Saturday 23 May 2015

Death - the final frontier

While participating passively in an amputation the other day, I reflected briefly about how anaesthesia in the sheep was not an exact science. That required that I go and find out something about it.  But the idea was ringing distracting alarum bells along two threads in a disturbing skein of news from across the Pond. The Boston Marathon bombing had particular resonance for me at the time: that story has been wrapped up a few days ago with Dzokhar Tsarnaev being sentenced to death.  He may hope that the federal authorities in Massachusetts make a better fist of it than Oklahoma did for Clayton Lockett [long-form article in The Atlantic]  The sciencification of our lives can get a little wearing - having the right iKit to communicate is far more important than actually communicating with another person: the medium is the message.  But the sciencification of death is an offense to science.

Somehow, the medical profession have managed to claim that terminal anaesthesia is nothing to do with them: they have all dressed up in medieval gowns and chanted the Hippocratic Oath "primum non nocere; primum non nocere; primum non nocere" when they got their licence to practice.  So they couldn't possibly help to off the sweepings of their society.  This high moral ground trembles with irony given that US medicos manage to kill between 50,000 and 100,000 of their fellow citizens each year from 'medical misadventure' aka a cock-up by Hippocrates or one of his minions. If the best teaching hospitals manage to achieve a costly adverse drug event for 2/100 of their admissions, what can be the rate in Bohunk County Hospital, Backwoods, Appalachia?  If the doctors won't do executions, a different class of people must take on the task and where do they get their training? Even the US States most gung-ho for the death penalty only get through a few every year, so where is the poor thanatotech going to build up the experience?  The most recent public scandal in Irish healthcare involves a statistical excess of neonatal deaths in the maternity ward in a regional hospital (Portlaoise, as you ask, but it could be any similar place).  The preferred solution is to close such small throughput entities and consolidate maternity care in a few centres of excellence where the midwives and obstetricians can meet all the rare-but-challenging presentations and know what to do the next time.  That seems logical from the perspective of minimising death, but is a royal pain in the tits for all the mothers and babies who will be required to deliver their babies 100km from home.  Maybe that's okay: mothers-and-babies get shoved out of hospital within a very short space of time nowadays: let the unsupported uteruses fall where they may.  The centres-of-excellence argument is more burdensome for long-term cancer or diabetes treatment: its hard to visit every day if it is a 200km round trip to bring tea-brack and love.

The sciencification of deathing [let us mangle the language to draw attention to the mangling of logical thought here] is being driven by a curious statement in the 8th Amendment to US constitution which they lifted from the Bill of Rights of a century earlier 1689 in England "That excessive Baile ought not to be required nor excessive Fines imposed nor cruell and unusuall Punishments inflicted".  Somehow a high-tech solution has become synonymous with 'humane'; although we are quite happy to by-pass this with other creatures that we feel the need to terminate: from thorough-bred horses (who have the misfortune to break a leg) worth upwards of $10,000 to a 40kg spring lamb which might fetch $100 at the factory. These animals are offed with the >!klunk!< of a captive-bolt human-killer to the brain-stem. They don't feel anything for very long.  In contrast Clayton Lockett took 100 minutes to die as a scarcely competent and inadequately trained technician was unable to find a vein (in the arm, the neck, the thorax or the groin) and the doctor who was there on an over-sight boondoggle wasn't able to help her either.  The serial cocktail of drugs sodium thiopental [barbiturate general anaesthetic], lidocaine [local anaesthetic], midazolam [sedative], vecuronium bromide [paralytic] and finally potassium chloride [which will upset the salt balance of the cardiac muscle so badly that the heart stops] were eventually administered in sufficient quantities to kill Mr Lockett. And I should add that he was woken up and tazed more than 12 hours before he finally died so he had a whole day to reflect on his crimes. This is what passes the test for nor cruell and unusuall Punishments inflicted in Oklahoma and 31 other States.

In 2014, 35 people were judicially killed in the USA, all by lethal injection.  The average difference in age between the time of the offense and them time of retribution was 20 years with a range from 10-39 years. Dzokhar Tsarnaev is off to a secure federal holding unit where he will be confined, alone for 23 hours a day for the next several decades, in a cell 2.1m x 3.7m with a concrete bed, as his appeals work their way up and down the courts. That isn't cruell and unusuall Punishment either. Between 1972 and 1976, the US Supreme Court had declared the death penalty unconstitutional. Science has not served execution well, there is a very long list of botched executions [harrowing reading alert] since they became constitutional again in the USA in 1976.

For a nation with such a high proportion of gun-nuts, it's a wonder there isn't more active advocacy for death by firing squad, a method preferred in Utah and allowed in Oklahoma. Although the sample size is tiny (N=3 since 1976), this is the only method method that has a 100% track-record of successful administration. In the interests of 'transparency' most of the States allow journalists and even the families of victims to sit in to witness the last minutes of the perpetrator. I'm sure there would be no shortage of volunteers to make up a firing squad: submit CV with evidence of at least 2 dozen clean kills on deer and other large mammals?  The 'paramedic' [as above, I prefer my coinage thanatotech] who terminated Mr Lockett got $600 for his pains, the firing squad might well be happy to divvy that amount up amongst themselves. Talking of money, three days ago the Irish Department of Justice released the figures for the cost of incarceration = €86,000 every year. It can't be cheaper in the US, so Justice is costing on average 20 x $90K = $1.8million before execution - and I haven't yet found out who pays the defense lawyers.

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