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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