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Capital Punishment or Capital Gain?

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(Presented before the Criminology Section, American Assn. for the Advancement of

Science, Washington, D.C., December 1958; subsequently published in Criminal Law,

Criminology, and Police Science, vol. 50, no.1, May-June 1959, 50-51.)

Experimentation on human beings has, of necessity been limited to volunteers during normal times whether it involves prisoners or others. However, there is always a limit in such cases which curtails the means to any medical end, and thus detracts from the total of knowledge obtainable from the undertaking.

Capital punishment as it exists today offers an unparalleled opportunity to break those limits by introducing into the situation an involuntary factor without destroying the necessary safeguard of consent. I propose that a prisoner condemned to death by due process of law be allowed to submit, by his own free choice, to medical experimentation under general anesthesia (at the time appointed for administering the penalty) as a form of execution in lieu of conventional methods now prescribed by law. After his choice has been made, let the condemned deliberate at his leisure, and have professional consultation at his request; and even let him reverse his decision during the week before the date set for execution.

The experiments should be important, very seriously outlined, and should deal with questions that can be investigated under usual clinical circumstances only on laboratory animals. They should be submitted from research scientists of many nations to an agency of the United States composed of reputable researchers who would select those deemed to be exceptionally promising. The same agency would then arrange for the research team to travel to the nation in which a prisoner has chosen to die under anesthesia. Thus the medical genius of all civilized nations can participate in a program of benefit to us all.

The medical, legal, and moral principles involved can best be discussed by considering the advantages and disadvantages to the parties concerned.

The disadvantages: (1) For the condemned there are none. The choice is entirely his.

(2) For medicine, too, there are none. Physicians could not be deemed executioners, because their aim is not to kill but to learn. Ultimate death could be induced by an overdose of anesthetic given by a layman. (3) For the law one might say that the plan ostensibly tampers with the formality of law which stipulates executions in a prescribed manner. However, the plan simply offers a new form of execution which promises much more than the bleak aim of ending a criminal's life. (4) For society it means tax dollars to run the agencies. But these costs need not be great, and a few human experiments would make allocation of funds for much animal work now in progress a complete waste of time and money.

The advantages: For the condemned it allows the dignity inherent in being permitted to decide how he is to die. The only immediate rewards he can expect are the feeling of utility through death and the avoidance of a potentially harsh death (in contrast to non-condemned volunteers who usually anticipate special consideration at parole hearings.) Furthermore, any experiment would actually lengthen the condemned's life and revival from anesthesia might create hitherto unthinkable "thirteenth" and even "fourteenth" hour chances for commutation. (2) For medicine it would mean rapid progress in those fields where animal work cannot help (for example, anatomy and physiology of the human brain.) It also would make available a final and indispensable means of screening every new drug, device, or procedure before ultimate trial on sick patients. (3) Law would acquire another beneficent aspect of enormous potential good for humanity. The plan would detract somewhat from the pure negativity per se engendered by law. (4) For society this proposed "judicial euthanasia" for the first time introduces the altruistic concept of recompensing into a matter now of crass vengeance. It offers the means of restoring some honor to the family of the condemned, and, in a case of murder, of imparting positive significance to the involuntary death of the victim. And it offers the ultimate means of assuring all of us and our descendents of improving health and lengthening life.

The plan differs markedly from the Nazi crimes of World War II which, in themselves, were unpreventable and uncontrollable wartime atrocities under the auspices of a demented government. The victims were unjustifiably condemned under makeshift "laws" on racial or political grounds; they were not asked for consent and were not anesthetized. The medical objectives were frivolous—the scientists sadistic.

The pros and cons of capital punishment are not at all involved in this proposal. My only contention is that so long as it is practiced, and wherever it is practiced, there is a far more humane, sensible, and profitable way to administer it. I have substantiated this through interviews with two men now facing electrocution (in Ohio), one of whom eloquently confirmed it (his decision) in writing. Whether or not the plan is practicable on a worldwide basis remains to be seen. But it is feasible, and I hope that one of the states in our country which endorse capital punishment will legally allow a condemned man the choice and thereby set an example for the world to follow

(The first death row inmate I interviewed concerning this issue was a young adult male who agreed wholeheartedly with my proposal, which was the proof I needed to know that I was right and encouraged to proceed. I arranged to present the proposal to the Criminology Section at the annual meeting of the American Association for the Advancement of Science in Washington, D.C. in Oct. 1958. Below is a copy of the inmate's eloquent letter confirming his decision:)

Retribution through the death penalty: "Impossible" Research

(From my speech at the 2nd International Meeting on World Medical Law, Washington,

D.C., Aug. 1970)

This short article has a simple aim: to restate an old idea. Logically it is a sound one, albeit rather unpleasant, even repugnant to some. If and when discussed, it seems

generally to bare the emotional basis of human intellect, which makes the matter easy to ignore entirely. And it has been ignored for over two millennia.

During the 3rd and 2nd centuries B.C. the enlightened Ptolemies of Alexandria are said to have decreed that condemned criminals be executed through experimentation in the anatomic laboratories of the time. There is no extant, incontrovertible documentation as to if, when and exactly how such executions were carried out—unfortunately. Knowledge of the purported practice was transmitted by a few ancient chroniclers such as Celsus and Galen.

The overpowering logic of the idea compelled me to propose it (or, more accurately, to restate it) openly before an august scientific group in December 1958 in the following form: modern, enlightened civilized society (which most of us would avow ours is) should allow some persons, condemned under civil law during peacetime, the choice in some circumstances to die as now prescribed by that law (by electrocution, gassing, hanging or shooting), or to undergo irreversible deep surgical general anesthesia and subsequent experimentation, from which there would be no revival or consciousness. In essence the basic scheme is relatively easy to reduce to practice, perhaps through high courts or other authoritative bodies, making use of the world's best minds and materials for research aims now not at all accessible to clinical probing. At this point, discussion of details would understandably be superfluous and out of order; and there is little doubt that how it would work in practice would be largely determined, as are all human undertakings, by the sincerity and incorruptibility of those so charged.

What are the foreseeable good points involved? For medical science, at least in some fields, all bars to investigation would be lowered or removed. The limits would be set by natural bounds of imagination and genius exemplified by men such as Claude Bernard and Alexis Carrell. Advances in human brain anatomy and function would be swift and astonishing. Heart and lung transplants and reattachment of severed limbs could have been tried and perfected decades ago. Given suitable scientific conditions, how is the first brain transplant in man going to be done? If not on the willing condemned men or women, then some pathetic, innocent future patients, perhaps yet unborn, are doomed to certain agonizing harm or death as the first such subjects. These are the dramatic procedures. Less dramatic ones would be no less important and almost innumerable.

As for jurisprudence, by legally sanctioning this choice it will have imparted for the first time a really positive aspect to the gloomy and necessarily retrogressive concept of capital punishment—positive in that all parties would benefit.

For the condemned it offers the dignity of choice, deserved or not; a more tolerable mode of death, deep general anesthesia; and the opportunity for true atonement in the form of tangible retribution to society. The condemned's choice, based on any kind of medical or freely available legal consultation desired or requested, would have to be unflinching and sure, and could be reversed by him or her at will. Finally, one should take account of the remote but valid consideration of hitherto impossible "13th" and even "14th"chances of reprieve and survival in rare cases of inadvertent injustice.

For society, knowledge gained might conceivably affect the health and welfare of millions, if not everyone. Strong, healthy hearts, livers, and kidneys could be transplanted instead of "fried." Retribution in the purest sense would become an undeniable attribute

of the death penalty. If the condemned's crime involved murder, the involuntary death of victim's and the condemned's, would have the means to salvage some vestige of honor, self-respect, and peace of mind.

