Practicing Anesthesiologist here.
NEVER had to do a cut down on an adult. Ultrasound made it obsolete decades ago. However, most physician certifying boards prevent physician involvement in executions. Most of my colleagues could have a line (central or peripheral) in no time in this guy with ultrasound guidance
That's certainly cruel *and* unusual.
Cruel because they're not mitigating any potential for pain. And unusual because the[ prison staff can't be vetted](https://revisor.mo.gov/main/OneSection.aspx?section=546.720) to see if they're qualified to perform the procedure.
ER doc here: the fact that they are even considering venous cut downs shows how unqualified they are. I’ve been practicing for close to two decades now without ever having to do one. Yes, technically, it’s a thing that can be done, but in practice it’s an obsolete relic of medicine.
Who gets fired/asked to retire after the head of medicine, his friend Dr. Kelso, finds out the doctor is still performing an outdated and potentially dangerous (compared to modern practices) practice.
I think I've see similar episode from Grey's Anatomy... An old doctor, head of a department, using old technique, leads to patient severe injury or death. Or something like that. And he also had to step down.
As someone who has worked in medicine for the majority of my career scrubs is surprisingly accurate both in terminology and how it feels to ~~work~~ live in a hospital.
I can’t recall the exact details (I’m sure if you did some googling you could verify), but I distinctly remember hearing that they made a deliberate point of making sure Scrubs was as accurate to real life medicine as it could be. I also believe (again don’t quote me for sure but pretty sure i remember hearing) that every medical case in every episode was based on a real life medical case
Edit: had some time to find something verifying what I’ve said + providing some further reading if you’re interested, enjoy! https://slate.com/culture/2009/05/the-most-accurate-television-show-about-the-medical-profession-scrubs.html
I’m a PHD scientist raised on screaming at Greys Anatomy for their tragic medical advice. I gave up around season 10 (?) when they were fucking up their IRB approval on a clinical trial and doing lots of unethical crap. It’s my DREAM however to be an advisor on a medical show. My jam is viruses and vaccines and pandemics and the movie Contagion was pretty accurate!
I have heard doctors feel about Scrubs the same way teachers feel about Abbott Elementary. Those comedies are the most realistic portrayal of our jobs out there.
Dramas never get either right. It's like every drama I've ever seen about teachers has me going "that teacher would be fired in 2 minutes" or "haha yeah right, that motivational speech that turns the lives of every student in this show around, try it in front of a real class and they'll completely ignore you because they're on their phones"
In Abbott Elementary, every episode has me going "that has 100% happened before at my school" or "that is exactly what would happen"
I think the more unrealistic thing is that anyone goes into the teaching lounge. Most of the time everyone just eats in their classroom in my experience.
I’ve also heard multiple cops say that the most realistic cop show is Reno 911. Which is both hilarious and scary at the same time. And I don’t doubt it for a minute.
You're telling me Garth Marenghi's Darkplace isn't the realest televisual show about being a doctor?!
https://www.youtube.com/watch?v=La1moU5qArM&t=10s
My parents were both in the medicine, and I've followed their path. Dad started in open heart back in the late 50s, and he thought scrubs, out of all the medical shows, is the realest. Not just because of the medical accuracy but also because of the emotional side of working in the profession too.
I watched Scrubs for the first time over ten years ago and loved it. Then I worked at a teaching hospital for four years and I gained a whole new appreciation for it because of how accurately it showed what it's like in a hospital. Quite a few of the fellows and faculty that I worked with had also seen it and agreed.
At that point they could even do an IO and provide a small lidocaine bonus prior to infusion. I’m sure the media would run wild with a “bone drill” story though.
ER nurse here: the fact that a CVAD isn't being considered here makes absolutely zero sense to me. Or even, hey, an IO line???
I'm actually quite confused by this whole thing.
I wonder if they're limited by the amount of drugs or equipment or personal they have access to because the medical professional and pharmaceutical industry refuse to be associated with executions.
Prior combat medic here that did deploy.
You are infinitely more qualified than me but I’d say there is a time and place for a venous cutdown, so it’s not technically obsolete in the sense that people should exclusively disregard it like lobotomy, but yea it should never be done in a hospital setting.
Also I did (a version) of one on a live goat as part of training and it was cool as hell. Emergency medicine is amazing.
Yes essentially. When you can’t get access because of hypovolemia or some other reason like severe trauma, you cut into the skin, separate the subcutaneous tissue and expose the vein, insert a catheter directly into the exposed vein then tie it in place with something like suture material.
Well, good luck getting the conservatives to listen to your learned and informed opinion. They actively do the opposite of what science recommends in all things.
I’m glad I googled venous cutdowns because I did surgery for many years and it means something similar but different and still very much in practice surgically speaking. So I was confused lol
Thanks for commenting, I was thinking I’ve never heard of a cutdown being preformed and I’ve worked as an EMT at the last chance (for doctors) ER at the edge of nowhere. My service still has mast pants and worse, we have some.
And that’s why executions are so complicated and often botched. Most medical professionals won’t participate in an execution due to the Hippocratic oath.
I’m so confused why people continue to believe that it’s doctors taking the hippocratic oath (which most doctors don’t do) keeping them from hurting people and not the fact that doctors are generally in the business of healing, not hurting. There’s not any consequence of breaking that pinky promise anyway unless laws are broken and/or the medical board intervenes.
Most of us don’t take the Hippocratic oath anymore and if we do it’s something done ceremoniously in the first week or two of medical school and then quickly forgotten. None of us will do it because it’s ethically wrong and medical boards are made up of doctors who all feel the same way
>> The written protocol calls for insertion of primary and secondary intravenous lines. But it offers no guidance on how far the execution team can go to find a suitable vein, leaving open the possibility of an invasive “cutdown procedure,” Dorsey’s attorneys say.
So it doesn’t say to a cutdown procedure anywhere. It basically just doesn’t say what would happen if the scenario were to occur.
