ABA will revoke your certification if you execute someone

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...waiting for the AANA to step up to the plate and offer their services.


Seriously, though, I'd like to understand what else can get your cert revoked. They seem to be overstepping their boundaries with this one. I don't see how an ethical dilemma such as execution affects your competency as an anesthesiologist, which is what the ABA is responsible for protecting.

Granted, their are ethical questions that play to your competencies, but there does not seem to be a sufficient consensus on physician participation with executions to make this worthy of revoking certification.
 
if i'm not mistaken, california has removed any physician involvement in executions. we are not asked to participate.

also, i heard that the judge has now ok'd calif's death penalty protocol. i don't know the details.
 
The new protocol, first used by Ohio, is a single drug: 5gm thiopental. No potassium, no pancuronium. If IV access is impossible, the inmate gets IM midazolam 10mg and hydromorphone 40mg IM.

A lot of states are going to adopt the one drug protocol without knowing if it resolves the issues with the three drug protocol.

Regardless of your stance on the dealth penalty, this action by the ABA should be commended. We have no business using our specialized knowledge to kill people.
 
proman said:
The new protocol, first used by Ohio, is a single drug: 5gm thiopental. No potassium, no pancuronium. If IV access is impossible, the inmate gets IM midazolam 10mg and hydromorphone 40mg IM.

A lot of states are going to adopt the one drug protocol without knowing if it resolves the issues with the three drug protocol.

Regardless of your stance on the dealth penalty, this action by the ABA should be commended. We have no business using our specialized knowledge to kill people.
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All we need to do is let it slip to the AANA that some prison boards feel that anesthesiologists are the best trained physicians for the job, and they will jump at the chance to use their "unique" "compassionate" skills to assist with the inmates "transition".
 
proman said:
If IV access is impossible, the inmate gets IM midazolam 10mg and hydromorphone 40mg IM.
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That is pretty close to what I gave to my last abscess patient so that I could establish IV access before we went into the OR. Perhaps we will see a large increase in opiate abuse among death row inmates if this protocol is adopted.

-pod
 
Narcotized said:
If I sign up for the firing squad and don't use lethal injection, would that be ok with the board?
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Funny, I was thinking the same thing, a la Utah/Ronnie Lee Gardner:


spacer.gif
 
I don't know where the ABA gets off using its shtick to enforce their political philosophy. This should be a personal choice. Frankly, I think it violates the ethical principle of non-maleficence if a lethal execution is not quickly, efficiently and expertly carried out. It amounts to torture.

The state has already made the decision for execution, not me. An anesthesiologist's or other MD/DO role would be to ensure it is as painless as possible.

I take issue with this.

BTW, Goodman, you bring up some interesting topics 🙂
 
Narcotized said:
If I sign up for the firing squad and don't use lethal injection, would that be ok with the board?
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There are countless ways of killing someone without involving a physician. The father of someone I know, a retired surgeon, was an executioner.

Narcotized said:
I think this is awesome. I think they should take it one step further and have an extra 25% surcharge on all board exam fees to be put in a murderers fund. We show our compassion by stopping executions and then providing these unfortunate people imprisoned against their will with a fund to provide legal expenses, cable TV, high speed internet, green fees, and occasional Caribbean cruises. Let's prove we are the specialty that cares!! (cares about murderers that is; not victims or families... )
Click to expand...

I'm not for leniency of the convicted. This issue has nothing to do with how inmates are cared for. Have you ever been in a prison? I've been in several (county jails and state pens). There's nothing fancy or cush about it.

Eta Carinae said:
I don't know where the ABA gets off using its shtick to enforce their political philosophy. This should be a personal choice. Frankly, I think it violates the ethical principle of non-maleficence if a lethal execution is not quickly, efficiently and expertly carried out. It amounts to torture.

The state has already made the decision for execution, not me. An anesthesiologist's or other MD/DO role would be to ensure it is as painless as possible.
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Why would a physician become an instrument of the state? Participating in an execution devalues the primacy of our standing in society. This isn't political as there are pro and con execution members in both parties. Participating does violate non-maleficence, ie "do no harm" because one's direct actions cause the death of a person.
 
proman said:
Why would a physician become an instrument of the state? Participating in an execution devalues the primacy of our standing in society. This isn't political as there are pro and con execution members in both parties. Participating does violate non-maleficence, ie "do no harm" because one's direct actions cause the death of a person.
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If you are an employee of the VA or the prison health system, what does that make you? What if you work for the city or state's public health office? Are you not then an "instrument" of the state.

The prisoner's death is inevitable because sentence by the state has already been passed. It is only right that a specialist with expertise in this area ensure that the sentence is carried out in the most humane possible manner- therein is non-maleficence.

