Title : Nevada law says chief medical officer must advise on executions despite ethical clash
link : Nevada law says chief medical officer must advise on executions despite ethical clash
Nevada law says chief medical officer must advise on executions despite ethical clash
Nevada's Chief Medical Officer Dr. John DiMuro's role in helping choose the lethal drugs for an upcoming execution could put him in an ethical quandary as an anesthesiologist committed to preserving life.
Most states use lethal injection in executions and often seek help from anesthesiologists, and Nevada law requires the Department of Corrections to consult with the chief medical officer on an execution.
The American Osteopathic Association, the board that certifies DiMuro, recently released a statement that it is unethical for physicians to deliver the lethal injection.
DiMuro, who resides in Washoe County, would not be administering the lethal injection but is consulting on the combination of drugs to be used in an upcoming execution.
But consulting on the lethal drugs could still present an ethical problem because it means participating in an execution, according to Johan Bester, medical ethicist director of bioethics at the University of Nevada, Las Vegas School of Medicine.
"Saying that the Nevada chief medical officer is doing something wrong is difficult to say because this is still a controversial issue," Bester said.
"You can imagine if you’re a physician and you think your ethical obligation is to not do this, but you’ve got a law telling you you have to do it," he said. "You’re in a difficult situation."
Asked for comment, DiMuro responded via email: “I can confirm that I am consulting with the NDOC as required by Nevada statute. This consultation process is ongoing and not complete at this time. Our expectation is that any final decision is likely to be reviewed by the court.”
It's unknown who will be delivering the lethal injection, but more than one person is usually involved, according to Brooke Keast, spokeswoman for the Nevada Department of Corrections.
Keast said the state Department of Corrections does not release information on the people involved in the execution because of safety concerns.
According to the American Osteopathic Association's policy, the organization "deems it an unethical act for any osteopathic physician to deliver a lethal injection for the purpose of execution in capital crimes, whereas our code of conduct stipulates a physician should do no harm nor give any medication to a patient that would be deemed harmful," spokeswoman Jessica Bardoulas said in an email.
Consulting in an execution, as DiMuro is doing as part of his required responsibilities as chief medical officer, "has not been evaluated and is not in violation" of the ethics resolution, Bardoulas said, and DiMuro is not at risk of losing his certification.
Bardoulas said the association’s policy is limited to involvement in delivering the lethal injection.
DiMuro, who earns an annual salary with benefits of $124,332, declined to discuss any ethical issues of a physician's role in capital punishment.
Several other medical boards such as the American Medical Association and the American Board of Anesthesiology have also taken a stance against doctors participating in executions.
According to the American Medical Association, doctors can have personal views on the matter and can observe an execution as a private citizen. They can also give their medical opinion to corroborate that the person is dead.
But acting as physician in an execution goes against a doctor's oath to preserving life, Bester said.
"So when you start to practice your medical skills on somebody, you start to establish a doctor-patient relationship," Bester said. "That means there are certain obligations. You have to seek the best interest of the patient, and you have to protect them against harm."
Bester said the question is: Does the inmate become the patient?
"(The execution) is the state’s responsibility," he said, adding some medical professionals worry the public would slowly lose their trust in doctors. "They should train somebody else to do that stuff. This is not what doctors do."
“Physicians should not be expected to act in ways that violate the ethics of medical practice, even if these acts are legal."
The Nevada Medical Association has also previously stated in its ethical policy that physicians should not “actively participate.”
The American Board of Anesthesiology, which also certifies physicians, declined to discuss the topic because the "situation is outside of the Board’s purview," spokeswoman Cristalle Dickerson said in a recent email.
But the Board of Anesthesiology did issue a statement in 2014 on its ethical policy, which describes anesthesiologists as “healers, not executioners.”
“Patients should never confuse the death chamber with the operating room, lethal doses of execution drugs with anesthetic drugs, or the executioner with the anesthesiologist,” the board said. “Physicians should not be expected to act in ways that violate the ethics of medical practice, even if these acts are legal."