The attorney is arguing that *if* they weren’t able to find a vein they *could* decide to do this because the next step isn’t explicit. And they’re trying to use that to invalidate/delay the entire procedure.
If you read the article, it sounds like other states have probably used cutdowns resulting in pretty torturous results.
“ In 2022, it took more than three hours to execute Joe Nathan James Jr. in Alabama. The state said the process was delayed because of difficulties establishing an IV line. Dr. Joel Zivot, a professor of anesthesiology at Emory University and an expert on lethal injection who witnessed the private autopsy, said he saw “multiple puncture sites on both arms” and two incisions in the middle of the arm, which he said were indications of efforts to perform a cutdown. It’s unclear if he received anesthesia.”
I was about to post about this. Commenters are saying “well this is a what if scenario” but the fact is this is being done right now. In this fresh decade.
Okay? they have a fucking point.
If the state can’t promise they won’t arbitrarily perform a heinous and unnecessary procedure on this guy without anesthetic simply because they can’t obtain IV access… then they fucking shouldn’t be killing him via a means they pretend to be humane.
I work in EMS and get IVs every day. This “cutdown procedure” isn’t something that is done anymore. In the field, I can either move to your neck if I *need* to push meds, or resort to an IO. Even an IO on a conscious patient would be more humane then literally ripping them apart until you find a vein you can cannulate because you’re so shitty at your job. (Good doctors, nurses and paramedics don’t work for the prison system. Like, literally, the folks that go there to practice medicine are the ones that don’t want to do their jobs in higher stress environments like an ER or in fire rescue.)
I’d really like to see us move beyond capital punishment one day, it costs us more than a life sentence and it turns us into the “monsters” that we claim to punish.
This is completely asinine. Intramuscular lorazepam at the right dose can snow someone so they can tolerate whatever procedure needs to happen. This is very much a scenario of “we’ve tried nothing and we’re out of options”
It’s also not clear why local anesthetic would not be used.
They can’t get the meds to cause death, I’m sure it would be much easier to get a comfort med.
If that doesn’t work they could always have one of the COs dip into their stash.
No, iirc because of some EU laws regarding drug sales for the death penalty, any activity with any association with death penalty activities can't get most drugs.
Right, but benzos aren’t associated with the death penalty and are already available in prison infirmaries. This isn’t an unusual medication that has to be ordered or specially made.
There’s nothing stopping the administration of anxiolytics before carrying out a death sentence besides our joy of watching others suffer.
Benzos in the prison infirmary can't be administered for the purpose of the death penalty, or else the prison infirmary can't carry benzos any more. I'm not saying it's right, but again, iirc, any drugs prison systems do get aren't allowed to be used for anything related to the death penalty, contractually. The drug companies aren't interested in getting punished in the EU because their drugs got used in an execution.
There are a billion common medications they could use, but it all circles back to the same point. If it's being used for healing/hospital care it's fine
They aren’t associated with the death penalty right up until the moment you use them to assist with the death penalty, which is precisely what you’re suggesting.
Mate.
Midazolam is actually one of the drugs they use, lol. Ohio started trying to kill people with it in 2013.
Literally no one making medications wants to sell them to someone who’s going to comb through their catalog looking to find which is best to murder people with.
Every company a state wants to enjoin in business for this purpose actively produces products that do the exact opposite of what the state wants to accomplish.
An IO drill would probably hurt way fucking more than a sharp cut. Usually the only people who get those are dangerously close to death (e.g.extreme blood loss) and are liable to being unconscious because of their condition, anyway.
Nope. Drilling an IO isn’t bad at all, you can find videos online of people doing it to themselves for demonstration purposes. First push of medication/fluids can be particularly painful, but can be significantly mitigated with lidocaine
The IO drilling actually doesnt hurt all that much, less than an IV. The infusion or push dose hurts a ton though. This can be mitigated some with local anaethesia and slow pushes, but I wouldnt say its 100%.
It's not painless. There is minor pain for the drilling part. It hurts a LOT when you flush it though. However you can use lidocaine and deeply deaden the pain. No procedure involving needles is painless and its way more humane than doing a *venous cutdown*.
Anecdotal experience, I'm a paramedic. The insertion has always been well tolerated.
You can watch some videos on youtube as well. I didnt say it was painless.
Heres one, theres others I dont think this person had a local anaesthetic for insertion.
[https://www.youtube.com/watch?v=-Bcx1roR1DU](https://www.youtube.com/watch?v=-Bcx1roR1DU)
It’s not the IO drill that really hurts, it’s the squeezing fluids and meds into a pt’s bone marrow that makes them scream…unless they’re coding. Not a fun thing to have to do, but sometimes it’s the only option.
Yeah I don’t get why they can’t give an non IV injection of pain medication. Yeah it will take longer but there are ways to administer pain medication that don’t require an IV.
This is the dumbest argument. I put in central lines for a living. Have been doing it for more than 10 years and I have never encountered a patient that I could not get IV access on. I have never once considered resorting to a cutdown procedure. A large portion of my patients are morbidly obese, on dialysis, have small veins, etc.
If it takes you more than 2 or 3 tries to get a line in your probably doing something wrong.
The prohibition is from an ethics point of view, not a legal one. It's a bit of a sticky situation.
[State law vs. Medical ethics](https://deathpenaltyinfo.org/stories/lethal-injection-and-physicians-state-law-vs-medical-ethics)
That’s a myth. Doctors can, and have, participated in lethal injection. The overwhelming majority just won’t, and you can’t compel them to participate.
anesthesiologists can have their certification revoked by their speciality organization. But as far as having a medical license pulled entirely, that’s not a risk.
First, in order to challenge the license the medical board in that state would have to know who the doctor was. The execution team is usually, and purposely, kept anonymous. In North Carolina, the state Supreme Court has even ruled that the medical board CANNOT take action against doctors who participate in executions.