What are the foreseeable bad points? For medicine, some would insist that the researcher would find himself in the indefensible role of crass executioner. This is a specious argument, because in that case every physician involved in instances of "accidental," unpredictable, or preventable clinical or surgical death would likewise be a perhaps less crass executioner, which no thoughtful person could justifiably conclude. The salient point is that of specific purpose. The researcher's as well as the physician's is to learn and enhance his or her skill for the benefit of ailing humanity; the executioner's is simply to obey the demand by man-made, arbitrary, and abstract law merely to painfully annihilate a human life functioning under natural law.

For jurisprudence I can see no drawback whatsoever.

For the condemned, the only conceivable argument might be that of introducing another profound and disturbing variable into the thoughts of an already overburdened consciousness. Yet there is little doubt that the enormous potential exhilaration in merely having the choice for a meaningful, dignified way to avert the gaping nothingness of simply ignominious extinction would counterbalance such a vexation. Personal interviews with condemned men have proved this to my satisfaction.

For society, one might object that the proposal would make capital punishment attractive enough to retard or thwart efforts to abolish it. Some argue that the number of condemnations will, contrarily, burgeon to furnish more sacrificial subjects for research or organ donation. This controversy can be solved definitively only through evidence gained from actual use of the plan. To lessen concern in this regard, perhaps the choice for the condemned should not be automatically granted, but rather contingent in each instance upon judicial assessment of worthiness of the criminal's character and behavior, and of the circumstances associated with his or her illegal act. Thus taken into account by a jury, judge or other authority, these factors could preserve what deterrent effect, if any, inheres in the death penalty. In the final analysis, as stated earlier it all boils down to the integrity and sense of dedication of those operating the plan. Equating the latter to the horrendous Nazi crimes is inexcusable for any objectivist. In contrast to those atrocities, this proposal: (1) Demands unwavering consent freely given. (2) Involves deep, general surgical anesthesia at all times. (3) Makes use of extremely competent research talent of any nationality. (4) Involves research aims of a very profound nature unobtainable under any other acceptable circumstances. (5) Would assure stringent control of all experimental conditions and action through uninterrupted observation by a specially designated multidisciplinary group. And (6) would be promulgated through laws entirely compatible with international standards and fostered under the auspices of a democratic society. It should be clearly understood that this proposal has nothing at all to do with the merits of capital punishment itself. History is full of trite pro and con arguments on that point. The extreme penalty will always exist somewhere in the world as the insoluble controversy rages on. But there is a better way to implement it whenever and wherever it is in effect—at least in some cases. This proposal embodies one of those ways.

Any realist knows that official adoption of this proposal is highly unlikely at present; but I have done all that I can do: the idea has been restated, mainly out of an obligation to human reason alone. However, there's always a faint hope of provoking some sympathy for it and thereby taking a tiny step toward its realization. Hope is often futile; yet coupled with the growing pressure of demand with diminishing supply in this age of successful organ transplantation, and with the disquieting awareness of the wanton waste in those executions carried out since the restatement of the proposal in 1958, that hope can become the catalyst for a more reasonable assessment of, and reaction to, this whole sordid facet of human existence.

Profane wasting of unavoidable homicide by Our Irrational

"Civilization"

(From my speech at the 3rd World Congress on Medical Law, Gent, Belgium, Aug.1973)

The aim of this short paper is almost as ambitious as its chances of being taken seriously are remote. Its theme is deeply philosophical as well as practical, very unusual, and certainly difficult to elaborate convincingly in a terse presentation like this. Perhaps the best approach would be merely to define terms in explaining the title above as a sort of summary.

We all know that homicide is killing of man by man. Unavoidable homicide stems from the completion of a basically inevitable, humanly preordained voluntary act, examples of which are judicial execution and suicide. Both are revocable only through special legal channels, or through intangible, unpredictable, and essentially uncontrollable psychical mechanisms. Accidental killing is free of calculated intent, and therefore not relevant here.

There is no doubt that medical research is good and necessary under present conditions, and that the huge sums of money and countless animal lives spent in pursuing it do not constitute waste. After thorough initial trials in research comes the first attempt on living human beings; and whether there is success or failure, cure or kill, there is still no waste within the framework of today's allowable means and the ends in view. Only when that framework is examined closely and dispassionately does the waste become apparent—indeed appalling.

What real "gain" is there after a murderer, traitor, robber, or rapist is gassed, shot, roasted, or choked to death mandated by the "due process" of law? Except for the dubious subjective "gain" of assuaging a vague longing for vengeance, justified by the misnomer of "retribution," or the objective "gain" of absolute prevention of more crime by the annihilated evildoer, the deplorable situation is one of total loss of life

of the condemned and his victim(s), but especially the grievous loss of an unparalleled opportunity to learn what may advance medical science. One marvelous, intact, living,

and functioning human body thus senselessly destroyed is the unforgivable squandering of a complete and natural "laboratory" of magnitude and quality infinitely superior to those makeshift and intricately concocted tubes, wires, electronic marvels, and animals which have begun to strain our national budgets.

The only differences in cases of suicide are the sources of condemnation (society's laws or dogmas and an individual's judgment or coercive whim) and the tentative nature of the act's completion. Based on history and a knowledge of human nature, there can be little doubt that both forms of wasteful killing, execution and suicide, will continue forever. Capital punishment has always existed in recorded history of every civilization. But even if it were to be totally abolished, the waste of suicide will most likely persist and grow as populations skyrocket and economic fortunes fluctuate.

If a sane society's laws condemn an individual to death for a capital crime, thereby obligating him or her to maximal retribution, and the condemned is allowed to choose to submit to deep surgical anesthesia and medical experimentation to fulfill that obligation, then he or she should be allowed to do so. This idea is millennia-old, said to have been the policy of the enlightened Ptolemies of ancient Alexandria who made this form of retribution mandatory in their anatomic laboratories. Today the condemned would be granted the choice; continuous anesthesia would be used; and ultimate death of the condemned would result from an overdose of the anesthetic agent administered by a specially designated layman, not by medical personnel. This proposal offers the only way to meet the magnitude of obligation required of the condemned. If nothing else, it offers the only feasible way to elucidate the ultimate source of criminal behavior through unfettered research on such afflicted brains.

Although suicide is devoid of the concept of retribution, it does concern the far more important concept of the value of life, which at present can never be meaningfully expressed. The destruction every year, for absolutely nothing, of these thousands of intact and often young human beings is another incalculable loss which society has never been able to diminish. These unalterably self-condemned individuals should also be permitted to choose self-immolation through anesthesia and research, a way which at least holds a promise of yielding real value from a life otherwise tragically doomed to vacuous extinction.

Once the necessary mechanisms and safeguards are enacted into law, the entire situation would become as clear-cut and automatic as it is with the use of the death penalty when all decisions and actions are contingent upon and derived from the relatively objective, abstract, and man-made foundation called law which will determine the parameters: Who may thus commit suicide? After how much fruitless therapy? After how many abortive, painful, and harmful attempts? After how much counseling and how much delay? With whose concurrence? Etc., etc. It is even conceivable that the first attempt in every case in the first episode of anesthesia the subsequent research can be definitely valuable but purposely less than lethal, and the subject allowed to revive from the anesthesia. This could be a kind of "super-shock therapy" aimed at perhaps nullifying the suicidal impulse and re-establishing the lost sense of personal worth and inculcating a concrete reason for being, all of which the positive and useful results of the experiment endured might accomplish.

