U.S. Supreme Court Justice Cites Miller School Anesthesiologist in New Death Penalty Book

In his new book, Against the Death Penalty, U.S. Supreme Court Justice Stephen Breyer relies on both the research and the expert scientific testimony on lethal injections by a leading anesthesiologist at the University of Miami Miller School of Medicine.

“Justice Breyer has paid close attention to the science involved in lethal injections and has come to the conclusion that the execution process is inhumane,” said David A. Lubarsky, M.D., M.B.A., Emanuel M. Papper Professor and Chair of the Department of Anesthesiology, Perioperative Medicine and Pain Management.

“In several studies, we found that the blood levels of the drug used to put criminals to sleep – sodium thiopental – was insufficient to last the course of the execution,” Lubarsky said. “That fact was obscured by the second drug administered in a lethal three-drug cocktail, leaving the individual paralyzed but awake – a terrible way to end anyone’s life.”

Lubarsky was co-author of a landmark 2005 study, “Inadequate Anaesthesia in Lethal Injection for Execution,” published in the British journal The Lancet. That study cited toxicology reports from Arizona, Georgia, North Carolina and South Carolina showing that post-mortem concentrations of the anesthesia thiopental in the blood of 43 of 49 executed inmates were lower than that required for surgery, and that 21 inmates had concentrations consistent with awareness.

The study also noted that protocol information from Texas and Virginia showed that executioners had no training in anesthesia, and drugs were administered remotely with no monitoring of their effect.

“Methods of lethal injection anaesthesia are flawed, and some inmates might experience awareness and inhumane suffering during execution,” Lubarsky and his co-authors concluded.

The study in The Lancet helped precipitate an unprecedented public and judicial review of lethal injection during the past decade, and Lubarsky has been called upon as an expert scientific witness in execution cases.

“Many state departments of corrections ordered modifications in the lethal injection protocol, eliminating thiopental, and using other anesthesia drugs like midalozam,” Lubarsky said. “However, that did not resolve issues like inadequate training – no physicians are involved – remote monitoring of the process, lack of reviews of efficacy for the new protocols, and a complete lack of peer-reviewed studies on the outcomes.”

In 2007, Lubarsky outlined those problems as the lead author in a study, “Physician Participation in Lethal Injection Executions,” published in the medical journal Current Opinion in Anaesthesiology. Execution personnel do not sufficiently assess depth of anesthesia prior to injection of the painful lethal drugs, he said in the article, noting the difficulty in obtaining medical and scientific information from state authorities following executions.

“Initial physician involvement in the creation of the first lethal injection protocols back in the 1970s started a flawed process,” Lubarsky said. “The physician’s complete protocol was never instituted, and then it was copied from state to state without any rigorous assessment. Physicians and particularly anesthesiologists now have the opportunity to redress the mistakes of the past, and inform the growing debate over whether medicine should be used to kill. All organized medicine societies have formalized policies that state physicians should have no part in the development of these protocols. In short, the physician community has come together to say that we are here to save lives, not end them.”

While the debate over the appropriateness of the death penalty continues, Lubarsky said it is disturbing to see such a lack of concern for the individual, as well as a lack of quality control and oversight when ending a person’s life.

“We have the ability to end a criminal’s life with humanity,” he said, “but we are not doing so today in executions by lethal injection.”

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