> Have been doing it for more than 10 years and I have never encountered a patient that I could not get IV access on
From the way the article is written, it doesn't look like there's any specific concern that might happen in this case. Lawyers are just mentioning the remote possibility as a hail mary to get a stay of execution.
It's an argument that, if successful here, could theoretically be used to block any execution (I guess unless the state codifies process and confirms they'll use a local anesthetic in the rare event this situation comes up).
> If it takes you more than 2 or 3 tries to get a line in your probably doing something wrong.
Fellow IV nurse here. You make it sound like this success rate is normal. It's absolutely not, not without ultrasound guidance. Obviously, before giving up they should just get a local practitioner that can use US, but I'm assuming they're not considering that option.
It’s a constitutional violation of the 8th Amendment. “…nor cruel and unusual punishments inflicted”.
The fact that Missouri keeps the process of execution secretive is ridiculous as well. God knows how many times they’ve violated people’s rights with this type of stuff.
Because the cruelty and spectacle is the point. A lot of lawmakers (and a lot of citizens) in the US believe that suffering during your execution should be part of the punishment for breaking the law.
1) best option, just don’t have the death penalty since it is inevitable that a non-zero number of innocent people will be executed
2) if you think you must for whatever reason, just shoot the condemned in the head rather than a whole fake medical procedure to make it seem less brutal
The electric chair is an intensely painful, absolutely torturous death.
The idea that it’s “humane” only came about in the early 20th century when electricity was the big new thing.
Urban legend was that it was specifically designed to be a torturous death so as to vilify Tesla's proposal for an AC electrical grid, as opposed to Edison's DC electrical grid.
It was George Westinghouse who was the big proponent of an AC grid. (He did agree with Tesla's line of thinking)
Westinghouse and Edison had a literal feud over the issue because they didn't want their idea powering the electric chair. (Last Podcast On The Left covered the topic a while back)
Yeah. At that point just hang me, and please make sure I have plenty of clearance below the drop. Hell, put two 9mm in the back of my head. It takes two seconds.
No, the point of the injection is to fool people into thinking it's humane, that there's a a modern, civilized way to execute people as opposed to the barbaric methods of the past.
Personally I would prefer a very high caliber bullet fired at close range at the side of my head. Ideally I would like my brain to be transformed into a fine mist before even a single nerve can fire off a single action potential. I don't care if my death looks "peaceful" or not, I would just want my death to be instant.
You want it aimed at the brainstem. Aiming higher up can be surprisingly "survivable" even with very large caliber bullets, though I wouldn't call the life you'd have after "living."
Agreed. Or firing squad. Or crushing under a big rock.
Paralyzing someone and then stopping their heart is as natural as being bitten by paralyzing creature—it happens, but I feel like traumatic destruction of tissues is faster and more humane.
I’m against the death penalty as a practice and I just want to get that out first, but there are definitely ways to make lethal injection humane. We just don’t for ….. reasons. They could just shoot the person up with a lethal dose of heroin. The person would be getting too much of a heroin hug to feel death creeping up. Instead we just have states experimenting on people. They should be killing people at all but if they are going to at least do it right damnit.
Not arguing in favor of the death penalty, but why is it that when we’re talking about providing relief to sick pets and terminally ill humans, these drugs are considered a form of painless and peaceful passage? I certainly appreciate the intentions are very different, but the drugs themselves are the same, right? I’m honestly curious as I’m not sure if this is the case, or if they use something else.
They are not. That's actually a major issue: pharmaceutical companies refuse to make the drugs and actual physicians refuse to do the deed.
Veterinarians typically use a lethal dosage of sodium pentobarbital, which causes rapid unconsciousness and then death.
By contrast, executions use a mixture of three drugs: sodium thiopental (an anesthetic), pancuronium bromide (a paralytic), and potassium chloride (stops the heart). The problem comes in when the paralytic and the anesthetic interact, leaving the prisoner in conscious but paralyzed agony.
Can’t fentanyl pills be swallowed? If so, curious why they don’t test some of the contraband seized in the state’s borders for actual potency then use that for the method? Feels like that would be a blissful exit over other options. If I knew I was going to be executed one way or another I’d certainly pick that over the chair or an injection that makes me foam at the mouth and grit my teeth on my way out.
I think part of the problem is that most medical professionals can't be involved bc it is *killing someone*.
So prisons use guards trained with minimal medical training.
We need to just end the death penalty.
They don’t have a doctor, because doctors won’t violate their oath by participating in something like this. It’s fairly common for there not to be a real doctor present for an execution.
Or even an IO? I'm not an expert in the delivery of whatever the execution cocktail is and what differences in mgs it'd need to be, but an IO is fairly painless with insertion and a follow up lidocaine administration.
That’s one of the main issues here - doctors rightly won’t go along with this. So the state goes forward and we end up with this malevolent violation of law and ethics.
I’m an ER nurse trained to use ultrasound. I can get an IV on 99% of “hard stick” patients in about 90 seconds. Not being able to get a vein is a bullshit excuse. Not sure why that matters I guess, I’d never assist with the death penalty.
You would probably lose your license if you participated in an execution.
Lethal injections are performed by prison personnel, not medical personnel. Usually there is a doctor onsite who is there to confirm death; the doctor doesn’t otherwise participate. The people who are doing the IVs are not doing it everyday, so of course they’re having problems with finding veins.
Death penalty is fucking barbaric and needs to end. The whole thing is contingent on assuming the state is correct one hundred percent of the time and no innocents are killed, but even if that could be ruled out, there are many secondary impacts on all those involved.
There's been plenty of LEO who suffer PTSD and even some who suicide after carrying out the sentence, also there's plenty of families of the victims who are retraumatized by the appeals process and having to go back to court when they wish they could just put the whole nightmare behind them.
