ACA Healthcare vs. State’s Deathcare

Posted on  September 11, 2017


We generally grant the last wish of a person condemned to die if it is reasonable – what happens when the last wish is to be put to death?

While America grapples with myriad issues regarding the healthcare of its citizens, the states that allow capital punishment and seem to have ample funding are similarly grappling with which drugs/medications are allowable.

It is beyond the scope of this post to take any position on the propriety of capital punishment, however, to the extent it is allowed and often mandated in certain states, it is interesting to see the realities that play out.

Nevada is a striking example.

In terms of funding, there are reports that Nevada spent $900,000 to renovate its execution chamber at Ely State Prison. One can only wonder what the justification is for that expense. Spending $900,000 on a death chamber before all Americans are covered for healthcare may be somewhat disjointed.

In terms of which drug or cocktail of drugs to use for the currently scheduled November 14 execution of Scott Dozier, there seems to be some uncertainty. Historically, lethal injections involve a three-drug cocktail: a sedative to knock out the condemned, a muscle relaxant to induce paralysis, and then the fatal injection. Alternatively, the paralysis could be used as the method of execution.

The current case of Scott Dozier is particularly noteworthy because there are anti-capital punishment groups trying to stop his execution. While Nevada struggles to find a method of execution, in 2016 Dozier began demanding that the state execute him, a wish that was granted by a judge on July 27, 2017. In fact, there are reports that Dozier told the court in August that “if they tell me, ‘Listen this a good chance it is going to be a real miserable experience for you, for those few hours before you actually expire,’ I’m still going to do it.”

In the past, Nevada used midazolam and hydromorphone as anesthetics. Surprisingly, the drug manufacturer Pfizer is refusing to allow either to be used in executions.

The refusal by Pfizer raises a host of questions. Typically, the government can appropriate lands owned by private individuals if it deems the lands necessary although it is required to pay market value. This concept is known as eminent domain. One would think that the government has the right to purchase any drug it needs as long as it pays the going rate. It appears, however, that Nevada has not made an issue over the Pfizer refusal to sell the drugs that it needs.

The inability to obtain drugs that were historically used for execution has caused an issue in Arkansas which was scheduled to execute eleven men in April before it supplies of midazolam went past their “use by date” which resulted in only three men being executed.

Once again, not being a pharmacologist, and considering that we are talking about sedation leading up to execution, one might wonder how far past the “use by” date a particular sedative could be used.

Because of Nevada’s inability to obtain its sedative of choice for execution, Nevada is now looking to fentanyl in conjunction with diazepam (otherwise known as Valium) for sedation and cisatracurium for paralysis — which can lead to suffocation as the body cannot expand the rib cage.

It is interesting to note that Nevada chose fentanyl after receiving a $5.6 million grant to combat opioid abuse. Apparently, there is enough fentanyl in Nevada.

The newly proposed drug cocktail is not without its own controversy. Susi Vassallo, a New York University professor of emergency medicine, reportedly said “it doesn’t make much sense; you don’t need Valium if you have fentanyl.” The problem, however, is that it takes a long ongoing dose of fentanyl for someone to lose consciousness. If that doesn’t happen, the person might wake up and experience the terror of slowly suffocating to death, while paralyzed and unable to register his/her distress.

An Emory University anesthesiologist, Joel B. Zivot, reportedly testified that the paralytic would only disguise whether the fentanyl is being properly administered. In his opinion, the fentanyl takes away the pain and the Valium takes away the anxiety. In his expert opinion, these drugs are not designed to block the pain or anxiety of death.

Without taking a position on the propriety of capital punishment, one can only wonder how we can accomplish medically induced comas and routinely anesthetize patients for surgery, but cannot figure out how to adequately relieve pain and anxiety relating to an execution

Similarly, one might question why the government cannot compel the sale of drugs.

Given the totality of the circumstances, what do you think?


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