The Christa Pike Case And The Ethical Dilemma Of Saving Someone The State Is Trying To Kill

Christa Pike, 50, has been hospitalized for almost a week after receiving two injections that allegedly contained lethal pentobarbital. On Tuesday, her lawyers said she had regained consciousness and speech, though her prognosis remains uncertain. The state of Tennessee had attempted to execute her for the 1995 murder of a fellow student, but Pike survived and was taken to hospital. If she stabilizes and is discharged, the state could send her back to death row and try to execute her again.

There is still no official account of what happened last Wednesday afternoon when the execution was briefly halted before the Supreme Court authorized it hours later, but experts say the pentobarbital may have leaked into the tissues around the vein, causing injuries that authorities have not yet confirmed. Because of what occurred during the failed execution, and the medical care required to save her life, Pike’s case raises ethical dilemmas about the obligations of the doctors and caregivers treating her and about the state’s responsibility for her condition.

Dr. Arthur Caplan, a bioethics expert and emeritus professor of medicine at New York University, says there is “no place for doctors, nurses, or any health worker in executions.” “That violates their oath not to cause harm. An execution is not intended to benefit the person,” he adds.

Caplan argues that even when a doctor’s presence at an execution is presented as a way to reduce suffering, there is a boundary between punishment and medicine. “Doctors have no role in executions. Even when someone says, ‘Well, if better-prepared doctors had been present, this execution wouldn’t have gone wrong’ — you don’t need doctors, you need better-trained executioners,” he says.

“Some argue that in parts of the world doctors help terminally ill people end their lives. But remember that is meant to relieve the suffering of someone who is dying. The patient is the focus. An execution is something the judicial system seeks to carry out,” Caplan explains.

Pike was sentenced to death 30 years ago for the murder of Colleen Slemmer, a 19-year-old fellow student, when Pike was 18. On September 30, after last-minute appeals that delayed the execution for several hours, she was given two injections of pentobarbital and, because she remained alive, was taken to a Nashville hospital. Over the weekend, her lawyers said she was unconscious and on a ventilator.

Caplan says the question of who legally represents a person who cannot communicate is fundamental. If there is no designated decision-maker to represent and defend her interests, a court must appoint someone. “I don’t think it should be the state of Tennessee, the prison warden, or any official involved in the execution attempt” who decides what care she should receive, he argues.

“Another question is who is in charge of her care. Doctors, absent other instructions, will try to improve her condition. But she may have a mother or other relative who wants to intervene and say, ‘I don’t want that. Let her die. She will be left with disabilities and I don’t think she would want to live like that,’” the expert adds.

Stephen Ferrell, one of Pike’s defense lawyers, said Pike signed a power of attorney naming someone else to make her medical decisions, according to The Associated Press.

The dilemma has precedents in cases of inmates with mental illnesses who do not understand they will be executed, Caplan notes. “Doctors have encountered situations where psychiatrists and psychologists treat someone on death row who has severe schizophrenia or many other mental health issues, and some have refused to restore that person’s competence to be executed so they cannot be put to death,” he explains.

Until the extent of Pike’s injuries — both physical and cognitive — after the failed execution is clear, it will not be known whether the defense will raise this kind of argument. It is also not yet known what steps the state of Tennessee will take in Pike’s case.

“Lending the prestige of medicine to execution”

The American Medical Association has declared it ethically incompatible for a physician to participate in a legally authorized execution because the profession is “dedicated to preserving life when there is hope of doing so.”

Caplan says the presence of healthcare personnel amounts to “lending the prestige of medicine to the execution,” giving the impression that “it is more humane because it is supervised by doctors.”

However, the presence of doctors does not by itself guarantee humane treatment. “We know that throughout history there have been doctors who participated in torture. The presence of doctors does not make things better,” he says.

Dr. Joel Zivot, an anesthesiologist and critical care physician who advised Pike’s lawyers, wrote in an essay in The New York Times over the weekend that authorities have “tried to make executions appear like medicine,” with stretchers, intravenous lines and cardiac monitors, but that it is a “sinister impersonation of the medical profession” without consent or therapeutic purpose.

The Tennessee Department of Correction has said that all protocol steps were followed.

“We have laws, judges and courts so society does not descend to the level of brutality of its criminals,” Caplan adds. “We try to set punishments that have a rationale and objectives, such as rehabilitation, deterrence — preventing others from doing what she did — or, in some cases, retribution, that you will pay for what you have done. But we also try to remain, so to speak, civilized and mindful of the ethical need for punishment not to reproduce the same cruelty as that of the criminals.” Pike’s case shows that this is not always achieved.

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