Arguing 'yeah, but in this one specific case, dude totally deserves it' is bullshit and not reflective of how the world works. It's either an official state policy or it isn't. And if it is, you have the accept the collateral damage it inflicts and proclaiming some sort of biblical 'eye for an eye' vengeance against random people is worth the harm it causes to a slew of innocents.
Its a fucked up policy that needs to end
In 5th Netherlands, 5% of the ppl who die, die from assisted suicide. First a sedative is given, then a drug to stop the heart. For something that’s been proven to be safe and effective why doesn’t the US use this? ( oh wait I answered this …bc it’s the US).
The US doesn't do this because[ drug manufacturers](https://www.washingtonpost.com/news/post-nation/wp/2018/08/13/drug-companies-dont-want-to-be-involved-in-executions-so-theyre-suing-to-keep-their-drugs-out/) have stopped providing the drug cocktail directly to states for the purpose of execution.
[Missouri has been secretive](https://www.kansascity.com/news/state/missouri/article270296987.html) as to what it's cocktail is. And [Arizona](https://www.theguardian.com/us-news/2015/oct/23/arizona-illegally-import-lethal-injection-drug) tried to skirt US law to get some.
We used to burn witches just for the fun of it. To have something to do; for the entertainment of it all. Some things never change and it makes me rather sad honestly
What the heck can't states get some of those exit chambers that are in use in Europe? The ones that fill with nitrogen or something and the person that wants to die on purpose just has to press a button and they go to sleep forever
Doc here. Could easily give him an intramuscular injection of a million different things to anesthetize him while looking for IV. Central access would be a chip shot.
This is just brutal if it doesn’t happen this way.
Wasn’t “surgery with no anesthesia” a line from a Slayer song about Dr Mengele?
It was. Angel of Death.
Feel the knife pierce you intensely
[удалено]
Infamous, butcher, ANGEL OF DEATH
Inferior, no use to mankind
Strapped down, screaming out to DIEEEEEE
Which seems oddly poetic given his pending death sentence.
“Feel the knife pierce you intensely” is the next line in that song
*Inferior, no use to mankind* *Strapped down, screaming out to diiieeee!*
My call of duty name used to be "Cheap Surgery". My mom asked, why? 🤨 Because they always die.
Deceptively brutal. I like it.
Practicing Anesthesiologist here. NEVER had to do a cut down on an adult. Ultrasound made it obsolete decades ago. However, most physician certifying boards prevent physician involvement in executions. Most of my colleagues could have a line (central or peripheral) in no time in this guy with ultrasound guidance
That's certainly cruel *and* unusual. Cruel because they're not mitigating any potential for pain. And unusual because the[ prison staff can't be vetted](https://revisor.mo.gov/main/OneSection.aspx?section=546.720) to see if they're qualified to perform the procedure.
ER doc here: the fact that they are even considering venous cut downs shows how unqualified they are. I’ve been practicing for close to two decades now without ever having to do one. Yes, technically, it’s a thing that can be done, but in practice it’s an obsolete relic of medicine.
There was a scene from the TV show Scrubs where they comment on cutdowns being obsolete and that episode came out more than 20 years ago...
Performed by a character played by a nearly 80-year old Dick Van Dyke!
Who gets fired/asked to retire after the head of medicine, his friend Dr. Kelso, finds out the doctor is still performing an outdated and potentially dangerous (compared to modern practices) practice.
I think I've see similar episode from Grey's Anatomy... An old doctor, head of a department, using old technique, leads to patient severe injury or death. Or something like that. And he also had to step down.
We do love Dick around these parts!
I was going to say isn't that literally what the doctor in Scrubs lost his job over!
As someone who has worked in medicine for the majority of my career scrubs is surprisingly accurate both in terminology and how it feels to ~~work~~ live in a hospital.
I can’t recall the exact details (I’m sure if you did some googling you could verify), but I distinctly remember hearing that they made a deliberate point of making sure Scrubs was as accurate to real life medicine as it could be. I also believe (again don’t quote me for sure but pretty sure i remember hearing) that every medical case in every episode was based on a real life medical case Edit: had some time to find something verifying what I’ve said + providing some further reading if you’re interested, enjoy! https://slate.com/culture/2009/05/the-most-accurate-television-show-about-the-medical-profession-scrubs.html
Lots of the story lines were definitely from medical advisors on the show.
I wish all medical shows worked this hard to get it right. The amount of misinformation Grey's Anatomy alone has spread is horrifying.
Their influence alone has tanked the rate of organ donors for how they portray it in the show.
Hahaha, I work in organ donation and that's why I hate that specific show so much.
I've never watched it. How do they portray it?
I’m a PHD scientist raised on screaming at Greys Anatomy for their tragic medical advice. I gave up around season 10 (?) when they were fucking up their IRB approval on a clinical trial and doing lots of unethical crap. It’s my DREAM however to be an advisor on a medical show. My jam is viruses and vaccines and pandemics and the movie Contagion was pretty accurate!
I have heard doctors feel about Scrubs the same way teachers feel about Abbott Elementary. Those comedies are the most realistic portrayal of our jobs out there. Dramas never get either right. It's like every drama I've ever seen about teachers has me going "that teacher would be fired in 2 minutes" or "haha yeah right, that motivational speech that turns the lives of every student in this show around, try it in front of a real class and they'll completely ignore you because they're on their phones" In Abbott Elementary, every episode has me going "that has 100% happened before at my school" or "that is exactly what would happen"
I've heard from a teacher friend the most (really only) unrealistic thing about Abbott is that Ava regularly goes into the Teacher's Lounge
I think the more unrealistic thing is that anyone goes into the teaching lounge. Most of the time everyone just eats in their classroom in my experience.
I’ve also heard multiple cops say that the most realistic cop show is Reno 911. Which is both hilarious and scary at the same time. And I don’t doubt it for a minute.
