The BMJ Today: Prisoners and medical professionalism

Sarah Kimball and Stephen Soldz’s editorial on The BMJ’s website today raises important questions about medical professionalism when dealing with prisoners. A recent report into the role of doctors in prisons such as Abu Ghraib in Iraq presented some disturbing findings, the authors say.

The report disclosed that, among other unethical roles, doctors in Abu Ghraib, Guantanamo, and other CIA secret prisons monitored oxygen saturations during waterboarding, watched for edema in detainees forced to stand in stress positions, and helped to increase psychological distress by sharing prisoners’ individual health information with interrogators.

In order to prevent such atrocities from happening again, doctors must support legislation that would protect prisoners from the involvement of medical professionals in interrogations and provide clinicians with credible justification to decline such involvement, the authors say. “By adhering to internationally recognized standards and ethical guidelines, healthcare professions can secure our respected position and help safeguard the human rights of all,” the authors say.

From one type of prisoner to another. In a feature on today, Owen Dyer examines how the medicalisation of execution in the United States has caused a number of difficulties.

It is three years, Dyer says, since an EU ban deprived the US of sodium thiopental, the key drug in the three drug protocol used in most executions, and states have been forced to adopt “desperate and sometimes disreputable” methods to carry out scheduled executions.

Most worrying, perhaps, is that a restriction on the traditionally used drugs has led to executioners using previously untested drug combinations. “They’re playing at science, at pharmacology,” Joel Zivot, anesthesiologist at Emory University Hospital in Georgia, tells Dyer. “They don’t know what they’re doing, but they won’t accept that they don’t know.”

Despite the controversies, Oklahoma medical examiner and pathologist Jay Chapman, who devised his own cocktail of execution drugs, believes that no ethical barrier prevents doctors from administering a lethal injection, Dyer writes.

Most lethal injections are performed by prison staff with some paramedic training, but doctors’ participation is greater than generally believed, says Dyer. However, when the state of Missouri wrote to 298 anesthesiologists asking them to take part in the process it found, perhaps unsurprisingly, that none were willing to help.

Due to the restrictions on drugs and a lack of willing medical staff some states are beginning to look for alternative methods of execution, says Dyer, especially those that do not require medical input.

Michael Rushford, president of the Criminal Justice Legal Foundation, suggests nitrogen or carbon monoxide. “Rather than involve a quasi-medical procedure, training people to insert needles, a much more peaceful passing would occur with some of these methods. You eliminate all the medical questions. No doctor is going to have his career at risk, no drug company will be picketed or boycotted,” he says.

Abi Rimmer is BMJ Careers news reporter.