Thursday, May 01, 2014

Physician involvement in legal amputations and lethal injections

The government of Kelantan, a state within Malaysia, is considering the implementation of hudud, a particularly strict form of Islamic law. Under hudud, the punishment for crimes such as theft, robbery,  adultery, rape and sodomy would be flogging, death by stoning or amputation. The prospect of amputation, in particular, being considered as a form of legal punishment has medical authorities in Kelantan cringing and objecting. After all, who else but doctors are in a better position to perform safe and effective amputations? And who is in a worse position to perform such non-medical amputations, seeing that they conflict directly with the Hippocratic tradition? Limb removal, when not medically indicated, is hard to reconcile with the principle of 'do no harm.' Should the hudud come into effect, physicians called upon to conduct amputations will find themselves in a lose-lose situation: fail to amputate, and they will likely run afoul of their own government; amputate, and risk having their license revoked by their medical association. The situation is likely to strike outsiders as strange and barbaric: what sort of state contemplates cutting bits off their own citizens in order to punish them?

The case seems exotic, but it is not difficult to bring it closer to home. This week, there was a botched execution of a convicted murderer in the United States. What botched it, apparently, were the chemicals in the injection. Drugs of choice to dispatch convicts (such as sodium thiopental and pentobarbital) are in short supply, partly due to their ban by the European Union. So the botched execution was in essence a botched experiment. US federal law has all sorts of protections for prisoners when they are used in medical research, but when an experimental cocktail of drugs is administered with the intent of killing convicts, those protections fall by the wayside. Worse yet, in
17 US states with the death penalty, a physician is required to be present at such disturbing events. But it is not as if having a more effective means of killing would make the health care professional's involvement morally palatable. Medical professionals have no place in facilitating state-legitimated execution by injection, amputation or public stoning. If governments wish to savage their non-law abiding citizens, they should not be allowed to use medicine to legitimize what they are doing.

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