Oklahoma Executions 2021

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This is probably too controversial a topic for SDN, but given the current urgency of a pending execution (Julius Jones, whose deadline is today), I think it's worth an attempt at a meaningful discussion on here.

Article in question: Oklahoma executes inmate who dies vomiting and convulsing.

The ABA's position on our involvement in executions: Anesthesiologists and Capital Punishment.

A few questions come to mind for me, specifically regarding the meds:
- if not us, who pushes the meds (i.e., midazolam, vecuronium, potassium chloride)?
- who decides the dosages? 5 mg midazolam? 10 mg midazolam? 20 mg midazolam? 10 mg vecuronium? 20 mg vecuronium? How much potassium chloride is considered lethal?
- who decides which medications to use? Is midazolam enough of an amnestic to avoid "cruel and unusual punishment?" Should there be a hypnotic as well? Why vecuronium versus rocuronium?

When I see midazolam, I don't immediately think "convulsions" or "vomiting." Some would say you usually see the opposite reaction, which begs the question: which meds are being pushed when, and do they have somebody qualified enough to know the difference? Dubious, in my opinion.

I'm not looking to start a conversation about whether or not executions should exist in our judicial system, but I do wonder about the logistics in carrying out these executions "properly." We are arguably the most qualified profession to handle these medications (I gave all three meds at some point during a case last week), so if not us, then who? Is it considered an ethical obligation for us to make sure that these executions are carried out in a humane manner (which is a controversial statement in and of itself, I'm sure)? Before we go down that road, let me remind you that there have been plenty examples of wrongly convicted people sentenced to death, so I do think if we decide as a society that execution is an acceptable form of punishment, we need to go to great lengths to ensure that we do it without cruelty.

Edit: update regarding the Julius Jones case.
 
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Hooey, this is a good one. I'm a pretty apolitical person by nature, but this discussion will eventually devolve into "should capital punishment exist". I don't have strong feelings about it either way as those types of decisions are way beyond my paygrade or existence. So I will answer the questions as they currently stand, knowing that capital punishment exists.

And no I wouldn't want to be involved. But I can appreciate that some people would, and may have high motivation to ensure the person in question is protected from as you said, cruel and unusual punishment.

I don't think a physician should necessarily be the one that HAS to push those drugs, but a physician should decide on it and I think should be present should things not go perfectly. I think that dosages should be decided by a physician, heavy handed and weight based. I would add an agent in addition to midazolam. Propofol, high dose fentanyl, ketamine are all acceptable in my mind. I think it is clear that the process of the execution is not and should not be part of the punishment. The person in question should not experience pain or awareness during the act.
 
chessknt said:
This really shouldn’t be that hard. NPO the morning of, push 20 mg of versed, some glyco for secretions, and 200mg of roc they’ll be dead in 5-10 minutes. It is amazing all the agonizing that goes on over this. The medical aspect of delivering an execution is super easy.
Click to expand...


But imagine if you are a prison guard who’s never inserted an IV before doing it for the first time. There have been executions that have lasted over 40min because of bad IVs and difficult IVs.

Edit: here’s some links

www.nytimes.com

A Prolonged Execution in Arizona Leads to a Temporary Halt (Published 2014)

The state’s attorney general called for a temporary halt to executions a day after it took one hour and 57 minutes for Joseph R. Wood III to die.
www.nytimes.com www.nytimes.com


One Execution Botched, Oklahoma Delays the Next (Published 2014)
 
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chessknt said:
IO access very easy and reliable but admittedly will look rough to the untrained observer. IM injection of high dose ketamine would probably be effective by itself but the secretions would look bad even though the prisoner would be unaware. If they can't get IV access then they should try an alternative method of execution. Or just stop executing people but if it is going to be a thing then agonizing over the how of it seems pretty stupid.
Click to expand...


I’m not sure how much ketamine is required to reliably kill someone. It’s a very forgiving drug. Maybe high dose ketamine+curtain+pillow.
 
Lots of good options for IM administration. Ot do IO. No need to bumble around for an IV. Agree thr whole thing with dosing is stupid. Just give them a lot. Plenty of amnestic and hypnotic.

