Saturday, April 22, 2017

Why It's Not OK for Docs to Participate in Executions

Sandeep Jauhar's op-ed in the New York Times today poses precisely the opposite formulation, theoretically offering his musing on ethics as the State of Arkansas rushes to execute as many death-row inmates as possible prior to having their stockpiles of lethal injection drugs expire, for which there have been a flurry of legal challenges, although they have succeeded with one thus far. Given the topicality, Jauhar decided to wedge in some thoughts about how this policy interfaces with the practice of medicine, deciding in the end that it's copacetic.

It isn't, and from the moment the article appeared, a whole lotta people--including a whole lotta doctors--pointed this out, noting the intellectual contortions required to suppose that setting up the killing of an otherwise healthy human being doesn't violate the dictum, "do no harm." (Often dressed up in the fancier Latin phrase primum non nocere, the injunction against doing harm is taught to precisely every medical student, everywhere, on day #1 of school.) Jauhar's main argument revolves around the idea that only physicians have the required expertise to mix a batch of lethal drugs correctly, and therefore they are, in fact, relieving the patient's suffering. It is hard to write this with a straight face.

When I woke up at six and happened upon the article, there were perhaps a dozen replies; within an hour, there were two hundred. As of now, there are more than 500 comments. Most aren't impressed: the vast majority were outraged, and those that defended Jauhar often missed the point as they seemed to think the debate was about the death penalty itself, not the medical ethics of doctors participating in the process.

"As a correctional physician, it is chilling to wake to this. From his tone, it is doubtful to me that he has entered a correctional facility," wrote Matt from Boston in a comment. "The Times' decision to publish this comes as a shock. I entreat the author to refrain from more writing on the topic until he spends time in the correctional setting, meets our patients, and educates himself further on the ethical grounding of medical-correctional standards." Boom.

I had once thought myself a fan of Jauhar as I like to root for physicians who write for the public and help unravel medical complexities, but I'm less enthusiastic than I used to be, that's for sure. A few years ago, he had used similarly questionable logic while he advocated for the return of the old model of Doctor Knows Best, which led me to harrumph about it at the time. I haven't read his writing systematically or exhaustively, and now I'm beginning to worry what I might find if I do.