Arguing for or against the death penalty as an instrument of justice is another matter. But when the sentence has already been handed down, your participation as an anesthesiologist is not a matter of ill will.

I fully support the death penalty but if the ABA has decided (in the interim) that Anesthesiologists should neither participate nor supervise at the risk of revoked certification, I will be content to step back and let the state recklessly (if that winds up being the case) and brutally carry out the execution- in the case of botched repeated attempts.

The willingness of healthcare providers to participate is actually a matter of benevolence in ensuring that even the worst criminals receive the weight of the law in punishment with some decency. Not because any of us enjoys the killing of another human being.
 
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ProRealDoc said:
Does the physician administering the lethal injection receive payment from the state?
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I remember reading of a nominal reimbursement, I will try to locate the source; I believe it was one of Atul Gawande's essays on the subject. I remember it being about enough to cover the cost of gas for your commute or something just as paltry.
 
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proman said:
Why would a physician become an instrument of the state? Participating in an execution devalues the primacy of our standing in society. This isn't political as there are pro and con execution members in both parties. Participating does violate non-maleficence, ie "do no harm" because one's direct actions cause the death of a person.
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Of course, the alternative is to bury a prisoner while he's still alive.

An article in the April 16, 2005 issue of The Lancet titled “Inadequate anaesthesia in lethal injection for execution,” authored by Koniaris, Zimmers, Lubarsky, and Sheldon concludes in part that “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.

For the record, I find this alternative far more repugnant.
 
Simmer down cowboy. This is an argument about anesthesiologist participation in an execution. It is not about capital punishment or abortion.

The ABA has said that anesthesiologists participating in capital participation violates fundamental principles of medical ethics.

As for my believes, you have no idea what my political philosophies are. I don't care what your politics are. What I do care about is the use of specialized, highly valued training in a manner that leads to a persons death. Talk about those issues and I'll respond.
 
I'm no attorney either but I guess the counter argument would be that since some hospitals/groups require ABA certification and having it makes you marketable and affirms your competence, denying or revoking certification constitutes a restriction of free trade as below:

"it is the privilege of a trader in a free country, in all matters not contrary to law, to regulate his own mode of carrying it on according to his own discretion and choice. If the law has regulated or restrained his mode of doing this, the law must be obeyed. But no power short of the general law ought to restrain his free discretion" Mitchell v Lloyd 1711

As capital punishment/execution by lethal injection is legal in some states, your participation as a physician does not violate the law and so it cannot be regulated based on the whim or political philosophy of any particularly private body.

This would be like (and this is a far-reaching example) the ABA deciding it did not believe in providing free anesthesia care in third world countries and as such threatening certification penalties for anyone who is involved with MSF (medicines Sans Frontieres).

It can also be countered as an overreach of a private NGO into the activities of a private citizen whose actions are neither in violation of the law nor pose a danger to society.

I guess the legal circumlocution of this idea would be to suggest that it is outside of/contrary to the boundaries of medicine. Then again, if we had invested any time in defining what the practice of medicine is, we wouldn't have the encroachment from midlevels seeking to practice (medicine) independently.

I sincerely hope these guys sought legal counsel before they went ahead with this decision. My guess is that knowing the response from the medical community would likely be supportive or at the very worst passive, they issued this edict pretty much independently.

Who's going to stand up and challenge this? I'm assuming few Anesthesiologists actually care to be involved with criminal executions to begin with.
 
Impromptu said:
Does anyone know the CPT code for an execution?
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I don't know the CPT code, but the ICD-9 code is E978 - I don't know the modifiers (like specific means), but that code is for legal executions performed at the behest of the judiciary or ruling authority.

As such, it would go like this (for example):
1. Cardiac arrest, secondary to 427.5
2. Respiratory arrest, secondary to 799.1
3. Medication administration, toxic 971
4. Execution E978
 
Narcotized said:
It is extremely obvious what you're political view on this is no matter how you disguise it. You don't need to respond. Just please don't tell others what "we all agree on" when it's just your political view. No I don't agree on it, and yes an anesthesiologist should be allowed to be the lethal injector if he so desires that employment. But we all agree on that, too, right?
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I think everyone with intact cerebral activity agree people like you have no place in either society or the medical profession.
 
Apollyon said:
I don't know the CPT code, but the ICD-9 code is E978 - I don't know the modifiers (like specific means), but that code is for legal executions performed at the behest of the judiciary or ruling authority.

As such, it would go like this (for example):
1. Cardiac arrest, secondary to 427.5
2. Respiratory arrest, secondary to 799.1
3. Medication administration, toxic 971
4. Execution E978
Click to expand...