Most of us are in no way directly or intimately involved in executions or suicides. Because we don't know or talk to the subjects during their agonal crises and don't observe their actual dying, we can smugly ignore these extraordinary and distasteful proposals as being "barbaric," unrealistic, remote. Would any of that matter if you were condemned or suicidal? Or your son or daughter? Would you then still rather see a man grimace in the gas chamber or convulse in the electric chair? Or a young man blow his own face off with a shotgun? Or a young woman fall 15 stories to smash onto a sidewalk,

or turn ashen white after a lethal dose of barbiturates, or pink from motor exhaust fumes?

Would you oppose trying to change some or all of this?

Well, society does oppose changing this brazen, this puerile disregard of such senseless and irreverent extinguishing of human dignity and vitality which Western man's highest ideals speciously imbue with a modicum of divinity. Such is the profanity, the downright vulgar desecration which doesn't seem to matter to our intelligentsia.

History has taught me that this exposition is a futile and colossal mistake. A few of you may agree but understandably will remain silently sympathetic at best. Those who disagree can afford to be vociferous, backed by the might of the current majority. But in spite of this stifling atmosphere of irrationality, I am making this pragmatic "mistake" for the sake of academic integrity, as a bit of evidence that a few of us in law and in medicine can still make logic and emotions supplement rather than substitute for one another as a guide in a hitherto well-balanced scheme of things not always as beautiful and pleasant as we would naïvely wish.

Legal execution and random suicide are two examples of homicide which, although surely not inevitable, are generally unavoidable. Both have been with us throughout recorded history, and probably will persist for centuries. Indeed, suicide may become more prevalent. At present, both acts constitute a terrible and total loss to self, to families concerned, and to society and humanity in general.

There is an excellent way to reduce the loss to a degree less than total, and that is to allow persons condemned to death (either by law or by self) to choose between the alternatives of pointless destruction (as is the case today), or of submitting to deep anesthesia as now performed in thousands of operating rooms, for the subsequent acquisition of priceless medical knowledge or skill; and with a most calm, serene, and mercifully unconscious death through an overdose of the anesthetic agent administered by a specially designated lay counterpart of an executioner. Perhaps in that way the elusive enigmatic mechanisms of a somehow deranged brain physiology can be discovered and understood. The value of such knowledge is commensurate with that of the vitality inherent in a God-given or natural, uniquely sapient being.

It appears to be too much to expect these proposals to be even seriously considered in an effete, degenerating "civilization" too aware of its deep-rooted hypocrisy and corruptibility which render it incapable of consistency in the formulation of rational principles of thought and action, and which feels quite pseudo-piously comfortable on an ostensibly safer course of blithe "hit-or-miss" determinism mandated by its fictive mythology called religion. That evolutionary course seems to be headed downward, and will ultimately meet the harsh sentence of that almighty "hanging judge" called Nature.

Moral Infraction in Heterotransplantation (Xenografting) Due to

Ethical Phobotaxis

(One of my unpublished articles)

A coherent and universal code of medical ethics no longer exists. Anachronistic Hippocratic maxims have been weakened or invalidated by rapid and overpowering technological and social changes.1-3 Unprepared for the jolt to ethical torpor, which tended to equate ethics with mere etiquette4, various medical specialties and organizations now are frantically cobbling a plethora of supposedly updated codes.3,5-8 But there is no unitary compendium from which could be distilled on demand any illative rule of proper conduct for any contingency, real or imaginary, for every medical discipline. Even worse, the disparate concoctions strive heroically to remain faithful to the demonstrably inadequate anachronisms they are expected to rehabilitate.3,5

It is understandable how physicians would in desperation seek salvation through the labyrinthine pedantry of non-physician "ethicists," Through bland reassurance from faceless and surely not infallible "ethics committees"---one should not forget that such a committee of his time condemned Socrates to death---and through abrupt and deleterious stopgap governmental regulations.5,9,10 To fill the ethical vacuum with the latter would require an entire criminal compendium, which would be a futile endeavor. That is the dangerous course society is being forced to take; dangerous, because it makes an unaccustomed leader of law which has always relied on the mores and the derivative societal consensus as a guide.3.8.12

Medical authorities must act quickly and boldly to reestablish ethical sanity.9,13,14 That calls for the boldness to invoke insuperable medical expertise in open, objective, and consistently rational re-examination of outdated clichés and in the purging of the crippling restraint of mindless obeisance to secular or clerical dogma, pagan or otherwise.1,2,4,15

The aim of this article is to help foster the necessary boldness and ethical sobriety by concentrating on the ethical demands and implication of xenograft research now underway, and how they are and are not being, but should be, addressed. In order to establish a base of agreement and to fend nit-picking sophistry at the outset, I start with dictionary (Webster's Third) definition of the words in this article's title:

Moral: of or pertaining to principles or considerations of right and wrong action or good and bad character.

Ethical: (essentially synonymous with moral): of or relating to the field of ethics or morality; relating to or involving questions of right and wrong;

Infraction: the act of breaking or violating: breach, violation, infringement;

Heterotransplantation: the operative replacement of lost or damaged parts or tissues by tissues taken from an individual of a different species (a xenograft, Dorland, 26th ed.)

Phobotaxis: A random avoiding reaction in response to a distasteful stimulus.

I. Accepted Facts (the Ethical Problem)

1. Human homotransplantations (donor organs from same species as the recipient)

now is a well established therapeutic option, and its use will increase

dramatically.

2. Despite existing and planned legislation, the supply of human donor organs is and

will continue to be short of recipient demand.

3. Xenografts (from animals) will help to alleviate the donor shortfall.

.4.Xenografts from the most closely related species offer the best chances for

successful heterotransplantation (transplantation among different species).

.5. Routinely successful heterotransplantation between distantly related species is

improbable for the near-term future.

6. Much additional research in xenografting is needed.

7. Xenograft research as therapy will involve severely afflicted human beings, and

therefore requires scrupulous adherence to all currently laid out stringent

ethical guidelines relative thereto. (Not necessarily true)

The above very brief summary fairly accurately depicts the xenograft problem at present, and the majority concerned will agree with these facts. Unfortunately other equally relevant facts which partly invalidate the somewhat biased, highly selective tenor of the current outlook are entirely (and conveniently) ignored.

II. Ignored Facts (the Distasteful Stimulus)

1. Human beings are being judicially executed in the United States.

2 .All condemned individuals now on death row in the U.S. are sane and capable of

giving well-reasoned and informed consent.

3. Execution by lethal injection or an overdose of general surgical depth anesthesia

does not impair or render useless, the transplantability and therapeutic utility of

bodily organs and tissues.

.4. Many condemned human beings who were and are yet to be executed in the U.S

were and are willing, even pleading, to be allowed to donate their organs, and

thereby to submit to profound, and now impossible terminal experimentation

when executed by irreversible deep surgical general anesthesia.20,22

5. Throughout history there have been well documented instances of experimentation,

often by noted and revered physicians, associated with the death penalty.23

.

Comments

Condemned individuals would not be on death row if legally judged to be insane Critics who insist that impending execution represents unfair distress that diminishes their mental competence, rendering their less informed decisions as having been less freely given. Such an argument is no more credible or valid than the contention that the anguish for patients and their families resulting from the undeniably coercive circumstances associated with conventional and routine homotransplantation is also unfair duress, whether or not donors are alive or brain-dead.

Even though dosages at or somewhat greater than the LD/50 levels of drugs now used for lethal injection do not irreversibly impair the biological integrity of any tissue, the point is irrelevant. Organs would be taken from willing condemned donors only after induction with routine surgical anesthesia (at the exact time set for execution) to establish

an artificial brain-dead state comparable to that currently deemed to offer optimal conditions for procurement. The only modification of the execution procedure would be the protracted interval of general anesthesia to assure a tranquil and uniquely unhurried atmosphere. That scenario, identical to the one at present lauded as the insuperable advantage of working with animal donors,19 is much more dignified than, and contrasts sharply with, the tense atmosphere permeating clinical transplantation hampered by annoyances and uncertainties of timing, of consent, of organ availability, and of death itself.