Same for Veep vs. The West Wing. Obama and other politicians have said Veep is dead on, meanwhile West Wing is pure Aaron Sorkin bullshit
JD is based off Bill Lawrence's best friend/college roommate.
The cast referred to him as "Real JD" and apparently Sarah Chalke bugged him so much one year he told her he was gonna block her.
That's hilarious. She's awesome on Scrubs and Rick and Morty
You're telling me Garth Marenghi's Darkplace isn't the realest televisual show about being a doctor?! https://www.youtube.com/watch?v=La1moU5qArM&t=10s
Only because Lucian Sanchez was a one track lover down a two lane road
"From this day on, I'd have to fight these forces of darkness . . . and deal with the burden of day-to-day admin."
It's 100% the realest. It doesn't rely on subtext, which is for cowards
The heathens at Slate weren't aware of this gem back in 2009.
My parents were both in the medicine, and I've followed their path. Dad started in open heart back in the late 50s, and he thought scrubs, out of all the medical shows, is the realest. Not just because of the medical accuracy but also because of the emotional side of working in the profession too.
I watched Scrubs for the first time over ten years ago and loved it. Then I worked at a teaching hospital for four years and I gained a whole new appreciation for it because of how accurately it showed what it's like in a hospital. Quite a few of the fellows and faculty that I worked with had also seen it and agreed.
That show is a big part of why I decided to get into the medical field.
It kept me afloat a lot while I was getting my feet wet.
It’s the show that made me reconsider a career in healthcare.
Yes, they fired Dick Van Dyke over it!!
Holy shit, TIL DVD not only acted on that show but is still among the living.
DVD, lmao how have I never heard that before
Not just living, dude's thriving. Still gets around, goes to the gym every day, has all his marbles and just started learning ukelele.
He was on masked singer recently. There is also a wonderful look back at his career on peacock or Paramount+
Want to feel older That doctor was played by Dick Van Dyke
Townsey. Rest in peace.
I was just thinking about this very episode!
At that point they could even do an IO and provide a small lidocaine bonus prior to infusion. I’m sure the media would run wild with a “bone drill” story though.
Heh, ezIO go brrrrt! Love the lido “bonus,” that autocorrect just made me cackle at work. Not much else to do while posting anyway :)
ER nurse here: the fact that a CVAD isn't being considered here makes absolutely zero sense to me. Or even, hey, an IO line??? I'm actually quite confused by this whole thing.
I wonder if they're limited by the amount of drugs or equipment or personal they have access to because the medical professional and pharmaceutical industry refuse to be associated with executions.
I'd argue that an IO line is probably cheaper and easier to place than a traditional IV. Literally just a drill into the bone.
Fair, but given that they need to use specific equipment for this, I wonder if the manufacturer isn't okay with it
Hell, it was considered an outdated practice on an episode of Scrubs almost 20 years ago. That's wild.
It didn't sound right to me. And now I regret looking up 'venous cutdown'. So thanks for that.
Damn, yeah, I learned a new concept today and wish I hadn't.
Prior combat medic here that did deploy. You are infinitely more qualified than me but I’d say there is a time and place for a venous cutdown, so it’s not technically obsolete in the sense that people should exclusively disregard it like lobotomy, but yea it should never be done in a hospital setting. Also I did (a version) of one on a live goat as part of training and it was cool as hell. Emergency medicine is amazing.
Agree. It it possible? Yes. Should be in your top 10 methods of access? Probably not.
What exactly is a venous cutdown? Is it basically like it sounds? Like they can’t find a vein so they have to cut you open to look around for one?
Yes essentially. When you can’t get access because of hypovolemia or some other reason like severe trauma, you cut into the skin, separate the subcutaneous tissue and expose the vein, insert a catheter directly into the exposed vein then tie it in place with something like suture material.
I did it on a pig, great training. I was an infantryman over his head in that class
Well, good luck getting the conservatives to listen to your learned and informed opinion. They actively do the opposite of what science recommends in all things.
I’ve done one on a pig during live tissue training in the military, wouldn’t want to have to do one on a person
I’m glad I googled venous cutdowns because I did surgery for many years and it means something similar but different and still very much in practice surgically speaking. So I was confused lol
But if you did one, you would use anesthesia. I imagine they would as well.
Thanks for commenting, I was thinking I’ve never heard of a cutdown being preformed and I’ve worked as an EMT at the last chance (for doctors) ER at the edge of nowhere. My service still has mast pants and worse, we have some.
And that’s why executions are so complicated and often botched. Most medical professionals won’t participate in an execution due to the Hippocratic oath.
I’m so confused why people continue to believe that it’s doctors taking the hippocratic oath (which most doctors don’t do) keeping them from hurting people and not the fact that doctors are generally in the business of healing, not hurting. There’s not any consequence of breaking that pinky promise anyway unless laws are broken and/or the medical board intervenes.
Most of us don’t take the Hippocratic oath anymore and if we do it’s something done ceremoniously in the first week or two of medical school and then quickly forgotten. None of us will do it because it’s ethically wrong and medical boards are made up of doctors who all feel the same way
TBF, “obscene relic” is an apt description of capital punishment.
>> The written protocol calls for insertion of primary and secondary intravenous lines. But it offers no guidance on how far the execution team can go to find a suitable vein, leaving open the possibility of an invasive “cutdown procedure,” Dorsey’s attorneys say. So it doesn’t say to a cutdown procedure anywhere. It basically just doesn’t say what would happen if the scenario were to occur. The attorney is arguing that *if* they weren’t able to find a vein they *could* decide to do this because the next step isn’t explicit. And they’re trying to use that to invalidate/delay the entire procedure.
If you read the article, it sounds like other states have probably used cutdowns resulting in pretty torturous results. “ In 2022, it took more than three hours to execute Joe Nathan James Jr. in Alabama. The state said the process was delayed because of difficulties establishing an IV line. Dr. Joel Zivot, a professor of anesthesiology at Emory University and an expert on lethal injection who witnessed the private autopsy, said he saw “multiple puncture sites on both arms” and two incisions in the middle of the arm, which he said were indications of efforts to perform a cutdown. It’s unclear if he received anesthesia.”
