The execution of Dennis McGuire, a convicted killer in Ohio has once again raised the issue of the drugs used for executing prisoners. I think it’s about time a few facts were put in the public domain rather than this constant sensationalism we get from the mainstream media.
The word anaesthesia means quite simply without feeling, or without sensation.
If you give someone an anaesthetic, and then surgically operate on them, with sharp scalpels and various other instruments you can be sure that if they were in pain the monitors that they are hooked up to would be going berserk.
I know each year a number of patients feel pain under anaesthetic, and I can say without reservation the anaesthetist should be sued and barred from future practice as there are so many signs to point to this that there is no excuse for them not to spot what’s happening.
If someone under anaesthetic is feeling pain their blood pressure goes up. This shows in three ways, an audible alarm, a flashing light and as a readout on the monitoring equipment.
If their heart rate increases, as it invariably does if they are experiencing pain, the same happens, there is an audible alarm, a flashing light and the readout tells you what is happening.
Only an anaesthetist who is not paying attention to what’s happening could miss the multiple indicators that something is amiss.
It’s a sad fact of life that if you do enough cases you are going to have patients die on the operating table. These people do not die writhing in agony, they slip away quietly. I have NEVER had this happen during a routine case. It has always been where the patient has had a catastrophic injury, and that’s why they are on the table in the first place, or, uncontrollable bleeding has occurred during the case and working blood pressure has not been maintained, or they have had a cardiac arrest during the procedure. It’s fair to say that unexplainable deaths do occur on the operating table, but fortunately I haven’t had one, and even the unexplained ones do not involve a patient being in agony before their demise.
Right moving on.
The fact is that if you administer a surgical anaesthetic and once you KNOW that the patient is surgically anaesthetised you administer either a muscle relaxant, or a large dose of a narcotic analgesic, that patient will die unless they have ventilatory support.
Now I understand people getting upset about using muscle relaxants, they literally stop the patients muscles contracting thus facilitating whatever it is the surgeon wants to do without muscles twitching left and right…for reference they do this without conscious effort. The assumption that the condemned would know this is happening is actually incorrect, but I can understand the unease this crates for the family and even the prison staff.
Using narcotic analgesics, opioids such as morphine, diamorphine, fentanyl, alfentanil etc removes any doubt at all that the patient is aware that their heart and lungs are failing.
These drugs act on the central nervous system, depressing respiration to the point where it stops.
A case study in a few lines: I have a death certificate that says my father died from a brain tumour. In reality he died from a morphine overdose. He required so much to stop the excruciating pain he was in, he died. Within a minute or so of getting the drug he stopped squeezing his head between his hands, a few seconds later gave a big sigh and relaxed. He smiled. He had already had enough morphine to knock out a football team but such was his pain that it wasn’t enough. Within five minutes he was drifting off to sleep. Five minutes later he was gone. His last few minutes with us had been pain free and comfortable.
Now my father hadn’t had an anaesthetic before the opioid. He was debilitated and chronically sick. In someone who has been kept well fed and is generally fit, as is usually the case of death row inmates giving an anaesthetic prior to the opioid will ensure a calm, pain free death.
Propofol, the drug that killed Michael Jackson comes to mind. That coupled with a good sized dose of morphine will satisfy all the criteria that needs to be adhered to regarding not making those who are to be executed suffer. If you put a couple of ml of lidocaine in with the propofol it won’t even sting as it enters the vein.
It seems to me that all this outcry over the use of drugs for death row inmates is out of proportion. We don’t consider the pain of an anaesthetic drug going into the vein of someone going down for a hip replacement, but we consider it for a condemned person…
There are many combinations of induction agents…that’s the correct name for drugs that induce anaesthesia, and opioids, that would ensure a pain free death.
Why the authorities are having such a hard time working this out I have no idea. Maybe a rule or regulation that I have no idea about.
Midazolam is often used to induce unconsciousness in intensive care units where patients need to be kept calm. It is often given prior to surgery and has an amnesic effect on patients. Used in combination with hydromorphone, a strong pain killer often used to treat cancer patients, the cocktail given to Dennis McGuire should have had the desired effect quickly and painlessly.
It should be noted though that hydromorphone can induce severe itching, and confusion as well as mood alteration and disorientation. Without knowing the dose administered to McGuire, and his weight prior to execution, it’s impossible to say why he took 25 minutes to die and why he appeared to be struggling for breath
If a state decides that it is going to execute someone using drugs it goes without saying that the dosage, route of administration and the procedure as a whole needs to be quick, efficient and without incident.
There are drugs available that will cover that criteria in every operating department in the country.
NOTE FROM LIZZIE
I have been reading the comments…Bit of a misunderstanding going on. I do not give a toss if these people die in agony, see some of my previous articles to understand where I stand on paedophilia, rape etc. I was trying to get across that there are choices for the state. It comes across from mainstream media that everything hurts, and everything is terrible etc. This was me trying to point out that the choices are there that will allow the execution of scum whilst at the same time satisfying all those who are worried about the rights of the condemned…I think they lost all those rights when they committed their crimes, but that’s just me.
Sandman…I can’t reply on comments, I can’t get in. If your chosen method is so great why does nobody use it? I’ll tell you, because as you state such methods will NOT catch those people feeling sensation under anaesthetic. If you are referring to a full anaesthetic a midazolam pre-med followed propofol, atracurium and fentanyl and maintained with isoflurane and oxygen will do it every time…but that was not the subject was it? It was how to execute using drugs calmly and cleanly. Also, I think MAC would be the least of the states concerns. MAC for those who don’t know is maximum alveolar concentration. As for me being an idiot…like beauty idiocy is often in the eye of the beholder.
Sorry I won’t be answering comments until the system lets me back in.
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Contributed by Lizzie Bennett of Underground Medic.
Lizzie Bennett retired from her job as a senior operating department practitioner in the UK earlier this year. Her field was trauma and accident and emergency and she has served on major catastrophe teams around the UK. Lizzie publishes Underground Medic on the topic of preparedness.