How moral is the medial community in pressing the public for strictly gratuitous sacrifice of organs, and rejoicing in the virtual theft of organs by means of enactment of coercive "required request" and "implied consent" laws, while at the same time ignoring the more noble procurement from unconditionally willing condemned inmates almost pleading to recompense society with unarguable retribution through donation of any organs or tissues and submitting to any experiments when executed by routine surgical depth anesthesia?

In the 16th century Fallopius twice investigated opium therapy on a feverish condemned man, the second trial resulting in death.24 In the 19th Claude Bernard, who opposed the death penalty nevertheless endorsed the use of tissues from executed criminals. In the early 20th century a noted professor of tropical medicine at Harvard University used many condemned men in the Philippine Islands in two experiments dealing with plague and beriberi, the latter causing some deaths.26,27 Later, at the beginning of transplantation, a famous French surgeon removed and used kidneys from guillotined criminals28. That was before the days of brain-dead donors, but the pioneer surgeon undoubtedly would have advocated taking advantage of fact 4 above.

The Random Avoiding Reactions

(1) In the war crimes trials at the end of World War II in Nuremberg, the authorities who enunciated the 19 summary statements known as the Nuremberg Code were guilty of the worst kind of phobotaxis. They completely dodged their primary responsibility and instead came up with prosaic generalizations of absolutely no use in solving today's wrenching dilemmas.3 Nowhere in that code is there even a hint about capital punishment, about executions, or about experimentation on doomed human beings, for which the defendant Nazis were condemned and hanged. Every subsequent parroting code perpetuates that dereliction of jurisprudential duty, which only reinforces the secular immorality now being committed in the field of xenografting.

(2) Except for pronouncement of death, some claim that any medical maneuver in any way associated with capital punishment is reminiscent of the Nazi medical crimes and therefore should never be considered or attempted. The absurdity of such an unreasoned viewpoint resides in the outrageously implied equivalence of the enormous differences in the two scenarios---concerning consent, volition, research procedures and aims, integrity of medical personnel, and especially the extremely antipodal socio-political settings.20,33

(3) The failure of the Nuremberg judges and their imitators might have resulted from inability to cope with the, to them, relatively strange thought that the familiar Hippocratic dicta primum non nocere (first do no harm), act only for the good of the patient, and a favorable risk/benefit ratio might in certain circumstances become mythical. Had they resorted to the plasticity of so-called situational ethics, which always anticipates change with the demand that principles illuminate rather than dictate to ratiocination with regard to peculiar nuances of any specific ethical problem,3,12,34 the judges would have been prepared to acknowledge the less than absolute mandate of the cited medical bromides.35

(4) The situational approach was the original intent when the first medical ethical code was formulated in the U.S.,11 an intent later subverted by subtle hypocritical rigidity which, astonishingly, persists in revised codes failing to live up to their initial promise of flexibility.2,5

(5) That the three time-honored dicta are entirely irrelevant to experimentation on willing condemned criminals in no way justifies outright renunciation of, or even worse, failure to consider such a reasonable policy. The maxim that "Thou shalt not kill" also does not pertain due to faulty definitions. Secular and clerical philosophers have clarified that the commandment proscribes merely illegal killing, such as murder or manslaughter, not killing per se.36,37 A soldier who kills an enemy in warfare does not murder or thereby commit an immoral act. And in St. Augustine's opinion, a judicially authorized executioner doesn't murder or kill.

It behooves physicians to bear in mind a logical contradiction at the heart of the Hippocratic Oath.38,39 The hallowed proscription of purposely ending human life inescapably clashes with another principle which mandates relief and suffering. Perhaps negligible in the past, the wonders of our modern technocratic age have made that clash deafening.

One newly formulated ethical code states tersely that participation by physicians in the lethal injection of prisoners is unethical. The formulators of that imprudent principle were mistaken in having made it inflexible, except to protect the life of a pregnant woman. They failed to learn from the same mistakes made in former codes dealing with abortion, all of which also included that solitary exception. Yet today's "updated" codes," in a kind of schizoid way countenance a strained, in essence an almost coerced lenity with regard to elective abortion in general now sanctioned by law, letting morality of abortion be a matter of conscience for every physician. In contrast, these "updated" codes obdurately reject conscience as a basis of ethical judgment for physicians with regard to performing lethal injection endowed with the same kind of legal sanction.

The Catholic ban of elective abortion is also not absolute in some circumstances. At the end of World War II in Berlin, Germany, many raped and humiliated women pleaded for help....The Roman Catholic Bishop of Berlin, Cardinal Preysing, finally gave Catholic doctors permission to perform abortions. This is rare in church history, a grim indication of how high the number of victims must have been."59 It is tragic that physicians doing "cutting-edge" research, and their truly repentant, condemned want-to-be subjects have only a hypocritical medical hierarchy and a thoroughly corrupt Supreme Court to hear (and callously ignore) their futile pleas.

In spite of all its pretentious ethical codes, the medical profession unethically kills every day in this era of successful organ transplantation. Many organs are procured from brain-dead donors after all tests and expert opinions certify the absence of any trace of cerebral or cognitive function5. Nevertheless biological or vegetative life persists. When the liver or heart is to be removed from such a donor, the surgeon arbitrarily decides when to stop heart action with a paralyzing drug and thereby end the brain-dead donor's biological life. Simply and bluntly put, the surgeon thereby kills the insensate human body. That act may still be said to be legal killing, but the significant hierarchical difference in the entities which authorize the act (the difference between society's laws and the medical profession's principles of practice or ethics) and the timing of the occurrence of death (by society's laws or by the surgeon's whim) would, in any instance of doubt always cast any suspicion of illegality of the termination of human life in the direction of the current manipulation by surgeons of brain-dead bodies. Yet this comparative discrepancy apparently is not weighty enough to keep the profession from

traducing itself by blithely ignoring an alternative impeccably free of any taint of murder. That is not so picayune a violation in the adjudication of true morality

It is futile to invoke human fallibility for corruption or abuse as a critical argument, because that is an inescapable risk in any abstract or concrete human invention, manifested as corruption or other abuse after reduction to practice. That risk of moral infraction is far more prevalent than most critics realize, Even highly esteemed medical moralists occasionally and innocently commit it. That point is exemplified by the lamentable fall from grace of Dr. Andrew Ivy 40 years ago, an outstanding expert on medical ethics who, four years after service as a prime witness for the prosecution at the 1947 Nuremberg trials,29 was himself found guilty of unethical conduct by, and expelled from, his local medical society41

No further argument is needed to prove that the potential for abuse is of little moment in the mere evaluation of a contemplated social experiment of eminent logic, promise, and importance; and within the framework of legal and moral controls, such potential is by itself insufficient reason the foreswear the experiment.

In the early days of gleaning organs from the brain-dead, a few "ethicists" tried it once again through furtive euthanasia by raising the specter of wholesale unplugging of respirators in hospital intensive-care units to maintain and increase the available supply of transplantable organs. Such scaremonger "ethicists" should be ignored when they predict that death rows will become gigantic "organ farms."31

Medical authorities often mistakenly display the mentality of a safe follower, not of a virile leader---an attribute more befitting prudent politics than pithy morality. There has been at least one feeble attempt to acquire objective evidence in this regard; and it revealed that 42% of condemned individuals, 86% of other inmates, and an average of 75% of professional and lay men and women of the general population approve of taking transplantable organs during anesthetized execution. These data still are not enough to convince worried surgeons incurably addicted only to the lure of high-powered "double-blind" statistics.

