is falling asleep. The 2nd drug will
paralyze him. If the drugs are not given properly, the sleep
drug can wear off, allowing the patient to be aware but
unable to move, even to breathe. He undergoes suffocation
and asphyxiation in a horribly painful way even though he
looks completely calm as he is lying on the table. Then he
experiences that deep burning sensation as the potassium
courses through his veins on the way to his heart.
Q. How often are mistakes made?
A. We know that in about 40 % of cases where lethal
injection has been used, there has been misuse in one way or
another, and it has taken as long as 45 minutes for the
person to die. The problem is they tried to make this a very
sterile kind of a procedure, but no matter how you dress it
up, you are still killing someone.
Q. What can go wrong technically?
A. The chemistry of the drugs is such that thiopental and
succinylcholine, when they react to each other, cause a
precipitation of a white, flaky substance that will block up
the needle from the IV. What has happened in a number of
cases is that they give the thiopental and follow with the
succinylcholine, then they get this precipitate which blocks
the needle. The thiopental wears off. The patient is partly
paralyzed and partly not, and begins to move around. In a
number of circumstances, they have to close the curtains so
that people can't see the struggling. Sometimes they have to
start all over again. It is not a clean process because the
people who are using the drugs aren't trained to use them.
Q. Why can't doctors administer the drugs?
A. Every medical society has looked at the problem, at this
issue--the American Medical Association, the American
College of Surgeons, the American College of Physicians and
the American College of Pathologists. The whole spectrum of
medical professional groups has condemned the participation
of physicians in this process. Doctors are trained to heal,
not to kill, and so it is unethical for doctors to
participate.
Q. So who administers the drugs?
A. They turn to people who are untrained and who have no
business using these drugs. Thiopental is a controlled
substance. To use it you need a special license, which the
executioner doesn't have and the warden doesn't have. So
they are in violation of federal and state regulations when
they use these things. More than that, the drugs have been
tested for safety in therapeutic uses. They have never been
tested for use in killing people. What they are really doing
is experimenting on humans, much like the German doctors did
in concentration camps. What they are doing is inhumane. The
subjects end up with a strong possibility of being subjected
to excruciating suffering.
Q. Is there a humane way of killing
anyone?
A. That is a difficult question to answer. I think from the
point of view of my morality, we don't have the right to
kill anyone. Technically, leaving morality aside, could I
kill someone? Yes. But I have had 4 years of college, four
years of medical school and 4 or 5 years of anesthesiologist
training. I think I could kill someone in a comfortable and
humane way, but I can't do that because of the ethical
standards of my practice and because of my own personal
ethics. I also have a doctorate in pharmacology, so I have a
great depth of knowledge about drugs and their actions.
Q. So lethal injection could be every bit
as inhumane as other methods of execution, hanging and
electrocution, for example?
A. That is correct, but it appears that it is not inhumane.
It's appearances, not actuality, that we are dealing with.
It would be much more humane to shoot somebody, but we have
done away with firing squads for some reason. The
electrocutions, especially the ones in Florida, where they
had fire and flashes of electricity coming out of the heads
of the prisoner, were very inhumane.
Q. Are you saying lethal injection is more
humane for the witnesses than for the person being executed?
A. I think that is correct. There is something very strange
going on with this Timothy McVeigh execution, where the
families of the victims want closure by watching him die. It
seems almost as though this is vengeance or retribution that
is coming into play here. There is no place for that in
human interaction.
Q. What do you teach your students in
medical ethics about execution and how do they react?
A. We have a course in medical ethics in which I have
discussed exactly this issue, in a class where several of
the students came from Oklahoma City, and they were very
adamant about the need of Timothy McVeigh to die and for the
execution to be observed to assure people that there was
closure in this whole thing. There is no question that
McVeigh is a criminal, and he did something that was
absolutely horrible. But because he did something horrible
doesn't mean that we are allowed to do something horrible
too. The students react very much as lay people react. Some
are strongly opposed to the death penalty. Many of them
support the death penalty and would participate, from their
point of view as a lay person. But it is important that we
teach the ethics of medicine to these people, which says
basically, first do no harm. That is a guiding principle in
the practice of medicine, to help your patient but never to
harm him. You have to recognize that what the criminal
justice system is trying to do is to convert this prisoner
to a patient, to make him look like he is a patient. He is
not a patient. To treat him as a patient is subversion of
the role of medicine.
Q. Why do you think they do that?
A. They do that for the conscience of the people who are
watching, for the conscience of the community killing this
man or woman: "We will do it in the nicest way
possible." There is no nice way to kill somebody. What
is awful is that these drugs are designed to help patients.
What would happen if a doctor told a patient, "I used
these drugs to kill Timothy McVeigh yesterday." That
would be awful. The drugs deserve better treatment than to
be used to kill.
