Wednesday, August 30, 2017

Dubious Milestone In Anesthesia

Anesthesiology has given the world great advances in medicine and healing. In fact, it was voted one of the highest achievements in the history of medical literature. Unfortunately, lately the only time anesthesia is mentioned is when it causes harm, or even death, usually in a sensational fashion.

Now anesthesia has entered the public discussion once again with the news of a prisoner execution in Florida last week. For the first time ever, the drug etomidate was used as part of the IV cocktail to cause the death of a convicted inmate. This news seems to be more widely covered in British media. They appear to be more fascinated with capital punishment than the Americans probably because capital punishment is outlawed in most of Western Europe.

Mark Asay, a white Floridian, was convicted of the racially motivated murders of two minority men back in 1987. After decades of litigation, he was finally put to death with a combination of etomidate, rocuronium, and potassium. This has caused an uproar besides the usual moral handwringing over the death penalty in general. The defense attorneys argued that etomidate is an unproven method for achieving death. They hired doctors who testified that etomidate can cause pain prior achieving its effects.

Meantime, the pharmaceutical company that manufactured the etomidate is objecting to its obviously non-FDA approved use of the drug. This is the reason that more drugs are becoming off limits for use in the death penalty. Previous attempts using pentathol, propofol, and midazolam have been thwarted because the penal system was unable to acquire the drug due to manufacturers' refusal to sell the product or the courts have deemed them cruel and unusual punishment and thus illegal.

Because of these difficulties with IV injections for capital punishment, some states like Mississippi are considering bringing back the old reliables like a firing squad, electrocution, or the gas chamber. That is probably the proper approach. Stop bastardizing anesthetics that were invented for medical purposes to somehow humanize an inhuman act. Centuries of human executions have given us plenty of methods to kill somebody for state reasons. Don't drag anesthesia into this mess.


  1. Long ago when lethal injections were in their infancy, I received a notice with my nursing license renewal that if a nurse participated in a lethal injection, the license could not be renewed. I cannot imagine who in the world would think a nurse could be involved with this activity.

  2. Thank you. We specialize in the opposite. Someone asked me once why more anesthesiologists don't go into palliative care....I'm still speechless. I'm still a resident, but I think it goes against every grain of our being to lose a patient even in a trauma setting because our resuscitation couldn't cut it. I can't imagine the other end of the spectrum.