On December 8, the state of Ohio broke with tradition and killed a condemned prisoner with a single-drug lethal injection – a barbiturate overdose – instead of the 3-drug combo pioneered by Oklahoma and Texas in the 1970s. The “traditional” 3-drug combo uses a barbiturate to sedate the person, with a curare-type drug to stop respiration along with potassium chloride to stop the heart. “3-drug” is controversial, in part, because if either of the other drugs takes effect before the barbiturate, the condemned prisoner will suffer severe pain and distress. The US Supreme Court deliberated, ultimately deciding that the 3-drug combo is not necessarily cruel and unusual, at least as practiced by Kentucky circa 2007. Described by ABC news as an “untested method,” the execution went smoothly, and Kenneth Biros was pronounced dead within 10 minutes.

I am a veterinarian, not an MD. Humans are the one animal species I am not licensed to treat.  Nonetheless, we do know how to kill a wide range of animals competently, and with a minimum of pain.  I am thus convinced that pain and mishandled executions should be extremely rare

As a young veterinarian in the 1980s, I first got interested in euthanasia when New York State banned the use of an animal 3-drug lethal injection product. Like the Oklahoma/Texas version, “T-61” contains a curare-like paralyzing drug (T-61 is purchased as a blend of 3 drugs in one vial; the Oklahoma/Texas recipe calls for injecting three drugs separately). The concern, I learned, was that if T-61’s paralyzing ingredient took effect before the tranquilizing component, it would paralyze an animal’s breathing before the sedative component kicked in.  This could cause extreme distress to the animal – conscious but paralyzed and unable to breathe: pretty scary stuff. This is the same concern that people have had (and brought to court) in 3-drug lethal injection of prisoners.

On a practical level, this meant that animal shelters lost access to an essential euthanasia tool, and the preferred option – lethal injection of a barbiturate overdose – was not available to most of them because of narcotics laws. Cash-poor animal shelters suddenly had to hire or cajole local veterinarians to come and kill animals for them. Vets were resistant; years of study on how to cure animals and we find ourselves killing them when the shelters can’t find homes for all the dogs and cats abandoned on their doorstep? I pitched in when a colleague convinced us vets that we had to help the local shelter; you can bet I didn’t like it. But I learned a lot about how animal shelters work, met wonderful people as well as my beloved Freddie the Boston Terrier, and developed my long-running fascination with the nuts-n-bolts of animal euthanasia.

The American Medical Association (a professional association with no actual authority over physician practice) has a Code of Medical Ethics. The AMA Code would keep MDs out of lethal injection: “A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution."

By contrast, euthanizing our animal patients is such an integral part of veterinary practice that our professional association, the AVMA, has a 39-page guide on how to do it best. [Disclosure: I’m on a working group contributing to the 2010 update of these guidelines] The AVMA Guidelines combine a review of the science of how different drugs and techniques work in different species, with an elaboration of principles to distinguish humane euthanasia from merely killing. These principles center mainly on animal pain, fear and distress; they also include concern for the safety and emotional well-being of shelter workers and others who take on this unpleasant responsibility. The big omission in the Guidelines is that there’s intentionally little guidance on WHETHER to euthanize a particular animal; instead the focus is on how.

The key principle is that we gently induce unconsciousness BEFORE inducing any sort of respiratory arrest (such as curare-type drugs cause) or cardiac arrest (potassium chloride). Overdose of barbiturate in a calm animal is our gold standard. For vets and animals, barbiturate euthanasia is not an “untested method,” though pentobarbital is the more common choice for animals than Ohio's choice of thiopental. That said, single-drug euthanasia is not universally appropriate with our animal patients. If a frightened cat or an aggressive dog requires prior tranquilization for safe and gentle handling, it is the veterinarian’s duty to prescribe that. No 1-drug or 3-drug approach fits all. While vet-trained technicians do most of this work, at least in animal shelters, it’s under guidance from vets and our vet association. We may not like the fact that so many healthy shelter animals are euthanized for lack of a good home, but leaving it to non-vets to guess how best to euthanize them feels to me like shirking our veterinary oath.

It should not be surprising that as controversy about human lethal injection grew over the past decade, people looked to a group – veterinarians – who’ve focused such attention over several decades on combining killing and compassion. While some veterinarians have shared their expertise in testimony on ways of killing, the AVMA as a body has not. There are enough differences between the human and animal situations that the AVMA reissued their 2000 report in 2007, primarily to emphasize that we vets limit ourselves to the several thousand species of nonhuman animals we are licensed to treat and can not will not do not have authority on that one other species, the human one. AVMA also clarified that the Oklahoma/Texas 3-drugs-in-3-syringes combo is not addressed one way or the other in the vet guidelines, and that while the AVMA guidelines do discuss use of paralyzing drugs, pancuronium per se, the paralytic favored in executions, is not specifically mentioned. 

The  AVMA has recently been promoting a “one health initiative” emphasizing the evolutionary continuity of human and veterinary medicine. Despite this, the AVMA has resisted being tapped to tell our MD colleagues (or law enforcement, when the MDs refuse to get involved) how to kill their patients and prisoners is not what One Health and the AVMA is about. Vets have good reason to be squeamish on legal/ethical grounds about pronouncing on human medical procedures but on biological grounds, a report written to cover animals from fish to gorillas may in fact have a lot of info relevant to human animals. In fact, extrapolating our knowledge of animal biology to human biology is exactly what laboratory animal research, and the One Health Initiative, are all about.

But here’s another way that MDs might just have something to learn from us vets. In my book on laboratory animal welfare, I’ve discussed the intense focus vets put on how we kill animals in laboratories, with so much less attention to why we kill. I’ve faulted the AVMA guidelines for skirting the WHY questions as well. But veterinarians, especially in pet animal practice and shelter work, daily address the why question as well. True veterinary leadership includes telling folks how best to kill animals when that is necessary, but also getting involved in figuring out why so many healthy animals are sent prematurely to their deaths, and to addressing those problems. True veterinary service means helping pet guardians understand end-of-life care for their animals, and to make difficult life-and-death decisions.

Perhaps the American Medical Association and practicing physicians should be more involved in discussions of human lethal injection.  Instead of demurely looking the other way, human doctors should either get involved in making execution more humane, or should speak up to ban such executions.