Ultimately any complete and reasonably proleptic ethical code will cover much more than what is currently being practiced. It will also deal with what may or possibly can be done---should delineate proper conduct for every conceivable medical setting. This is where medical ethics always has fallen short. Had capital punishment never been with us throughout history, all of its aspects having any possible medical relevance would be essential components of any code of medical ethics deemed to be complete. Notwithstanding that failure, all codes thus far have done even worse by continually ignoring considerations made obligatory through association with really extant activity (executions) of at least tangential relevance to human health, life, and death,---not merely potential activity.

Especially deplorable is the profession's unalterable propensity to act after crises have reached almost insuperable proportions, at which point any formulation of maxim or law tends to be pathetically slipshod as an ethical guide. The reason for this dereliction is, in part, "the great and perpetual shortage of imagination"14, which is rampant today. It is reminiscent of the fairly superficial and banal secular thought characteristic of most theological scholars who tend to merely iterate platitudes based on their contrived dogma.

However, the serious and dynamic thought of scholarly Talmudists encompasses in detail every conceivable facet of human life and death. Many centuries ago these intrepid thinkers pondered in depth the "absurd" implications of transferring a fetus from one womb to another, of the legal ramifications of artificial insemination, and of switching heads of men and beasts45 (which in effect anticipated brain transplantation, not even mentioned in most or none of our current medical codes of conduct.)

It was only in the 20th century that Russian researchers made the first coarse scientific probes in this direction by successfully homotransplanting live heads between dogs64 and between frogs.47 These experiments were done despite the fact that no part of any medical code, of which I am aware, addresses the propriety of such conduct; and there certainly was not much discussion about future implications for humanity in the world's voluminous medical literature. History is replete with comparable daring, debatable, and often dangerous research in an ethical vacuum. It is time, indeed long overdue, to break the cowardly cycle by following the Talmudists' lead in codifying for resolute guidance as ethical principles---which can be higher than, but not above, the law12) the results of fearless, wide-ranging, and totally unbridled thought based on reason. And that codification, in turn, will be the unerring guide for the laws needed to reflect and protect the coeval attitudes of society,12,14,48now and in the future.

Critics condescend to admit that experiments involving the condemned might be of value, but only for short-term goals, and for that reason alone the step should perhaps be endorsed. If nothing else, the healthy bodies of condemned humans and animals offer otherwise wasted opportunities for perfection of surgical skill in heterotransplantation, either as training for neophytes or for investigating new techniques. Such limited experiments would be invaluable for elucidating the body's physiological and biomolecular mechanisms of xenograft acceptance and rejection, for finding new and better laboratory tests, and for enhancing efficiency of chemical intervention.

For the first time long and daring probes also would be possible as well as more fruitful. Obviously the condemned can be kept, with their permission, in a state of deep surgical anesthesia for days or weeks. That would simulate prolonged clinical death, and greatly extend the variable and normally very short interval between unconsciousness and final biological death when conventional means of execution are used. Because uninterrupted anesthesia is expensive and taxing, there is no reason why extant surgical and technological means cannot be used instead to induce a now permanent brain-dead state in the condemned's whose biologically live, anesthetized body could serve for well-planned and imaginative xenograft research performed leisurely, with decorum, and as long as necessary or desired. This kind of "organ bank" is the only practicable way to investigate, with repeated "withdrawals" of multiple organs from a single animal for heterotransplantation of multiple vital organs into a single human recipient.

Finally, In the Talmudic tradition I conjure another imaginative ramification to silence criticism of protracted anesthesia and artificial induction of a brain-dead condition. Why not reverse the xenografting, and transplant organs from the anesthetized

condemned human to one or many highly prized and perhaps needy primate recipients---especially if the species is threatened with extinction? The clinical course of the latter could be followed equally leisurely and without much added expense for any desired length of time.. No matter which direction the grafting takes, the resultant knowledge would be priceless and equally applicable for the benefit of humanity, of certain desirable and disappearing, as well as of the consequently emerging new field of theriatric research.

IV. Summary evaluation of factors (The Indictment re Phototaxis)

To make sure that no relevant detail is overlooked, a concise and fairly quantitative summary of aspects important for the elucidation of an ethical code of conduct regarding xenograft research would seem to be in order---in the form of a sort of "arithmetics" or "mathematics" anticipated by another "point scale of morality."9 The arbitrary but surely reasonable evaluations are summarized in Table I, using a scale of from zero to three. A higher number denotes better advantage, greater degree, more correct, or more justified

relative to xenografting and its implied research.

The final tally in Table I, arrived at through fair assessment, tells the whole

story. It reinforces what the foregoing discussion would certify; namely, that using therapeutic grafts from animals to humans (sum of 14 points) is less sensible when superb homografts are available from condemned humans (21 points); and that for xenograft research it is better to use a combination of condemned humans and animals (14 + 8 = 22 points) than the current combination of patients and animals (13 + 8 = 21 points).

Comments

The question of the scope or limits of such research seems to evoke a befuddled and somewhat panicky mind merely confounds the legitimate bounds of research on a patient with the legitimately unrestricted research on a criminal being executed. Through emotional imputation, nothing but wanton mayhem is seen in any kind of experiment on such criminals, no matter how simple or non-invasive. Such a state of mind would label a thoracotomy on a condemned man to procure his heart and lungs together as grotesque butchery on par with that of Nazi physicians, whereas a similar or even more gaping thoracotomy for the same multi-organ implantation in a patient is deemed to be highly laudable by the same impassioned mentality.

The fault lies in failure to differentiate between the morality of an act and that of the circumstances associated with the act. It was the latter which made the medical research in the concentration camps flagrantly immoral and downright criminal. Medical experimentation is, and always was and will be absolutely moral. The Nazi doctors were convicted and hanged, nor because of what they did, but rather because of how they did it. Had the "how" been ethically correct, there would have been no question of crime, simply because, in view of the potentially excruciating and mutilating experiments planned without the prospect of anesthesia, most likely none of the "condemned" concentration camp victims would have consented freely. But especially because valid peacetime laws ban all such condemnations anyway, there would be nobody left to experiment upon.

Nazi physicians were not the first to commit such medical crimes, nor will theirs be the last if the medical profession does not soon resurrect and solidify a truly comprehensive bioethical structure. Recorded sporadic instances of equally vile experimentation antedate the Nazi era. But the sheer scope, temporal proximity, and spectacular historical setting of the Nazi example understandably concentrated humanity's attention and wrath on it29. Nevertheless, some of the blame lies with the medical community of the whole world.51 It is incredible that much of what was later adjudicated to be criminal behavior was being acknowledged before the war with little protest, and with somewhat uneasy but polite approbation through silence on many contemporaneous reports of such research in reputable medical journals published in Europe and the U.S.52 One of the leading European doctors involved in the wartime experiments had even been invited in 1939 to present some of the fascinating details of his methods and findings at an august medical meeting in England.52

Docile tolerance at the time might better be understood in light of a tacit attitude openly expressed by a highly esteemed anthropologist at Harvard University in1936: "I do not claim to speak for all physical anthropologists, many of whom are either too wise or too timid to speak at all upon this subject...and run the risk of being pelted by the rabble...For myself, I...intend to assert bluntly and simply what I believe to be the best consensus of scientific anthropological opinion upon what races are and what they connote." After confirming that races cannot be categorized as superior or inferior on the basis of physical features or mentality, he concluded that "...this nation (the U.S.) requires a biological purge if it is to check the growing numbers of the physically inferior, the mentally ineffective, and the antisocial. These elements which make for social disintegration are drawn from no one race or ethnic stock."53 Note that the only real difference between this opinion and that of the Nazis was the latter's arbitrarily biased attribution of the listed traits to specific races and nations. Although "ethical" then in their own setting, a few years later and a few thousand miles distant, the anthropologist's honestly blunt but inflammatory words would have been unethical

enough to constitute conspiracy in "crimes against humanity"---and perhaps unethical enough to hang him.