And for christs sake give the prisoner a paralytic so you don't see the convulsions and involuntary movements that happen with the act of dying. That's what observers complain about anyways.
 
nimbus said:
I’m not sure how much ketamine is required to reliably kill someone. It’s a very forgiving drug. Maybe high dose ketamine+curtain+pillow.
Click to expand...

Plenty of people die from OD opioids. Sufentanil. Carfentanyl inhaled gas.. That might not be a bad way to go.
 
Just put them in a room and pump it full of CO. They will fall into a coma and expire. It may evoke some strong reactions from people for historical purposes, but it’s certainly less barbaric than watching some dude writhe around for 40 minutes after getting a bolus of subcutaneous midazolam/rocuronium.
 
IV Propofol, Rocuronium, Potassium. 800mg Propofol, 200mg Rocuronium, 400meq Potassium in 100ml bag. No need to go light handed here. This would insure the most humane, least visually disturbing, and most effective lethal injection. I also believe that the IV and medication should be administered by a healthcare professional.
 
Urzuz said:
Just put them in a room and pump it full of CO. They will fall into a coma and expire. It may evoke some strong reactions from people for historical purposes, but it’s certainly less barbaric than watching some dude writhe around for 40 minutes after getting a bolus of subcutaneous midazolam/rocuronium.
Click to expand...

why CO? Why not N2O? They will giggle until their heart stops.
 
IMHO, physicians should not be involved in punitive killings of individuals. There are many other methods available for executions that do not involve intravenous drugs. Euthanasia- possibly since these are mercy killings and the anesthesiologist could potentially ease suffering at the end of life.
 
Strictly as a physiologic consideration, CO2 or N2 are both used in mammalian animal euthanasia. Not sure why those can't be used, without any need for the presence of a medical provider of any type other than what is legally required for pronouncement after death. Breathing 100% nitrogen or carbon dioxide gas causes quick, painless unconsciousness and death follows shortly thereafter due to profound hypoxia. Nitrogen and CO2 narcosis are both very well understood concepts.

Totally agree that it's unethical and improper for any healthcare professional to participate in any execution.
 
jwk said:
Strictly as a physiologic consideration, CO2 or N2 are both used in mammalian animal euthanasia. Not sure why those can't be used, without any need for the presence of a medical provider of any type other than what is legally required for pronouncement after death. Breathing 100% nitrogen or carbon dioxide gas causes quick, painless unconsciousness and death follows shortly thereafter due to profound hypoxia. Nitrogen and CO2 narcosis are both very well understood concepts.

Totally agree that it's unethical and improper for any healthcare professional to participate in any execution.
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To play devils advocate, given the practice is occurring, is it ethical to allow the condemned to suffer through the actions or untrained/incompetent individuals when a trained MD has the skill set to prevent said suffering?

For the record I’m against capital punishment. But if it must be done it should be done correctly.
 
Zekchar said:
IV Propofol, Rocuronium, Potassium. 800mg Propofol, 200mg Rocuronium, 400meq Potassium in 100ml bag. No need to go light handed here. This would insure the most humane, least visually disturbing, and most effective lethal injection. I also believe that the IV and medication should be administered by a healthcare professional.
Click to expand...

Texas use to use a similar cocktail. Often times, the problems isn’t that there aren’t effective cocktails, it is that the state is unable to procure them because the manufacturers are unwilling to sell them. They have no problem selling high does barbiturates so people can kill themselves.

There was also a case where a femoral cvc was placed by a FM doc, but not in the vein.
 
nimbus said:
Lethal injection=medical procedure performed by inexperienced idiots. If you’re going to have execution, bring back the guillotine or a skilled swordsman.
Click to expand...
This has been my argument for years. Or a firing squad that is modern. Engineered guns on a rack and everyone "pulling the trigger" is in another room pushing a button and has no idea if their gun did it. The idea of killing people with drugs is dumb IMO. If we are gonna do it then we need to own it.
 
NITRAS said:
Texas use to use a similar cocktail. Often times, the problems isn’t that there aren’t effective cocktails, it is that the state is unable to procure them because the manufacturers are unwilling to sell them. They have no problem selling high does barbiturates so people can kill themselves.
Click to expand...
Wasn't that one of the reasons there were issues getting propofol a number of years ago? A couple manufacturers refused to ship to the US unless distributors guaranteed it would not be used in executions.

Seems like the original lethal injection cocktail was something like pentothal 2000mg, pancuronium 100mg, and some absurd amount of KCL.
 