Bester said state officials are acting on what they believe to be justice, but "that's not the goal of medicine."
Many argue doctors need to participate in an execution to prevent suffering. Bester said the state needs a trained person to deliver the lethal injection.
"They don’t know how much of the medication should be used, how to get a good vein, how much to inject, when the patient is dead and that can lead to the patient suffocating or suffering needlessly," Bester said. "That is the problem."
"So you don’t want to participate in a murder, but you know this person is going to be murdered anyway," he said.
Still, it could raise questions on whether the participating physician is acting in the best interest of the prisoner or just following orders
"You’re sort of a tool of the state or an arm of the state," he said.
Bester said state lawmakers should consider opinions by medical professionals and agencies, such as the American Medical Association, when passing laws requiring doctors to consult on an execution.
"I wouldn’t want to do it," Bester said.
He said delivering the lethal injection can be tricky even for an experienced physician.
"I agree largely with the (American Medical Association) that I think this falls outside of the scope of being a physician," he said.In August, the Nevada Department of Corrections confirmed the agency’s director consulted with DiMuro and then selected three drugs — diazepam, fentanyl and cisatracurium — to be used in the execution of 45-year-old Scott Raymond Dozier.
Dozier voluntarily gave up his right to appeal his death sentence for the murder of Jeremiah Miller, 22, whose torso was found in a suitcase six miles west of the Las Vegas Strip in 2002.
Dozier’s request to be put to death came after more than a decade behind bars. His will be the first execution in Nevada in 11 years.
State law requires Dozier to be executed by lethal injection. Before selecting the drug or combination of drugs, Nevada Department of Corrections Director James Dzurenda must consult with the chief medical officer.
"We are in danger of medicalizing executions and making it a medical procedure, when traditionally it has not been and should not be," Bester said.
Is Nevada's death penalty a 'broken system?'
The Nevada Department of Health and Human Services and the state Department of Corrections both declined to comment further on the extent of DiMuro’s involvement in the upcoming execution citing a pending litigation with ACLU.
But the civil rights organization has not filed a lawsuit nor was it planning on filing a lawsuit, according to Wesley Juhl, spokesman for the ACLU of Northern Nevada.
The state Department of Corrections also declined to release further details on Dozier’s execution.
Federal public defenders working on Dozier’s case challenged the state to provide more information about the execution. Attempts at reaching the Federal Public Defender's Office for the District of Nevada were unsuccessful on Wednesday.
A Las Vegas judge is expected to review the state's execution protocol next week to determine if it should be released to the public, said Keast.
Nevada is among 31 states with the death penalty. The last inmate to be executed in the state was Daryl Mack in 2006.
Mack, who murdered a Reno mother of three, voluntarily gave up his right to appeal his death sentence.
In that time, Dr. Bradford Lee, who served as the state health officer, also consulted on Mack's execution as required by state law, Martha Framsted, spokeswoman for the state Department of Health and Human Services, said in an email.
The title of state health officer eventually changed to chief medical officer when the Nevada State Health Division became the Division of Public and Behavioral Health.
Nevada had opened the entire process to the public, from viewing the full lethal injection to reviewing the prison’s execution protocol, after the Reno Gazette-Journal sued the state Department of Corrections.
“We are looking to release the (state's new execution) protocol in the near future,” Keast said.
DiMuro was appointed as the state’s chief medical officer in July last year. He is board certified in anesthesiology and pain medication. He also worked as the medical director of pain services for Sierra Surgery Hospital in Carson City.
DiMuro obtained a master’s in business administration from St. Joseph’s University and received his osteopathic degree from the Philadelphia College of Osteopathic Medicine, according to the Nevada Division of Public and Behavioral Health.
He also served as chief resident at Georgetown University Medical Center and chief fellow at Memorial Sloan-Kettering Cancer Center in New York City.
Source: Reno Gazette-Journal, Marcella Corona, Sept. 14, 2017
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