HA! Apollyon, I find it interesting (and almost darkly amusing) that your readiness with the ICD-9 codes matches your sig.

I want to laugh, but this is such a weighty issue, I can't.
 
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psychforme said:
I think everyone with intact cerebral activity agree people like you have no place in either society or the medical profession.
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😕

Umm,

so it's somewhat disconcerting that any one individual feels sufficiently empowered to make such judgments.

Why the conclusion?
Because he supports justice tantamount to the egregiousness of the crime or the humane enactment of a sentence meted out by society.

This is the nature of the left, to beat any dissenting voice into concession through intimidation, labeling and insult. And shame on this ^ poster for doing so.

At some point in the defense of convicted felons, it might benefit the leftist machine to call to remembrance the suffering of and the injustice done to the victims and their families and to society at large.
 
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Here is a link to the article.

Excerpts that emphasize the thrusts of the essay are quoted here:

How did we get here?
On February 14, 2006, a U.S. District Court issued an unprecedented ruling concerning the California execution by lethal injection of murderer Michael Morales. The ruling ordered that the state have a physician, specifically an anesthesiologist, personally supervise the execution, or else drastically change the standard protocol for lethal injections.1 Under the protocol, the anesthetic sodium thiopental is given at massive doses that are expected to stop breathing and extinguish consciousness within one minute after administration; then the paralytic agent pancuronium is given, followed by a fatal dose of potassium chloride.


The judge found, however, that evidence from execution logs showed that six of the last eight prisoners executed in California had not stopped breathing before technicians gave the paralytic agent, raising a serious possibility that prisoners experienced suffocation from the paralytic, a feeling much like being buried alive, and felt intense pain from the potassium bolus. This experience would be unacceptable under the Constitution's Eighth Amendment protections against cruel and unusual punishment. So the judge ordered the state to have an anesthesiologist present in the death chamber to determine when the prisoner was unconscious enough for the second and third injections to be given — or to perform the execution with sodium thiopental alone.
 
What about the victims of the crimes?
"My wife didn't like it," Dr. A told me. "She said, `Why do you want to go there?'" But he felt torn. "I knew something about the past of these killers." One of them had killed a mother of three during a convenience-store robbery and then, while getting away, shot a man who was standing at his car pumping gas. Another convict had kidnapped, raped, and strangled to death an 11-year-old girl. "I do not have a very strong conviction about the death penalty, but I don't feel anything negative about it for such people either. The execution order was given legally by the court. And morally, if you think about the animal behavior of some of these people. . . . " Ultimately, he decided to participate, he said, because he was only helping with monitoring, because he was needed by the warden and his community, because the sentence was society's order, and because the punishment did not seem wrong.
 
For an inevitable sentence…
Yet he also felt an obligation not to abandon inmates in their dying moments. "We, as doctors, are not the ones deciding the fate of this individual," he said. "The way I saw it, this is an end-of-life issue, just as with any other terminal disease. It just happens that it involves a legal process instead of a medical process. When we have a patient who can no longer survive his illness, we as physicians must ensure he has comfort. [A death-penalty] patient is no different from a patient dying of cancer — except his cancer is a court order."

He explained further. "I think that if I had to face someone I loved being put to death, I would want that done by lethal injection, and I would want to know that it is done competently."
 
Eta Carinae said:
HA! Apollyon, I find it interesting (and almost darkly amusing) that your readiness with the ICD-9 codes matches your sig.

I want to laugh, but this is such a weighty issue, I can't.
Click to expand...

Didn't do them from memory (not the numbers, at least - knew the diagnoses).

In reality, I've never even gotten close to an execution, in any capacity.
 
Narcotized said:
Excuse me Psycho, considering that I have more intact cerebral activity in just my rectum than you have in your entire skull, I can therefore categorically dismiss your assessment in its entirety.
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Some people live in a dream world, just look at that avatar of the cat hugging and stroking a fish. With counseling the cat can return to society, right?
 
Narcotized said:
ABA is more than just some random private club. We need that to practice our profession.
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I thought it was interesting that when I showed up for my oral boards a couple weeks ago, the ABA greeter made a specific point of noting that while board certification used to be purely voluntary, we're on the edge of a transition where it will be practically required if you want to practice and earn a fair market wage. Some would argue that we've already passed that point.

I certainly don't view board certification as "optional" ...