Restrain, about 500 fentanyl patches, return to cell, check in the morning.
 
DocVapor said:
Why has noone suggested sitting them in front of a pile of heroin and letting them snort to their hearts content?
Click to expand...
Big Heroin has already stated that, if this was allowed, they would cut off access to heroin for the rest of the country. That is the REAL reason that this idea was shot down years ago.
 
I don't think I saw this discussed yet, but the ABA came out years ago with a position that stated that they would revoke your board certification if it was discovered that you had participated in the execution process.
 
Gern Blansten said:
I don't think I saw this discussed yet, but the ABA came out years ago with a position that stated that they would revoke your board certification if it was discovered that you had participated in the execution process.
Click to expand...

Could be a new career opportunity for those who can’t get board certified. Just sayin.
 
Re: vomiting

Remember none of these prisoners are NPO before their execution. If you were anxious and had a stomach full of your last meal (which is probably very rich and fatty) a whopping dose of sedatives will probably cause you to vomit as well.
 
drmwvr said:
Passive regurge. Guess you could put the head of the table up and hold cricoid or somthing....
Click to expand...

You are worried about aspiration? In a prisoner being executed? I just want to stop the pesky reflexes that look like the prisoner is struggling. U know the gasping choking coughing vomiting
 
coffeebythelake said:
You are worried about aspiration? In a prisoner being executed? I just want to stop the pesky reflexes that look like the prisoner is struggling. U know the gasping choking coughing vomiting
Click to expand...
couldn't find the snark emoji...sorry...still... mouth filling up...gastric contents spilling on the floor...death is ugly one way or another I guess...
 
drmwvr said:
couldn't find the snark emoji...sorry...still... mouth filling up...gastric contents spilling on the floor...death is ugly one way or another I guess...
Click to expand...

This can happen whatever the method of execution up to and including firing squad or electric chair. Maybe the only one where this wouldn't happen is with decapitation. maybe we should institution ASA fasting guidelines? 🤔
 
coffeebythelake said:
This can happen whatever the method of execution up to and including firing squad or electric chair. Maybe the only one where this wouldn't happen is with decapitation. maybe we should institution ASA fasting guidelines? 🤔
Click to expand...


Last meal….

A1EE83E0-A25F-40D2-B8DE-4043D11BADD3.jpeg



On second thought that would be cruel and unusual punishment.
 
lethal injection protocols can reasonably be described as:

a camel is a horse designed by a committee

  1. An expression critical of committees — which by analogy can extend to both group decision-making as well as abstract or unrelated managerialism — by emphasizing the weaknesses of incorporating too many conflicting and inexperienced opinions into a single project. The distinguishing features of a camel, including its humps, plate-shaped feet, habitual spitting, strange shape and poor temperament, are treated as the sort of deformities that typify a conflicted, or overly idealistic, design process. quotations
2. Rube Goldberg machine - Wikipedia
 
Why does there need to be an IV? Russian opera house attack was stopped with an inhalation narcotic, sufentanyl I believe. More lives would have been saved if paramedics would have been aware and administered narcan. Carfentanyl could be administered in the gas chamber . Humane imo. No paralytic necessary due to stiff chest. I suppose inhalational benzo could be added before carfentynal.
 
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anaesthetic said:
Is it considered an ethical obligation for us to make sure that these executions are carried out in a humane manner (which is a controversial statement in and of itself, I'm sure)?
Click to expand...
Indeed, it is controversial. In my opinion, the real ethical obligation to ensure that we as anesthesiologists do not use our expertise, in any capacity whatsoever, to aid in the state-sanctioned killing of prisoners.

It shouldn't be "it's wrong and you're doing it wrong, so let me help." It's "it's wrong and you're doing it wrong, so fking stop"
 
vector2 said:
Indeed, it is controversial. In my opinion, the real ethical obligation to ensure that we as anesthesiologists do not use our expertise, in any capacity whatsoever, to aid in the state-sanctioned killing of prisoners.

It shouldn't be "it's wrong and you're doing it wrong, so let me help." It's "it's wrong and you're doing it wrong, so fking stop"
Click to expand...
I'm OK with state-sanctioned killing of prisoners who were convicted by juries of their peers for certain capital crimes after a fair and impartial trial. My moral compass is totally cool with that.

