As an anes­the­si­ol­o­gist, Dr. Joel Zivot applied some of the same drugs in oper­at­ing rooms as are used in exe­cu­tions in the U.S. He admired their life-sav­ing qual­i­ties for patients, but bri­dled at their use in tak­ing lives. Writing recent­ly in USA Today, he cau­tioned against this ​“poi­so­nous” use of med­i­cines, say­ing, ​“States may choose to exe­cute their cit­i­zens, but when they employ lethal injec­tion, they are not prac­tic­ing med­i­cine. They are usurp­ing the tools and arts of the med­ical trade and prop­a­gat­ing a fic­tion.” Dr. Zivot is a pro­fes­sor of anes­the­si­ol­o­gy at Emory University School of Medicine. In his op-ed, he called for a halt to all use of anes­thet­ics in exe­cu­tions: ​“From an eth­i­cal per­spec­tive, I can­not make the case that a med­i­cine in short sup­ply should pref­er­en­tial­ly be used to kill rather than to heal.” Read the op-ed below.

Why I’m for a moratorium on lethal injections: Column

I am an anes­the­si­ol­o­gist, and I pos­sess the knowl­edge on how to ren­der any per­son uncon­scious. You may call it sleep, but it is noth­ing of the sort.

I learned my craft with the use of sodi­um thiopen­tal, a drug in the bar­bi­tu­rate class. To wit­ness it for the first time, to watch as it raced into a vein, and in a moment, ren­dered the patient uncon­scious, was noth­ing short of astound­ing. In those moments, my job was to be reas­sur­ing and com­fort­ing, for I can imag­ine no greater moment of trust between a doc­tor and a patient.

Sodium thiopen­tal is no longer in my phar­ma­col­o­gy tool­box. Hospira, the last com­pa­ny to man­u­fac­ture the drug, stopped mak­ing it to protest its use in car­ry­ing out the death penalty.

So oth­er drugs have been sub­sti­tut­ed. One of them will be used Tuesday, when Oklahoma is sched­uled to exe­cute by lethal injec­tion Johnny Dale Black, who was con­vict­ed of murder.

An exe­cu­tion­er and the con­demned are not the same as a doc­tor and a patient, though it is easy to see how sim­i­lar­i­ties can be drawn. Had this sup­posed sim­i­lar­i­ty not been noticed, the death penal­ty in the U.S. would like­ly not have sur­vived. Instead, lethal injec­tion cre­at­ed an illu­sion of humane, pro­fes­sion­al exe­cu­tion. But the exe­cu­tion­ers are not doc­tors, and it’s been well estab­lished that the exe­cu­tions them­selves are not humane.

My right to use sodi­um thiopen­tal was earned through thou­sands of hours of the study of phar­ma­col­o­gy, anato­my, phys­i­ol­o­gy, train­ing and eval­u­a­tion. It was earned by the grant­i­ng of a med­ical degree. It was grant­ed by state med­ical boards whose job is to pro­tect the pub­lic. It was val­i­dat­ed by the grant­i­ng of hos­pi­tal priv­i­leges based on proof of my sound, safe and sage prac­tice and a license from the Drug Enforcement Administration.

Rue my silence

As a physi­cian, how­ev­er, I am eth­i­cal­ly pro­hib­it­ed from com­ment­ing on the details of lethal injec­tion lest even casu­al asso­ci­a­tion sug­gest sup­port or over­sight. I now see that my silence has cre­at­ed the oppo­site effect. My silence has sanc­tioned it, not prevented it.

States may choose to exe­cute their cit­i­zens, but when they employ lethal injec­tion, they are not prac­tic­ing med­i­cine. They are usurp­ing the tools and arts of the med­ical trade and prop­a­gat­ing a fiction.

When I gave a patient sodi­um thiopen­tal, it was a med­i­cine whose pur­pose was to heal. When the state gave sodi­um thiopen­tal to a pris­on­er, it was a poi­so­nous chem­i­cal whose pur­pose was to kill.

These days the debate is even more trou­bling. States are seek­ing alter­na­tives to sodi­um thiopen­tal. They col­lude with com­pound­ing phar­ma­cies to make pen­to­bar­bi­tal, a cousin of sodi­um thiopen­tal. When that is not avail­able, they raid the phar­ma­col­o­gy toolbox again.

In search of options

Missouri recent­ly obtained propo­fol, an exceed­ing­ly impor­tant anes­thet­ic agent, and threat­ened to use it for exe­cu­tions. It would have suc­ceed­ed if not for the threat of sanc­tion by the European Union, which oppos­es the death penal­ty. Because of our bro­ken domes­tic drug man­u­fac­tur­ing mar­ket, 90% of our propo­fol is pro­duced in Europe. EU sanc­tions would have stopped propo­fol ship­ment to the U.S. and left physi­cians with­out this critical drug.

Most recent­ly, Florida report­ed the use of mida­zo­lam, anoth­er essen­tial med­ica­tion, in an exe­cu­tion. Midazolam is in the class referred to as a ben­zo­di­azepine. These drugs replaced bar­bi­tu­rates, to a degree, because they were safer. That is, it is hard­er to kill some­one with them. How Florida grant­ed itself exper­tise in the use of mida­zo­lam, now repur­posed as a chem­i­cal used to kill, is known only to Florida.

Most shock­ing­ly, mida­zo­lam is in short sup­ply. From an eth­i­cal per­spec­tive, I can­not make the case that a med­i­cine in short sup­ply should pref­er­en­tial­ly be used to kill rather than to heal. What appears as humane is theater alone.

What we need is a mora­to­ri­um on the use of all anes­thet­ic agents for lethal injec­tion. If the state is inclined to exe­cute, it might be the time again to take up hang­ing, the elec­tric chair or the bullet.

Joel Zivot, M.D., is an assis­tant pro­fes­sor of anes­the­si­ol­o­gy and also the med­ical direc­tor of the car­dio-tho­racic and vas­cu­lar inten­sive care unit at Emory University School of Medicine in Atlanta.

(J. Zivot, ​“Why I’m for a mora­to­ri­um on lethal injec­tions,” USA Today, op-ed, December 15, 2013). See Lethal Injection and New Voices.

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