Anesthesiologists Advised to Avoid Executions

In a potentially significant development in the controversy over lethal injection executions, the president of the American Society of Anesthesiologists has strongly urged members to “steer clear” of any participation in them.

Dr. Orin F. Guidry, president of the 40,000-member group, posted a four-page “Message from the President” on the organization’s website (www.asahq.org) Friday, saying that anesthesiologists had been “reluctantly thrust into the middle” of a legal controversy and that it was not their responsibility to solve problems created by the nation’s judicial system.

“Lethal injection was not anesthesiology’s idea,” wrote Guidry, who works at Ochsner Hospital in New Orleans. “American society decided to have capital punishment as part of our legal system and to carry it out with lethal injection.... The legal system has painted itself into this corner, and it is not our obligation to get it out.”

In recent months there has been a flurry of litigation over lethal injections. Lawyers for condemned inmates say that procedures being used around the country may be causing unnecessary and excruciating pain in violation of the 8th Amendment’s prohibition of cruel and unusual punishment.

Guidry, in a telephone interview from his home, said he has been following the issue closely since mid-February, when California officials postponed the execution of Michael Morales after being unable to comply with a federal judge’s order to change the state’s lethal injection procedures.

The 61-year-old physician said he has never taken a position on the death penalty and emphasized, “I am not now.” However, Guidry said he was prompted to write to the organization’s members because of recent developments, particularly a ruling issued Monday by a federal judge in Kansas City, Mo.

U.S. District Judge Fernando J. Gaitan Jr. ordered a halt to executions in Missouri until the state makes major changes in its lethal injection procedures. The challenge was brought on behalf of Michael Taylor, sentenced to death for the murder of a 15-year-old girl in Kansas City in 1989.

Missouri, like all other states that use lethal injection, utilizes a three-drug cocktail: The first, sodium thiopental, is a sedative; the second, pancuronium bromide, is a paralytic agent; the third, potassium chloride, stops the heart from functioning.

Attorneys for Taylor said that the third drug could cause excruciating pain because of insufficient anesthesia from the first and that he would be unable to say anything because he would be paralyzed by the second.

Judge Gaitan expressed serious concern that the physician who has been administering the drugs during Missouri executions is an acknowledged dyslexic who has difficulty reading numbers. The doctor admitted in a deposition that he had administered only half the normal dosage of sodium thiopental in several recent executions.

Gaitan said the state should make a board-certified anesthesiologist “responsible for the mixing of all drugs which are used in the lethal injection process. If the anesthesiologist does not actually administer the drugs through [an IV], he or she shall directly observe those individuals who do so.”

The judge’s order states that an anesthesiologist needs to certify that the inmate has achieved sufficient anesthetic depth so as to not feel undue pain when the potassium chloride is injected. Gaitan also stated that it would not be a violation of an anesthesiologist’s ethical obligations to administer lethal injections.

Since the judge issued his ruling, news organizations have reported that Missouri officials are actively searching for anesthesiologists to participate in executions, a point underlined in Guidry’s letter.

He said the anesthesiologists society does not have a detailed position on the issue. However, Guidry noted that in 2001 the organization approved a recommendation supporting the American Medical Association’s position that doctors should not participate in executions.

The AMA states that the following acts, among others, constitute participation in an execution: “starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses, or types; inspecting, testing or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.”

“Clearly,” Dr. Guidry wrote, “an anesthesiologist complying with the Missouri ruling -- and despite this court’s position on ethical obligations -- would be violating the AMA position which ASA has adopted. It is my belief that the court cannot modify physicians’ ethical principles to meet its needs.”

Fordham University law professor Deborah W. Denno said she thought Guidry’s statement was an “extremely significant” development in the lethal injection debate.

Guidry’s admonition to “steer clear” could not have been firmer, said Denno, who has written scholarly articles on methods of capital punishment. She noted that Guidry’s position “was not a legal document” and not binding on any anesthesiologist, but she said she thought it certainly would have a strong impact on any anesthesiologist considering involvement in an execution.