Much of the blame for these terrible transgressions is a result of the medical profession's enduring ethical deficiency, which found suitable conditions most favorable in Nazi Germany for the florid explosion of its most lethal symptoms. But a generalized, essentially "subclinical" condition still smolders. Shockingly unethical research on a large scale was conducted in the U.S. during and even after the drafting of the Nuremberg Code.54 Obvious symptoms surfaced again more recently when some otherwise respectable journal editors declared that they would reject any article containing references to results of the criminal Nazi experiments.55 In thus having desecrated the only memorial gesture worthy of the involuntary sacrifice of the Nazis' victims,56,57 the misguided editors implied that the mere documentation of all aspects of an immoral act is as immoral as the act itself, fearing, doubtlessly, that documentation and culling useful tidbits of information therefrom would tend to condone the crime and its having been committed. As self-styled arbiters of what is or is not ethical to publish, our own emotionally biased journal editors faithfully emulated those benighted Nazi editors who forbade medical students in Germany from citing Jewish sources in their doctoral dissertations.55 It is this kind of purely emotional and quasi-"legalistic" nonsense which helped to subvert medical rationality of German physicians and to make the Nazi debacle inevitable.

Curative bioethical therapy requires much more than vacuous Hippocratic nostalgia. The medical profession had better take the lead in making sure that criminal human experimentation is never again contemplated, let alone attempted or performed. That heavy responsibility calls for courageous promulgation of highly imaginative thought4,14 free of any unjustifiably stifling imposed and irrelevant sectarian taboos, and from which can be extracted the long overdue, stringent, comprehensive code of medical behavior commensurate with the heavy demands of our space and time today and for the foreseeable future33. Because any parochial code almost certainly will be willfully violated,14 especially during the chaos of war, the creators of such a code must strive to abbreviate its desultory evolutionary course from birth to criminal law.9,14

V. The Moral Infraction (Verdict)

It is categorically unethical to disregard the irresoluble question of animal autonomy and to wantonly sacrifice innocent mute animals in order to obtain (i.e., steal) xenografts for therapeutic implantation into human recipients, while at the same time disregarding the clearly determinable autonomy of condemned humans who owe society a massive debt, and who want and need to donate any an all superior species-specific homografts otherwise doomed to senseless destruction, thereby making xenografting artificially seem to be desirable and necessary.

Furthermore, it is unquestionably immoral for the medical profession to ignore, as though they do not exist, healthy condemned humans eager to atone by serving as optimal subjects for now theoretically restricted and currently impossible human trials, and instead to compel debilitated human patients to serve as less than optimal subjects in trials of necessarily limited scope, and thereby to assume all the risks associated with daring research into totally unexplored realms.

Table I

Arbitrary quantitative assessment of aspects related to aspects of xenograft research

Need: Doubtless for patient (3 points)

A sense of atonement for the condemned (1 point)

None, as yet, for animals (0)

Consent: Informed & freely exercised autonomy for patient (3 points)

Same for the condemned (3 points)

Moot animal autonomy, arbitrarily overruled49.50 (0)

Benefit: Great for humans (3 points)

Minimal for condemned (0-see "Need"), for humanity (1)

For individual animal (0); for its species (1)

Cost: Surgery for patient (2 points)

Incarceration & surgery for condemned (3)

Care of donor animal & surgery (3)

Prospect of Success: Guarded for patient (1 point)

Irrelevant for condemned (0)

Irrelevant for animal (0)

Pace of research progress: Slow if only patients involved (0)

Most rapid if condemned involved (3)

Dependent upon donor species (1)

Scope or Limits: Restricted for patient (1 point)

None for condemned (3)

None for animal (3)

TOTALS: Patient (13)

Condemned (14)

Donor animal (8)

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2. Hickey, JB: Euthanasia 1984, Med. J. Austral., 1984, 140,141.

3. Anonymous: Amer. College of Physicians Ethics Manual, Part I: History of

Medical Ethics, Annals Int. Med., 1984, 101, 129-1

4. McIntyre, N, & Popper, K: The Critical Attitude in Medicine. Brit. Med. J., 287:

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6. Anonymous: Current Opinions of the Judicial Council of the A.M.A., 1981,

vii,viii, 1-9.

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1947, 39, 149, 218, 438.

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JAMA, 254:1985, 3353-3357.

17.Overcast JD, Evans RW, Bowen LE, et al.: Problems in the Identification of

potential Organ Donors, JAMA, 251:1984,1559-1562.

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Police Science, 50:1959, 50-51.

21. Anonymous: A Condemned Man's Last Wish, Hastings Center Report, 1979, 16.

22. Kevorkian J: Dr. Guillotin's Example, MD, Oct.1985, 26-28.

23. Kevorkian J: A Brief History of Experimentation on Condemned & Executed

Humans, J. National Med. Assn., 77:1985, 215-226.

24. Falloppii G: Medici Nostra Tempestate Clarissimi, Libelli Duo, Alter de

Tumoribus Praeter Naturam. Venetijs: Donatum Bertellum, 48:1563.

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Schuman, NY, 1949, 100-102.

26..Strong RP: Vaccinations Against Plague. Philipp. J. Sci, 1:1906,181-190.

27. Strong RP& Crowell BC: The Etiology of Breiberi, Philipp. J. Sci., :1912, 271-

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32. Zeik M: Commentary. Hastings Ctr. Report, Feb. 1979, 17.

33. Kevorkian J: A Comprehensive Bioethical Code for Medical Exploitation of

Humans Facing Imminent and Unavoidable Death, Med. Law, 1986, 181-197.

34. Fletcher J: Situation Ethics. The Westminster Press, Philadelphia, 1966, 18-46.

35. Gillon R: "Primum non nocore" & the Principle of Non-malfeasance. Brit.M.ed.J,

291:1985, 130-1.

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Hemithorax, Alone or Associated with an Isolated Heart, Arch. Inst. Cardiol.

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Canad.Med.Assn.J., 133:1985, 1169-71.

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1984, 5-7.

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Interviews with Three Prisoners on San Quentin's Death Row and

A Signed Petition from 25 Other Condemned Inmates

At my request I was kindly granted permission by Warden Daniel Vasquez to conduct the personal interviews on Monday, 23 April 1984, with death row inmates of his selection. I planned to present results of the interviews, which began at 11:15 am, and ended at 12:50 pm, at a California Senate Committee hearing on a bill to implement my suggestion (later withdrawn). Interviews took place in a large, pleasant wood-paneled conference room in the prison's Administration Bldg. A preliminary prior 15 minute discussion with the Warden was held in his office in the presence of his aide, Ms. Hubbard. The conference room was nicely but sparsely furnished, except for empty chairs and a large table upon which were a pen and a note pad for me to record a few details. All prisoners remained anonymous and were interviewed alone.

The First Condemned Man, Caucasian, appeared to be younger than his stated age of 44. He answered with an emphatic "Yes!" when asked whether or not he would prefer to have a choice between dying in the gas chamber or under surgical anesthesia for organ donation of for experimentation on his living body. I hadn't known that this man was active with legal personnel trying to persuade the Stanford University organ transplant surgery department to make use of his organs at the time of his execution; and he plans to continue to do so in order to avoid what he insists is a waste of life. He places no limits on the procurement of any of his organs; and likewise, no limits on the potential medical experiments, including in-depth probes of his brain which may be performed on his anesthetized body, including trials of new drugs for their physiological effects and their lethal doses. He had prior experience with intravenous amytal (a barbiturate) without any adverse or unpleasant effects through induction. His previous surgical history included seven operations on the knee, one on the thumb. When asked if considerations of his own family, of his victim's life or his victim's family played any part in his opinion or choice on this topic, he replied, "absolutely none". Near the end of the interview he stated that he is well known among other prisoners and knows what is going on among them, and that many of the non-condemned inmates sincerely prefer death to long-term incarceration in their current circumstances--and would also approve of my proposed choice.