But that's kind of like saying I'm OK with communism, as long as it's "done right."

Neither scenarios really exist outside of thought experiments in undergrad philosophy classes, and neither is ever going to exist, so I'm not OK with either.[1]

So long as we keep exonerating wrongfully convicted people who've been sitting on death row for years, so long as criminal trials are heavily influenced by prosecutors with TV appearances and careers to make, so long as an execution costs an order of magnitude more than life in prison, I can't support capital punishment.

Even at my most spiteful and vindictive, I can't support the death penalty because life in a concrete box 23 hours/day seems a far harsher punishment than sweet release into death.




[1] I confess I might be OK with throwing communists out of helicopters, but I never claimed to be perfect. We could finally get that prospective randomized controlled trial on the efficacy of parachutes, too.
 
pgg said:
So long as we keep exonerating wrongfully convicted people who've been sitting on death row for years, so long as criminal trials are heavily influenced by prosecutors with TV appearances and careers to make, so long as an execution costs an order of magnitude more than life in prison, I can't support capital punishment.
Click to expand...
Don't forget the innocent lives that have surely been taken. The "pro-lifers" and the evangelicals are ok with it though.
 
Drop them out of a helicopter on to a parking lot for all I care, just start doing more with less delays.
 
Botched execution


“Mr. Hamm was terminally ill when the death sentence was scheduled to be carried out, at 9 p.m. on Feb. 22, 2018. Doctors had warned that his veins were inaccessible because of his treatment for cancer and hepatitis C as well as for his intravenous drug use. As a result, an execution team struggled for nearly three hours, puncturing him at least 11 times in his legs, ankles and groin and apparently injuring several organs before giving up at 11:27 p.m. because the legal death warrant expired at midnight.
“I wouldn’t necessarily characterize what we had tonight as a problem,” Jeff Dunn, the Alabama Corrections Commissioner, said in a statement that astounded reporters during a news conference at the time.”

Doyle Hamm, Who Survived a Bungled Execution, Dies in Prison at 64


Botched prosecution

www.nytimes.com

Alice Sebold Apologizes to Man Wrongly Convicted of Raping Her (Published 2021)

Anthony Broadwater spent 16 years in prison after the author identified him as her attacker in an assault she described in her memoir, “Lucky.” Its publisher said Tuesday that it would stop distributing the book.
www.nytimes.com www.nytimes.com


Like medicine and everything else in life, our justice system is imperfect.
 
nimbus said:
…Botched prosecution

www.nytimes.com

Alice Sebold Apologizes to Man Wrongly Convicted of Raping Her (Published 2021)

Anthony Broadwater spent 16 years in prison after the author identified him as her attacker in an assault she described in her memoir, “Lucky.” Its publisher said Tuesday that it would stop distributing the book.
www.nytimes.com www.nytimes.com




Like medicine and everything else in life, our justice system is imperfect.
Click to expand...


Sounds like a very effective prosecution to me. The prosecutor is so good that he can convict the innocent.
 
nimbus said:
Botched execution


“Mr. Hamm was terminally ill when the death sentence was scheduled to be carried out, at 9 p.m. on Feb. 22, 2018. Doctors had warned that his veins were inaccessible because of his treatment for cancer and hepatitis C as well as for his intravenous drug use. As a result, an execution team struggled for nearly three hours, puncturing him at least 11 times in his legs, ankles and groin and apparently injuring several organs before giving up at 11:27 p.m. because the legal death warrant expired at midnight.
“I wouldn’t necessarily characterize what we had tonight as a problem,” Jeff Dunn, the Alabama Corrections Commissioner, said in a statement that astounded reporters during a news conference at the time.”

Doyle Hamm, Who Survived a Bungled Execution, Dies in Prison at 64


Botched prosecution

www.nytimes.com

Alice Sebold Apologizes to Man Wrongly Convicted of Raping Her (Published 2021)

Anthony Broadwater spent 16 years in prison after the author identified him as her attacker in an assault she described in her memoir, “Lucky.” Its publisher said Tuesday that it would stop distributing the book.
www.nytimes.com www.nytimes.com


Like medicine and everything else in life, our justice system is imperfect.
Click to expand...
It kind of boggles my mind that we are even wasting the time, money and resources on executing a TERMINALLY ill man.
 
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