That said, the death penalty as it exists today in the US is ******ed. It would be a cheaper and harsher punishment to let them rot in solitary confinement for 60 years, then when they finally reach the last days of their wasted lives, refuse to make them DNR (all life is precious!) and give them the full court press in the ICU for the final weeks of their lives. Preferably in a teaching hospital.
 
pgg said:
I thought it was interesting that when I showed up for my oral boards a couple weeks ago, the ABA greeter made a specific point of noting that while board certification used to be purely voluntary, we're on the edge of a transition where it will be practically required if you want to practice and earn a fair market wage. Some would argue that we've already passed that point.

I certainly don't view board certification as "optional" ...


That said, the death penalty as it exists today in the US is ******ed. It would be a cheaper and harsher punishment to let them rot in solitary confinement for 60 years, then when they finally reach the last days of their wasted lives, refuse to make them DNR (all life is precious!) and give them the full court press in the ICU for the final weeks of their lives. Preferably in a teaching hospital.
Click to expand...

Wouldn't that constitute cruel (if not unusual) punishment?

(This coming from someone eagerly anticipating joining the cadre of students who are sticking poorly-aimed IVs into people.)
 
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Eta Carinae said:
What about the victims of the crimes?
"My wife didn't like it," Dr. A told me. "She said, `Why do you want to go there?'" But he felt torn. "I knew something about the past of these killers." One of them had killed a mother of three during a convenience-store robbery and then, while getting away, shot a man who was standing at his car pumping gas. Another convict had kidnapped, raped, and strangled to death an 11-year-old girl. "I do not have a very strong conviction about the death penalty, but I don't feel anything negative about it for such people either. The execution order was given legally by the court. And morally, if you think about the animal behavior of some of these people. . . . " Ultimately, he decided to participate, he said, because he was only helping with monitoring, because he was needed by the warden and his community, because the sentence was society's order, and because the punishment did not seem wrong.
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What if what he knew was wrong and the convict was innocent? Are innocent convicts just collateral damage for you? Narcotized is at least surely guilty of pushing an agenda of murdering innocent people - unless he claims someone stole his password.

1 People's Republic of China Officially not released. At least 1700[44] - 5000[45]
2 Iran At least 388
3 Iraq At least 120
4 Saudi Arabia At least 69
5 United States 52
6 Yemen At least 30

Looks like the US is in good company.
 
psychforme said:
I think everyone with intact cerebral activity agree people like you have no place in either society or the medical profession.
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-1

I don't think we can agree upon that at all. It appears that you are saying that he should be removed from society because of his beliefs on a certain topic. That is what you said, right?
 
Gern Blansten said:
-1

I don't think we can agree upon that at all. It appears that you are saying that he should be removed from society because of his beliefs on a certain topic. That is what you said, right?
Click to expand...

"Certain beliefs." He is pushing an agenda that has murdered hundreds of innocent people. A crime much more hideous than any schizophrenic going on a killing spree due to psychopathology. The difference is the death penalty proponents carefully in a thoughtful manner murder innocent people while most technical killers murder because of psychopathology.
 
psychforme said:
What if what he knew was wrong and the convict was innocent?
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Then he'd be evil. But this question is a goalpost-moving fabrication in some bizarre fantasy world.


I oppose the death penalty on purely practical grounds
- it costs far more than to house the person in solitary confinement for life
- it's a gentler punishment than life in solitary
- rare mistakes can't be corrected (or at least mitigated)

In short, death's too good for those people. We can do better than an expensive, years-delayed, painless "anesthetic" death. Bonus points for not executing the rare innocent person.
 
pgg said:
Then he'd be evil. But this question is a goalpost-moving fabrication in some bizarre fantasy world.
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No, it is reality. Are you denying innocent people have been murdered through capital punishment?
 
psychforme said:
No, it is reality. Are you denying innocent people have been murdered through capital punishment?
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Why did you edit out the portion of my reply in which I answered that question (twice)?

pgg said:
I oppose the death penalty on purely practical grounds
- it costs far more than to house the person in solitary confinement for life
- it's a gentler punishment than life in solitary
- rare mistakes can't be corrected (or at least mitigated)

In short, death's too good for those people. We can do better than an expensive, years-delayed, painless "anesthetic" death. Bonus points for not executing the rare innocent person.
Click to expand...

I clearly wrote that I oppose the death penalty in part because of the risk of killing innocent people.

You're just running your mouth without thinking. Either read the posts you're replying to, or kindly STFU and go away.
 
pgg said:
Why did you edit out the portion of my reply in which I answered that question (twice)?



I clearly wrote that I oppose the death penalty in part because of the risk of killing innocent people.

You're just running your mouth without thinking. Either read the posts you're replying to, or kindly STFU and go away.
Click to expand...

Because that was the part I objected to. Why would I argue statements I agree with?
 
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