The Second Condemned Man, Caucasian also appeared to be somewhat younger than his age of 40. His only previous surgical experience was a tonsillectomy without intravenous barbiturates. He endorsed my proposal, but only for organ donation, because "there are many people in need, and that way I wouldn't be dying in vain. He would place no limits on organ procurement, but would limit medical experimentation only to the brain. He believes that his own family would feel better if he donated organs, because that would help the public at large; but the victim and the victim's family played no part in the formulation of his opinion on my proposal. At the end of the interview he advised me to convince the public and motivate them to petition legislators and pressure them to get the laws changed—and to bring along one or more legislators on future interviews with condemned men.

The third Condemned Man, age 27, a light-skinned Black man who appeared to be slightly depressed (the reason for that emerged later.) He also answered to my proposal with an emphatic "Yes!" His only prior surgery was tonsillectomy under ether anesthesia. He would place no limits on organ procurement because "people need them desperately, limits and "no on any kind of experimentation, because there's a great need

for research; and it could possibly save many lives." Similarly, "in that way I wouldn't be dying in vain." And also "I would put no limits on any kind of experiment because there's a great for research, and it could possibly save many lives." He stated that his own family agrees with and supports his opinions, and that his concern over the life of his victim did indeed play a role in their formulation. He also felt that his victim's family, too, (which he hinted was somehow involved in the crime itself) would endorse his (the inmate's) opinion regarding my proposal. Near the end of the interview he spontaneously volunteered the following thoughts and comments: that he preferred death to his present situation; that it is a rare pleasure for him to experience this very quiet and serene atmosphere of a private personal interview, even if for just a few minutes, and away from the very irritating and unrelenting noise of his prison environment; that he laments the seeming unfairness of his tragic fate, being thus condemned to die among brutal men when he never before had been in trouble or imprisoned; that he prefers a useful death to imprisonment without parole; that those who oppose my proposal because they oppose the death penalty and say that he's barbaric are wrong and do not help him; and that he had already explored the possibility of donating organs before this interview. Finally, he said that his decision is freely given, and not somehow "involuntary," as opponents of capital punishment continually argue.

The Petition

Almost three months later, in July, 1984, I sent the following to the condemned inmates in San Quentin's death row:

As we, the condemned population of California's San Quentin Prison, know, there is a new method called "lethal injection," that could be used for execution instead of the gas chamber.

A person who is executed by that new method would be able to donate any part of his body to save the lives of others in need of organs, whereas inmates executed by lethal gas would not be able to donate any part of his body to save another.

If you think that any condemned prisoner should have the right to choose which method should be used in the event that he must be executed and wishes to donate all his bodily organs for transplantation, please sign your name below. The following signed:

Adcox, Keith E., C-69600

Beardslee (sp?), C-82702

Bettcher (sp?), C-28400

Bigelow, Jerry, 5-C-3

Bonin, Wm. G., C-44600

Clark, Douglas, C-63000

Frank, Theodore F., C-13300

Fuller, Ronald E., C-25143

Griffin, Donald, C-23900

Harris, Robt., A,B-88663

Hamilton, Michael A., C-58200

Harris, Robt., A,B-88663

Hay, Richard Adams, C-04358

Howard, Gary Lee, Sr.,

Hunter, Michael Wayne, C-83600

Jennings, Michael Wayne

Leach, Mike, C-19000

Lucero, Phillip, 5-C-16

Massie, Robt. L., A-9159

Mattson, Mitchell, C-15604

McLain, Robt. C., C-30800

Memro, Harold R., C-12600

Odle, James R., C-71400 Pensinger, Brett P., C-54200

Phillips, R. (sp?), C-13707

Thompson, Robt. J., C-78000

Wade, Melvin M., C-48200

Condemned Men in Several States with whom I've Corresponded

Columbus, Ohio: Richard Rutherford, my first death row interview, Oct. 1958.

San Quentin, California: Melton, James, San Quentin, B-37187.

Jackson,Georgia: Mincey, Mitchell, Terry and Spivey, Ronald.

Angola, Louisiana: John Thompson, 110439.

McAlester, Oklahoma: Richard Norman Rojem, Jr., 146688.

Graterford, Pennsylvania: Roger Buehl, AM 7936.

Huntsville, Texas: Jonathan Wayne Nobles.

Opinions of the Noted Historian, Dr. Arnold Toynbee

(From: Choose Life. Oxford Univ. Press 1989, 161-169)

There are, however, cases in which there is no longer any hope, though there is still life. In such instances, when the person is compos mentis, I hold that a well-considered wish to die ought not to be thwarted.

If he prefers to commit suicide, I hold, most decidedly, that no attempt ought to be made to prevent him.

It is possible to commit suicide only surreptitiously, by stealth. This seems to me to be inhumane and also to be a violation of human dignity. Supposing that I myself had taken a well-considered decision to commit suicide, I should certainly feel it outrageous that I should be able to do this only by deliberately deceiving other people.

I hold that suicide is legitimate, and that to put obstacles in the way of it is very wrong. The prolongation of life by human action, as well as the cutting short of life by human action, would be an offense against God if it were true that God alone has the right to decree the length of time for which a human being is to live.

Christian practice has been inconsistent with Christian theory. (Christian Scientists are unique among Christians in forbidding their adherents to seek medical aid.)

I myself was brought up as a Christian, but I was educated in pre-Christian Greek and Roman literature and history, and my non-Christian education has had more influence on me than my ancestral Christian religion. The pre-Christian Greeks and Romans had no taboo against committing suicide. They held that freedom to commit suicide was one of the basic human rights. They also held that there were situations in which suicide was the only course that was consistent with the preservation of a person's human dignity, and people who committed suicide in these circumstances were highly honored. For instance, the Greek philosopher Democritus was honored not only for his intellectual achievements but also for his refusal to go on living when he had become aware that his mental powers were failing. Democritus is said to have committed suicide by deliberately starving himself to death. Cato, one of Julius Caesar's political opponents, committed suicide rather than fall under Caesar's unconstitutional and dictatorial rule, imposed by military force. Thanks to the glory that he won by committing suicide for the sake of his human dignity, he became posthumously, for the next century and a half, the most formidable opponent of the Caesarian autocratic Roman imperial regime. Many modern Westerners, including me, have supposed that the pre-Christian Greeks' and Romans' approbation of suicide for the sake of maintaining human dignity has also been the attitude towards suicide in India and Eastern Asia in all ages.

Review of My First Book on this Topic by the A.M.A.

Kevorkian, Jack: Medical Research and the Death Penalty. A Dialogue, Vantage Press,

Inc., NY. 1960.

The author argues that a condemned prisoner should be able to choose anesthesia from which he would never awaken (for the purpose of medical experimentation to be subsequently performed) as a method of execution. Whereas he does not discuss the merits of capital punishment, he asserts that, since it is used, the use of anesthesia would result in a more pleasant death for the condemned. This would also be of great benefit in medical research and, in turn, of great benefit to society (emphasis added). The material is presented in the form of a debate. The author assumes the role of the protagonist, while the antagonist is representative of newspaper articles, personal letters, and private communications.