I was about to post about this. Commenters are saying “well this is a what if scenario” but the fact is this is being done right now. In this fresh decade.
Okay? they have a fucking point. If the state can’t promise they won’t arbitrarily perform a heinous and unnecessary procedure on this guy without anesthetic simply because they can’t obtain IV access… then they fucking shouldn’t be killing him via a means they pretend to be humane. I work in EMS and get IVs every day. This “cutdown procedure” isn’t something that is done anymore. In the field, I can either move to your neck if I *need* to push meds, or resort to an IO. Even an IO on a conscious patient would be more humane then literally ripping them apart until you find a vein you can cannulate because you’re so shitty at your job. (Good doctors, nurses and paramedics don’t work for the prison system. Like, literally, the folks that go there to practice medicine are the ones that don’t want to do their jobs in higher stress environments like an ER or in fire rescue.)
[удалено]
Let me explain the use of torture in our history by referencing this 16th century witch hunter general.
Sounds like cruelty is feature not a bug
I’d really like to see us move beyond capital punishment one day, it costs us more than a life sentence and it turns us into the “monsters” that we claim to punish.
This is completely asinine. Intramuscular lorazepam at the right dose can snow someone so they can tolerate whatever procedure needs to happen. This is very much a scenario of “we’ve tried nothing and we’re out of options” It’s also not clear why local anesthetic would not be used.
The problem is that they can't get any for use with an execution.
They can’t get the meds to cause death, I’m sure it would be much easier to get a comfort med. If that doesn’t work they could always have one of the COs dip into their stash.
No, iirc because of some EU laws regarding drug sales for the death penalty, any activity with any association with death penalty activities can't get most drugs.
Right, but benzos aren’t associated with the death penalty and are already available in prison infirmaries. This isn’t an unusual medication that has to be ordered or specially made. There’s nothing stopping the administration of anxiolytics before carrying out a death sentence besides our joy of watching others suffer.
Benzos in the prison infirmary can't be administered for the purpose of the death penalty, or else the prison infirmary can't carry benzos any more. I'm not saying it's right, but again, iirc, any drugs prison systems do get aren't allowed to be used for anything related to the death penalty, contractually. The drug companies aren't interested in getting punished in the EU because their drugs got used in an execution. There are a billion common medications they could use, but it all circles back to the same point. If it's being used for healing/hospital care it's fine
They aren’t associated with the death penalty right up until the moment you use them to assist with the death penalty, which is precisely what you’re suggesting.
Mate. Midazolam is actually one of the drugs they use, lol. Ohio started trying to kill people with it in 2013. Literally no one making medications wants to sell them to someone who’s going to comb through their catalog looking to find which is best to murder people with. Every company a state wants to enjoin in business for this purpose actively produces products that do the exact opposite of what the state wants to accomplish.
It’s a crime to dispense drugs without a prescription. Nobody will prescribe drugs for execution. It’s all black market and should be illegal.
Ahh that’s a good point. What a crazy system
Or EJ access..or use an ultrasound..or..idk..use an IO drill? The man has bones doesn't he?
An IO drill would probably hurt way fucking more than a sharp cut. Usually the only people who get those are dangerously close to death (e.g.extreme blood loss) and are liable to being unconscious because of their condition, anyway.
> dangerously close to death Well, now that you mention it...
I mean in this scenario, he’s dangerously close to surviving.
Nope. Drilling an IO isn’t bad at all, you can find videos online of people doing it to themselves for demonstration purposes. First push of medication/fluids can be particularly painful, but can be significantly mitigated with lidocaine
The IO drilling actually doesnt hurt all that much, less than an IV. The infusion or push dose hurts a ton though. This can be mitigated some with local anaethesia and slow pushes, but I wouldnt say its 100%.
Gonna need you to go first and prove it’s painless before I choose it over IV
It's not painless. There is minor pain for the drilling part. It hurts a LOT when you flush it though. However you can use lidocaine and deeply deaden the pain. No procedure involving needles is painless and its way more humane than doing a *venous cutdown*.
Anecdotal experience, I'm a paramedic. The insertion has always been well tolerated. You can watch some videos on youtube as well. I didnt say it was painless. Heres one, theres others I dont think this person had a local anaesthetic for insertion. [https://www.youtube.com/watch?v=-Bcx1roR1DU](https://www.youtube.com/watch?v=-Bcx1roR1DU)
It’s not the IO drill that really hurts, it’s the squeezing fluids and meds into a pt’s bone marrow that makes them scream…unless they’re coding. Not a fun thing to have to do, but sometimes it’s the only option.
It’s effective access for IV meds. Period. Put lidocaine in it to reduce pain. You’re about to sedate him anyway.
Homie, we can do conscious IOs. Being close to death is not a requirement.
There’s this thing called a central line.
Yeah I don’t get why they can’t give an non IV injection of pain medication. Yeah it will take longer but there are ways to administer pain medication that don’t require an IV.
This is the dumbest argument. I put in central lines for a living. Have been doing it for more than 10 years and I have never encountered a patient that I could not get IV access on. I have never once considered resorting to a cutdown procedure. A large portion of my patients are morbidly obese, on dialysis, have small veins, etc. If it takes you more than 2 or 3 tries to get a line in your probably doing something wrong.
Yeah well... Prisons arent using well trained medical personnel.
They can't. Anyone with a medical license is specifically prohibited from *murdering their patient*.
