Sunday, November 9, 2014


   I was reading a book and the topic  of the Death Penalty and the physician's role came in . As a physician we have been asked to treat patients and cure them and not 'kill' them . Long time ago I had seen a sitcom in which the husband is a physician who had to see a patient in ER with a gun shot wound . He had to operate and give him blood and save his life , so the State Attorney ,which happens to be his wife could prosecute him for a murder and ask for the death penalty.This is not only a good topic for the TV drama but also a great Ethical question. Should physicians assist in the death penalty?AMA does not feel that physicians should have any role in the execution of the convicted killers. In fact they came out with a policy statement -guideline in 1980.But today 38 states the death penalty is carried out by lethal injection and in 2006 a District Court recommended a physician's presence and they recommended (or ordered?) anesthesiologist to be the one .So I was thinking about it .What is our true role?Let me explain.
     In a day to day work we as physicians discuss the diagnosis and the treatment of various diseases and also the prognosis. This may be as simple as bronchitis or high blood pressure or asthma, or it may be a serious condition like acute heart attack and cardiogenic shock or respiratory failure.Even when a patient is admitted to the hospital with simple element, like hernia repair or pain in the belly, by law we have to ask for what is called 'Advanced Directives'.This the statement which tells the treating physician as to patients desire to do aggressive treatment in case of the need for it.We also deal with this issue while patient is in hospital,especially in ICU with critical illness,especially if he or she is snot doing well.Then we talk about DNR,DO NOT RESUSCITATE order.
     In some cases when the patient in spite of being on respirator and on no of life sustaining medicines ,is not doing well and when the physician feels that the prognosis is likely to be poor, then we do recommend 'stopping'the treatment , the so called Withdrawal of Life Support.
    So let me analyse.In some cases we discuss and decide (with help of patient) to with hold the life saving treatment and in other cases we also stop the life sustaining treatment . IN NO CASE WE DO ANY THING ACTIVELY TO HASTEN DEATH.But the out come is same.Let me give an example. If I see someone drowning ,and I do not help him,(presuming that I can swim and save him), and in other case I actively hold someones head under water.The out come is same .Are the acts same?When we decide that we are not going to help some one by putting them on respirator and let them die and in other case we stop the respirator and let them die, are we not doing the same ?( I know that we always make sure that the patient is comfortable and not struggling and use plenty of narcotics to  achieve the goal).
       Now that I have confused every one that is reading this blog , tell you one thing. I don't think many of us would ever be in position to assist in execution of death penalty , though many of us believe in it.I also feel fortunate to help patients make educated on the prognosis and limitations of the treatment , so that they can make educated descion and not emotional. I am sure I will revisit this topic sometimes in future.

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