Welcome to the second Bioethics Digest, brought to you in association with the editors of the Bioethics Forum. This digest aims to bring you commentary on today’s most topical bioethics issues. The opinions expressed are those of the authors and not The Hastings Center.
Last month, the U.S. Supreme Court ruled that Oklahoma’s substitution of midazolam for sodium thiopental as a sedative in lethal injections does not violate the Eighth Amendment prohibition against cruel and unusual punishment. Now, an important question is whether states will even be able to obtain drugs used in capital punishment. Increasing numbers of professional associations that are essential for providing and compounding lethal injection drugs are urging their members not to do so.
The American Pharmacists Association (APhA) recently issued a statement discouraging pharmacists from participating in capital punishment. The APhA joins the American Medical Association, American Nurses Association, and American Board of Anesthesiology in defining capital punishment as inimical to ethical practice for health care professionals. Following on the heels of the APhA resolution, the International Academy of Compounding Pharmacists (IACP) has also declared that active participation of their members in the administration of the death penalty is unethical.
These changes could not come at a better moment, write Lillian Ringel, the Associate Director of the Columbia University Bioethics program, and Stephanie Holmquist is a course facilitator in the Columbia University Bioethics program, in Bioethics Forum, the blog of the Hastings Center Report. The capital punishment landscape in the U.S. is increasingly baroque. Utah recently reinstated the firing squad for execution when lethal injection compounds are unavailable. Oklahoma has approved capital punishment by nitrogen gas asphyxiation as its second line method of execution, after lethal injection, and before electrocution and the firing squad.
Capital punishment in the U.S. is also mired in concerns about states’ data collection. States that have adopted the Common Rule and collect data on the effects of execution drugs on death row inmates (prisoners are members of a categorically vulnerable population and require additional protections when they are subjects of research) must arguably receive oversight from an IRB and comply with other stipulations of the Common Rule. Otherwise, states’ data collection about lethal injection may constitute illegal human subjects research.
Decades of experiments have shown that rats are smart individuals that feel pain and pleasure, care about one another, can read others’ emotions, and will help unfamiliar rats even at a cost to themselves. It’s time to apply what we’ve learned from these animals and stop conducting experiments on them in laboratories.
Recently, there was substantial media coverage of experiments at Japan’s Kwansei Gakuin University demonstrating that rats will help other rats in need and even prioritize helping others over receiving a tasty reward.
The experimenters placed one rat in a water-filled tank, a situation that terrifies rats and from which they try desperately to escape to avoid drowning. A second rat on a platform had to figure out how to push open a door to help the drowning rat reach a dry area. The experimenters observed that rats quickly learned to open the door to rescue their cagemates. When given the choice between opening one door to save a drowning rat and opening another door to secure a chocolate treat, the platform rats helped the distressed rat first – and then shared the treat with the rescued rat. Rats who had themselves previously been thrown into the water tank were faster at opening the door to help their panicked cohorts.
This study is only the latest in a string of experiments that demonstrate that rats show sympathy for pain and distress experienced by other rats and take action to help them.
Unfortunately, many experimenters miss the forest for the trees, writes Alka Chandna, a senior laboratory oversight specialist for People for the Ethical Treatment of Animals (PETA) in Bioethics Forum. Instead of following this evidence to its logical conclusion that millions of rats shouldn’t be confined, burned, shocked, infected, and crippled in laboratories – or should at least receive some basic protections under the law – many use it as the basis for even more experiments. At least one such experimenter recently acknowledged the inherent conflict: “The more we do experiments like this, the more we wonder if we should do experiments like this.”
I was only there to learn how to place IV lines. But as my anesthesia attending and I gathered our needles, tourniquet, and gauze, I noticed that our patient, whom I’ll call Jamie, didn’t appear to fit into a narrowly defined version of gender, writes Colleen Farrell, a fourth year medical student at Harvard, in Bioethics Forum. I wasn’t sure whether to refer to Jamie as she, he, or some other alternative, but imagined it could be quite hurtful if I used the wrong pronoun. I wanted to eliminate that potential for harm.
When it comes to caring for patients like Jamie, in my experience, avenues for improving medical students’ communication skills seem to be lacking. While many communication skills are transferable from one scenario to another, there are also unique issues that arise in caring for transgender patients. My medical school had in fact attempted to teach me how to handle situations like my encounter with Jamie in a lecture on asking patients questions about sexual orientation and gender identity. But real life medical encounters are almost always more complex than the versions presented in a lecture hall.
To address the needs of transgender and gender nonconforming patients, we need physician-mentors experienced in transgender patient care who can help us work through our uncertainty. We need opportunities to gain experience and comfort, through elective rotations in specific LGBT health centers or through simulated encounters with patient-actors. And we need an institutional culture that says loudly and clearly: it’s important to do this well.