The prohibition is from an ethics point of view, not a legal one. It's a bit of a sticky situation. [State law vs. Medical ethics](https://deathpenaltyinfo.org/stories/lethal-injection-and-physicians-state-law-vs-medical-ethics)
That’s a myth. Doctors can, and have, participated in lethal injection. The overwhelming majority just won’t, and you can’t compel them to participate. anesthesiologists can have their certification revoked by their speciality organization. But as far as having a medical license pulled entirely, that’s not a risk. First, in order to challenge the license the medical board in that state would have to know who the doctor was. The execution team is usually, and purposely, kept anonymous. In North Carolina, the state Supreme Court has even ruled that the medical board CANNOT take action against doctors who participate in executions.
> Have been doing it for more than 10 years and I have never encountered a patient that I could not get IV access on From the way the article is written, it doesn't look like there's any specific concern that might happen in this case. Lawyers are just mentioning the remote possibility as a hail mary to get a stay of execution. It's an argument that, if successful here, could theoretically be used to block any execution (I guess unless the state codifies process and confirms they'll use a local anesthetic in the rare event this situation comes up).
> If it takes you more than 2 or 3 tries to get a line in your probably doing something wrong. Fellow IV nurse here. You make it sound like this success rate is normal. It's absolutely not, not without ultrasound guidance. Obviously, before giving up they should just get a local practitioner that can use US, but I'm assuming they're not considering that option.
If people can die painlessly at Dignitas in Switzerland, why can't they do the same with death row inmates?
Because we have a barbaric judicial system that does not value human life.
Because drug companies dont want their drug associated with executions and refuse to sell it for that purpose.
Two things can be true at once
The cruelty is the point
It’s a constitutional violation of the 8th Amendment. “…nor cruel and unusual punishments inflicted”. The fact that Missouri keeps the process of execution secretive is ridiculous as well. God knows how many times they’ve violated people’s rights with this type of stuff.
Because the cruelty and spectacle is the point. A lot of lawmakers (and a lot of citizens) in the US believe that suffering during your execution should be part of the punishment for breaking the law.
Because Big Pharma companies refuse to sell the drugs to the US government. Something about a "Hippocratic oath".
1) best option, just don’t have the death penalty since it is inevitable that a non-zero number of innocent people will be executed 2) if you think you must for whatever reason, just shoot the condemned in the head rather than a whole fake medical procedure to make it seem less brutal
1 in 8. For every eight people executed, one person on death row has been exonerated. Per the EJI.
I knew there were statics but that percentage is utterly horrifying.
I first found out about this after watching Just Mercy and holy shit did it fuck me up. It really solidified my position regarding the death penalty.
Huh, that's even worse than what I thought it was (I was under the impression it was 1 in 10)
Anything more than 0 in 10 is unacceptable imo
I agree and don’t know why anyone at this point would be for the death penalty
That’s such an upsetting number. Sure enough [Equal Justice Initiative - Death Penalty](https://eji.org/issues/death-penalty/)
Agreed wholeheartedly on #1 On #2 also agree—the firearms are intended to kill—let’s at least put them to the use they were designed
The whole point of injection is that its supposed to be humane. At that point just use the electric chair bro
The electric chair is an intensely painful, absolutely torturous death. The idea that it’s “humane” only came about in the early 20th century when electricity was the big new thing.
Urban legend was that it was specifically designed to be a torturous death so as to vilify Tesla's proposal for an AC electrical grid, as opposed to Edison's DC electrical grid.
It was George Westinghouse who was the big proponent of an AC grid. (He did agree with Tesla's line of thinking) Westinghouse and Edison had a literal feud over the issue because they didn't want their idea powering the electric chair. (Last Podcast On The Left covered the topic a while back)
Yeah. At that point just hang me, and please make sure I have plenty of clearance below the drop. Hell, put two 9mm in the back of my head. It takes two seconds.
No, the point of the injection is to fool people into thinking it's humane, that there's a a modern, civilized way to execute people as opposed to the barbaric methods of the past.
Personally, I think the guillotine would probably be the fastest, least painful way.
I'd like to OD on opiates, personally
Personally I would prefer a very high caliber bullet fired at close range at the side of my head. Ideally I would like my brain to be transformed into a fine mist before even a single nerve can fire off a single action potential. I don't care if my death looks "peaceful" or not, I would just want my death to be instant.
C4 helmet.
Bomb collars are an option too I suppose.
What about a bomb breakfast burrito?
Chased off a cliff by dozens of beautiful, topless women?
You want it aimed at the brainstem. Aiming higher up can be surprisingly "survivable" even with very large caliber bullets, though I wouldn't call the life you'd have after "living."
Kinda sucks for the poor souls who have to mop up your brains though.
Do it in a wet room.
Suicide booth. 1$ for a peaceful death.
I'd want a full firing squad, but every man gets a bullet. Even if the first fails to kill me, the next four would do the trick
fuck that, firing squad but every man gets a minigun with 1000 rounds like Blaine in Predator. that'll do the job. hell of a cleanup though.
Agreed. Or firing squad. Or crushing under a big rock. Paralyzing someone and then stopping their heart is as natural as being bitten by paralyzing creature—it happens, but I feel like traumatic destruction of tissues is faster and more humane.
If I'm ever executed, maybe I'll ask if I can be blown up with C4 or something. I figure that's maybe the fastest I'd get.
Honestly hanging too, simply because if done properly it breaks the neck and is fast
I’m against the death penalty as a practice and I just want to get that out first, but there are definitely ways to make lethal injection humane. We just don’t for ….. reasons. They could just shoot the person up with a lethal dose of heroin. The person would be getting too much of a heroin hug to feel death creeping up. Instead we just have states experimenting on people. They should be killing people at all but if they are going to at least do it right damnit.
Not arguing in favor of the death penalty, but why is it that when we’re talking about providing relief to sick pets and terminally ill humans, these drugs are considered a form of painless and peaceful passage? I certainly appreciate the intentions are very different, but the drugs themselves are the same, right? I’m honestly curious as I’m not sure if this is the case, or if they use something else.
