It's All Riding on This Doctor to Prevent Another Botched Execution This Month

To anesthesiologist and physician Joel Zivot, the use of lethal injection is a blatant insult to his profession. Practicing anesthesia is an art, one he studied for many, many years to master. And it's designed to save lives, not take them. In December, he wrote in USA Today:

"I am an anesthesiologist, and I possess the knowledge on how to render any person unconscious. You may call it sleep, but it is nothing of the sort. I learned my craft with the use of sodium thiopental. … To witness it for the first time, to watch as it raced into a vein, and in a moment, rendered the patient unconscious, was nothing short of astounding. In those moments, my job was to be reassuring and comforting, for I can imagine no greater moment of trust between a doctor and a patient."

Zivot is traveling to Potosi, Missouri on Monday to examine Russell Bucklew, 45, at the request of Bucklew's attorneys. Bucklew was convicted of murder and is slated for a May 21 execution. While the April 29 "botched" Oklahoma execution of Clayton Lockett was splashed over headlines across the country, it has not seemed to deter Missouri's plans. In fact, America may need to brace itself for another bungled capital killing; Bucklew suffers from malformed blood vessels and vascular tumors that block his breathing airway. "This should make his execution problematic," Zivot said.

In Missouri, Zivot's job will be to determine if Bucklew's life could be saved in the case that the execution does not go as planned. Understanding a doctor's role in this bizarre situation is tricky. Doctors live by the oaths to do good and to do no harm and while lethal injection impersonates medicine, it has the opposite intention. In the same USA Today op-ed, Zivot wrote, "When [states] employ lethal injection, they are not practicing medicine. They are usurping the tools and arts of the medical trade and propagating a fiction." (Image credit: Missouri Department of Corrections)

He became involved because, he said, "It was clearly an effrontery to medical practice and I saw no benefit to this. ... I'm a concerned person and a concerned physician. That was enough for me." He's determined to deliver the messages that there is necessarily cruelty in using lethal injection and there are not proper resources or equipment to perform resuscitation. "I just see this as an expression of a duty. … Here, I see some work to be done," he said. "The physician has to stand apart." 

A state is obliged to provide proper medical care to an inmate until the second he is declared dead. Doctors cannot be involved in the execution; they can neither advise nor administer it. If the execution "fails" — meaning the state has used all that it can based on its own protocol and the inmate does not die — that inmate then becomes a patient and it's mandated that he receive medical care. If a physician is present (which is only sometimes the case, based on state protocol), he or she could then engage in a doctor-patient relationship and commence resuscitation. "If you're going to plan an execution, you have to plan the resuscitation too," Zivot said. 

But how hard does the state try to execute the inmate before they give up? When exactly should a doctor step in and when does the inmate become a patient? As Zivot asked, "What are the rules of engagement in the execution chamber?"

In the case of Lockett's "botched" execution, there was a doctor present, according to Richard Dieter of the Death Penalty Information Center. The official cause of death reported was massive heart attack. So there was a moment, Zivot noted, in which the state was responsible for a living inmate who was gravely injured. But in failing to save him, they committed negligent homicide or manslaughter, in Zivot's opinion.

In a recent piece in TIME, he wrote, "I've been asked how the 'botching' could have been avoided. As a physician, I find that a strange and disturbing question, similar to asking a lifeguard to advise people on how to drown better." Science cannot be applied to science fiction, he said. 

(Image credit: AP)

When it comes to the death penalty, Zivot often feels that having medical knowledge is a curse. He has studied the details of the lethal injection protocol and knows the mistakes that lead to unnecessary cruelty. For example, Oklahoma began Lockett's execution with midazolam, a sedative that causes amnesia. Zivot, extremely familiar with this drug, knows that it's possible for a patient to stay awake under its influence and experience extreme anxiety. The benefit and real purpose of the drug is that the patient won't remember the negative experience later. In an execution, "such effect of the drug is moot — there is no later," Zivot wrote. He is at a loss, and understandably so. It doesn't make sense.

Next, Lockett was given a drug to paralyze all of his muscles, including the ones that control breathing. He could've been very much awake, but unable to breathe or move. So, as Zivot wrote in the TIME article, Lockett could have remained motionless and "died an outwardly peaceful but inwardly painful and terrifying death." The purpose of the third and last drug was to stop Lockett's heart. Though Oklahoma corrections claimed that Lockett died of a massive heart attack, Zivot is skeptical. "Pending autopsy, that is mere speculation. My view, based on a review of events as best can be determined, was that Oklahoma executed Lockett by subjecting him to a painful and terrifying death by suffocation," he wrote.

Zivot is fully aware of the argument that Lockett and Bucklew deserve to suffer for the horrendous crimes they committed and that it's ridiculous for the state to worry about how much pain they endure. But as a doctor, he has a moral obligation that demands he treat all human beings equally; that is part of the unique space he occupies. "When a doctor advises the state on lethal injection, he or she is not providing medical advice. That doctor has left the profession." 

He does not express a standpoint on the death penalty as a policy; he only speaks against the use of medical tools to carry it out. "I am opposed to lethal injection because it will necessarily contain the constant capacity for cruelty," he said, noting that our constitution bans torture for all individuals, whether we like it or not. In his opinion, the state can never prove that lethal injection a morally sound process because there is no way to measure if there was cruelty. "Execution does not have to be humane, just not cruel. These are difficult to define concepts. ... The absence of cruelty is not the presence of humaneness."

When it comes to the executioners, he has to walk a very fine line. He can't say anything that would suggest the process could be done better, so to speak. "I don't want to give it away. I don't want to aid and abet," he said.

So he may remain silent at times, but on certain points, he speaks up. And stands up. "They're playing in my world. And they're impersonating me, in a very egregious way." 

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READ: Executioners' Reflections Reveal a Twisted Side of the Death Penalty

What do you think of lethal injection? Contact or tweet Laura with thoughts or questions.