On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender.
Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago.
He's a 55-year-old African-American man with hypertension, elevated cholesterol, and a history of smoking. Florida will execute Henry with the drug midazolam, in combination with a paralyzing drug and potassium chloride. Midazolam is new for this purpose; it produces sedation, amnesia, and, in medically prescribed dosages, it lacks the ability to kill.
Florida will make deadly what is naturally not by using a dosage much larger than ever given by a physician. Scientifically, this reasoning is flawed as the drug works like a key in a lock. Once the lock is full, no additional drug increases effectiveness. Worse, midazolam is in short supply. The amount used to kill Henry could have treated 100 patients who now will have no access to midazolam.
Henry is likely plagued by coronary artery disease, common among men of his age, ethnicity, and health. Hypertension and coronary artery disease place Henry at risk of a heart attack from falling blood pressure as he is executed.
When the death warrant was signed for Henry, he was placed under constant surveillance. When he was moved within the prison, the entire prison was on lockdown. I was taken to a room within the prison where Henry was waiting.
How would I describe a professional relationship with Henry? He was not my patient. If he were, I owe him duties that I could not provide.
We chatted about his health, and he confessed the occurrence of atypical chest pain. In other circumstances I would change his medications, order tests to document coronary artery disease, advise on diet and exercise, all to enable a long life. No such follow-up would take place.
My examination also proved challenging. Privacy was ruled out immediately and he was shackled hand and foot, which proved to be a puzzling obstacle to obtaining his blood pressure. Shackled, he was unable to remove his shoes and socks. I assisted and replaced them on his feet after my exam, and tied his shoelaces. We discussed how he liked the laces tied and tucked so they would not catch and cause him to trip.
I documented a high suspicion of coronary artery disease. I thanked him for his time and was ushered away, out of the prison and outside under the cloudy Florida sky.
People wonder what is owed to Henry, a convicted double murderer, and why a doctor should treat him? Some say mercy is not owed to Mr. Henry, as long ago, he showed no mercy to those he killed. For me, a doctor's duty is to provide impartial care. If the patient is noble or terrible, my job does not change.
I believe murder is wrong and those who murder should be punished. But the Constitution of the United States prohibits cruel punishment, and I believe the use of midazolam to execute Mr. Henry will result in a needlessly cruel death. Doctors cannot make execution less cruel by advising on a better way to execute. I am not trained in execution. The medicalization of the death penalty has occurred by the State acting in place, but not in purpose, of physicians.
The use of midazolam, a drug in short supply, to kill when it should be used to heal, is unacceptable. As a final disturbing impersonation, execution by lethal injection occurs while laying on a gurney as opposed to "old sparky" and electrocution, which occurs while sitting.
The execution of Robert Henry will be cruel punishment, in spite of constitutional objection. When he is pronounced dead, a death certificate will be issued, and a cause of death must be stated. For all those executed in this country, that cause of death so listed is always "homicide."
Joel Zivot, MD, is assistant professor of anesthesiology and surgery at Emory University School of Medicine and the medical director of the cardiothoracic intensive care unit at Emory University Hospital Midtown.