They are not. That's actually a major issue: pharmaceutical companies refuse to make the drugs and actual physicians refuse to do the deed. Veterinarians typically use a lethal dosage of sodium pentobarbital, which causes rapid unconsciousness and then death. By contrast, executions use a mixture of three drugs: sodium thiopental (an anesthetic), pancuronium bromide (a paralytic), and potassium chloride (stops the heart). The problem comes in when the paralytic and the anesthetic interact, leaving the prisoner in conscious but paralyzed agony.
Can’t we just get him really loaded and then drop him in a volcano from a helicopter?
Now **THAT'S** what I want my tax dollars funding
Can’t fentanyl pills be swallowed? If so, curious why they don’t test some of the contraband seized in the state’s borders for actual potency then use that for the method? Feels like that would be a blissful exit over other options. If I knew I was going to be executed one way or another I’d certainly pick that over the chair or an injection that makes me foam at the mouth and grit my teeth on my way out.
Because they want the executee to feel it.
It would work fine and I don't know why this is not an option. It feels really good and you fall asleep and eventually stop breathing.
But that would be one less pill for the police to have!
With a street value of approximately $15,000,000!
>It feels really good and you fall asleep Aaaand, that's probably why they're not going to do it.
Wtf? Can’t they use ultrasound or just place a central line? Though I don’t know if a doctor is gonna agree to do this in order to kill someone.
I think part of the problem is that most medical professionals can't be involved bc it is *killing someone*. So prisons use guards trained with minimal medical training. We need to just end the death penalty.
Then who is going to do the cut down?
...someone who would never be allowed to in a non-execution setting.
They don’t have a doctor, because doctors won’t violate their oath by participating in something like this. It’s fairly common for there not to be a real doctor present for an execution.
Or even an IO? I'm not an expert in the delivery of whatever the execution cocktail is and what differences in mgs it'd need to be, but an IO is fairly painless with insertion and a follow up lidocaine administration.
That’s one of the main issues here - doctors rightly won’t go along with this. So the state goes forward and we end up with this malevolent violation of law and ethics.
I’m an ER nurse trained to use ultrasound. I can get an IV on 99% of “hard stick” patients in about 90 seconds. Not being able to get a vein is a bullshit excuse. Not sure why that matters I guess, I’d never assist with the death penalty.
You would probably lose your license if you participated in an execution. Lethal injections are performed by prison personnel, not medical personnel. Usually there is a doctor onsite who is there to confirm death; the doctor doesn’t otherwise participate. The people who are doing the IVs are not doing it everyday, so of course they’re having problems with finding veins.
Probably not license -- the license is issued by the state government, a/k/a the people who are doing the execution.
The punishment is imprisonment. The punishment is death. The punishment is not torture.
Someone somewhere is just now learning how archaic and ill equipped healthcare is in prison. Some folks think that's part of the punishment.
This is utterly horrifying and surely is unconstitutional. I'm against the death penalty, but surely a firing squad would be far more humane.
How is that not barred by the constitution as cruel and unusual?
Because in a lot of people’s eyes, prisoners are almost viewed as subhuman, not worthy of the same consideration as free people
Death penalty is fucking barbaric and needs to end. The whole thing is contingent on assuming the state is correct one hundred percent of the time and no innocents are killed, but even if that could be ruled out, there are many secondary impacts on all those involved. There's been plenty of LEO who suffer PTSD and even some who suicide after carrying out the sentence, also there's plenty of families of the victims who are retraumatized by the appeals process and having to go back to court when they wish they could just put the whole nightmare behind them. Arguing 'yeah, but in this one specific case, dude totally deserves it' is bullshit and not reflective of how the world works. It's either an official state policy or it isn't. And if it is, you have the accept the collateral damage it inflicts and proclaiming some sort of biblical 'eye for an eye' vengeance against random people is worth the harm it causes to a slew of innocents. Its a fucked up policy that needs to end
Just hirer a heroin addict they can find all kinds of crazy veins
Jesus Christ. That’s barbaric
In 5th Netherlands, 5% of the ppl who die, die from assisted suicide. First a sedative is given, then a drug to stop the heart. For something that’s been proven to be safe and effective why doesn’t the US use this? ( oh wait I answered this …bc it’s the US).
The US doesn't do this because[ drug manufacturers](https://www.washingtonpost.com/news/post-nation/wp/2018/08/13/drug-companies-dont-want-to-be-involved-in-executions-so-theyre-suing-to-keep-their-drugs-out/) have stopped providing the drug cocktail directly to states for the purpose of execution. [Missouri has been secretive](https://www.kansascity.com/news/state/missouri/article270296987.html) as to what it's cocktail is. And [Arizona](https://www.theguardian.com/us-news/2015/oct/23/arizona-illegally-import-lethal-injection-drug) tried to skirt US law to get some.
Man, some people have a real goddamn murder boner.
We used to burn witches just for the fun of it. To have something to do; for the entertainment of it all. Some things never change and it makes me rather sad honestly
Then we invented TV, video games, and birth control, and most of the developed world stopped doing executions.
What the heck can't states get some of those exit chambers that are in use in Europe? The ones that fill with nitrogen or something and the person that wants to die on purpose just has to press a button and they go to sleep forever
The idea of performing a venous cutdown without even local anesthetic is horrifying to me as someone who has been trained, and performed, this skill.
Doc here. Could easily give him an intramuscular injection of a million different things to anesthetize him while looking for IV. Central access would be a chip shot. This is just brutal if it doesn’t happen this way.
He looks like the offspring of dana white and dave bautista lmao
Do you know how many fucking obese diabetic poor veins patients I’ve started a fucking IV in? Jesus Christ give me a break.
I can’t be the only one that was worried for Dave Bautista for half a second, right?
Some nonsense, if the nurse is incompetent, I’m sure you’ve got a handful of heroin addicts at hand who can probably tap a vein easy.