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When doctors are expected to kill – administering a lethal injection At exactly 11pm on the 21st September 2006 forty-eight year old Clarence Hill was strapped to the table at Starke Prison, Florida. The warden gave the signal and a cocktail of lethal drugs was pumped into his veins. At 11.12pm the ECG flatlined and Hill was pronounced dead. Hill’s execution went ahead despite his lawyers arguing that the lethal injection is inhumane. Many doctors in California agree and believe the method of lethal injection, supposedly painfree, does cause the condemned pain and should be banned.


key point in the debate for death by lethal injection occurred when California postponed executions indefinitely after doctors refused to participate. They became opposed after a judge’s ruling stated that doctors would have to physically intervene if the condemned person appeared to be in pain.

Doctors would therefore have been expected to tell prison officials whether the prisoner needed more sedation, or possibly even to administer more drugs. “Any such intervention would be medically unethical,” the anaesthetists replied in a statement. “As a result, we have withdrawn from participation.” Lethal injections were suspended as a result. Michelle Connolly looks at the role doctors for JuniorDr.

What’s legal? Lethal injection under United States federal law states that ‘the punishment of death must be inflicted by continuous, intravenous administration of a lethal quantity of an ultrashortacting barbiturate in combination with a chemical paralytic agent until death is pronounced by a licensed physician according to accepted standards of medical practice.’ In it’s simplicity lethal injection simulates a medical procedure - the intravenous induction of general anaesthesia.

The procedure Once the prisoner has been strapped to the table the arm is swabbed with alcohol. Two 14-gauge catheters, the largest commercially available, are inserted, one in each arm. The second is a backup, in case the primary IV. fails. Both catheters are flushed with heparin to prevent clots forming inside.



All condemned prisoners are given the opportunity to make any final statement they wish, and then, on the warden’s signal the drugs are administered. Sodium thiopental (at 14 times the normal dose) is used to induce anaesthesia, pancuronium bromide is the substance used to paralyse the respiratory muscles and potassium chloride is administered to induce ventricular fibrillation. Even without inducing VF death would still follow by asphyxiation. Death typically takes 8-10 minutes and is pronounced

INVOLVEMENT OF DOCTORS The American Medical Association (AMA) specifically condemns the involvement of doctors in state-sanctioned executions. It cites eight acts constituting direct involvement:

1 2 3 4

Administering lethal drugs Maintaining injection devices Supervising technicians Prescribing lethal drugs

5 6 7 8

Selecting intravenous access sites Inserting IV lines Monitoring vitals Pronouncing the prisoner dead

Junior DR #15  
Junior DR #15  

Junior DR magazine design and layout. Issue 15.