The author believes that some of the merits of using anesthesia as a form of execution are as follows: It is a relatively more pleasant way to die than by the electric chair, the gas chamber, or hanging. The condemned would then be in a state of "clinical death, a term meaning that part of non-existence which is characterized by the possibility of being resuscitated". He could remain in this state for hours, days, or weeks, depending on the experiment. Much knowledge could be gained by such experimentation on live persons. The execution of a human being would not be entirely without gain. The condemned would be, perhaps, paying his debt to society, and society in the long run, could benefit from the research that would be possible. The condemned man cannot satisfactorily pay society by involuntarily losing his life; death by anesthesia, making research possible, gives him a chance for restitution. The choice would always be the prisoner's, and a survey has shown that many are for the idea.

The antagonist, on the other hand, believes that the use of anesthesia as a form of execution would be harmful as it might encourage more recommendations of capital punishment. The most conscientious physicians will oppose the plan as ethically he is bound to the proposition that human life should never be taken; the physician would become part an executioner. It will be harder to abolish capital punishment if the benefits derived from it seem worthwhile, as they might be from great medical experimentation. The condemned man might acquire an aura of saintliness. This would defeat the purpose of capital punishment and extol the transgressors.

One point that is not covered in this book is just how valuable medical research would be on a person who could not be resuscitated, and whose recovery and conditions could not be checked. Could such experiments as those performed on the brain, for instance, (a field which the author mentions) be judged accurately? How worthwhile would such experiments be? More could have been mentioned on specific gains from such research.

The discussion is presented in a concise manner, and the antagonist raises many questions that might be anticipated by the reader. Readership should appeal to others as well as to persons in the field of medicine as the problem is one for society as a whole.

The book provides incentive for further research on the possibility of the use of anesthesia as a means of execution (emphasis added).

(Review by Mary Ann Rosenfeld, in: JAMA, vol, 174, no. 10, Oct. 1960, p. 1351)

(The following group was formed in Southfield, MI, in 1995, and its members included an American board-certified psychiatrist (as our first official spokesman) and five other physicians, including a Muslim (nephrologist and pain specialist), a Jew (board-certified internist), an African-American (a general practitioner), a general surgeon (of Greek parents), and me, a pathologist (of Armenian parents.) Its creation received fair notice in the press as well as a favorable endorsement from one academic ethicist,--but no support from the profession at large to keep it going.

Physicians for Mercy

Declaration of Principles

As members of the medical profession, we have an enduring commitment to the health, safety, and welfare of our patients and of the public in general; and do hereby set forth the following guiding principles:

1. It is the natural right of every human being not to suffer involuntarily and

needlessly.

2. It is the obligation of physicians and other members of the medical profession not

only to simply prolong life, but also to ensure, to the best of their ability, that

persons entrusted to their care remain as free as is possible from irremediable,

agonizing pain inflicted upon them through biological or physical causes.

3. Mentally competent adult human beings have the natural right to request

consultation with competent and qualified medical personnel with regard to the

point at which further suffering should be terminated.

4. Qualified physicians have the obligation to establish, by consensus, a protocol

encompassing the guidelines according to which they would have the authority

to end an individual's irremediable suffering under the appropriate designated

circumstances, through merely indirect assistance to end the afflicted patient's

life, or by direct action to accomplish it humanely, painlessly, and quickly.

5. The rights mentioned above are congenital by nature, and were validated by

the Founders of our Constitution who incorporated them in the Ninth

amendment. Therefore, any unconstitutional jurisprudential decree or statute

which would bar or penalize a physician from performing his merciful and

rightful duty by ending a patient's irremediable agony would in effect not only

infringe the highest law of our land, but also affront its natural basis.

.

(The following is another of my unpublished articles)

Execution Worthy of Man

Contrary to popular misconception the trend toward the use of more humane methods for executing persons condemned to death is neither new nor unidirectional. It merely represents another of those frequent reversals of history, this time away from the ugly retrogression fostered by the Dark Ages. And we're not entirely free from it yet

Among the many cruel means for execution in ancient Greece and Rome was the benevolent exception of the use of carbon monoxide (CO).29 This bit of compassion was irrelevant to the misguided fanaticism of the Middle Ages which sought to assuage outraged morality by even exceeding the Roman penchant for head-down crucifixion through the brutality of stoning, burning, flensing, and shredding humans to excruciating death. The incredible savagery began to abate with the introduction of a new contraption designed to facilitate the slaughter of the French Revolution. Despite its intent for an ostensibly "quick and painless" decapitation, the device named after the unfortunate Dr. Guillotin (who did not invent it but endorsed its use through naïve altruism) was to become the symbol of terrible grotesqueness.28 Almost a century later a commission of physicians in the U.S. designated electrocution to be more humane than lethal doses of chemicals such as chloroform, morphine, and even cyanide.9 However, the latter gained acceptance in the early 20th century. Finally, the drive for compassion culminated with the adoption by several states of lethal injection of Pentothal (thiopental, TP).

But let's not forget that hanging is still in use, and that any trend is a two-way affair. With understandable bias ours is claimed to be the most highly developed society in history. That may be less arguable only from a materialistic rather than from a philosophical, moral, or spiritual point of view. Short-sighted altruists blithely dismiss the overpowering fact that in a little over one generation this century has witnessed the two most devastating "world" wars in history, and the two most thoroughly planned and efficiently executed genocides. It can be a painful mistake to assume that brutal methods will never again be used for executions in civilized societies, and that capital punishment itself is headed irreversibly toward permanent oblivion. After all, it is one of those human inventions distilled from a complex mixture of social, political, economic, and religious factors which always change with time and defy accurate prognostication. There always have been, and most likely always will be, equally sincere and intelligent advocates for and against the death penalty. At any given time the majority argument usually prevails, as it has in the U.S. intermittently. In view of all this, the only rational action is to validate our vociferous claim to superior civility by insisting that at least in our time all condemned humans be put to death by the most humane means known.

And what would that be? Of all thus far conceived or used, only two stand out today as equal candidates: an ultra-fast acting sedative solution of TP injected intravenously as a lethal dose mixed with a couple of ameliorating chemicals to paralyze breathing and the heart of a dying person; and secondly, concentrated colorless, odorless, and tasteless carbon monoxide (CO) gas inhaled in lethal amounts. Minimal agony attendant death by either agent is verified by the experience of millions of patients who have undergone major surgery under anesthesia initially induced by the former, and by the strong inference that fatal poisoning by the latter is not enough to annoy even a sleeping subject. But which of the two is best overall?

A quantitative assessment is summarized in Table I. Hydrogen cyanide gas (HC) is included, since heretofore it was generally considered to be the optimal means. Because the three agents are being compared in connection with a distasteful purpose, a negative minus signs, the better or more advantageous. Maximal advantage is signified by zero. Complete objectivity is, of course, out of the question for this kind of arbitrary study, since evaluation of some points of necessity depends exclusively on common sense, experience, and subjective extrapolation from very indirect data. Obviously a truly scientific experimental design of the hallowed "double-blind" type involving a small, heterogeneous coterie of condemned human beings is not possible.

As far as logistics or ease of performance is concerned, TP requires the least amount and manipulation of materials, and the least effort in accommodating the subject. The only necessities are a syringe with attached needle and filled with the lethal solution, a flexible tourniquet, and a simple table or chair. CO would mandate use of a tight-fitting facial mask connected by suitable flexible tubing to a steel gas-storage cylinder, and a stretcher or cot for the recumbent subject. HC calls for an elaborate and very expensive air-tight chamber with a built-in chair under which the lethal chemical reaction produces the HC gas. For each of the three methods the ease of performance of execution is inversely proportional to the complexity of the above material requirements. For example, execution with HC requires the most materials and is the least convenient to perform.

Many of the current lethal injection laws stipulate the simultaneous injection of other chemicals to supplement the action of TP, such as muscle relaxants and cardiolplegics.9 This essentially superfluous medley is a result of the mistaken notion that the physical state of a body undergoing execution by TP is identical to that of a body undergoing induction of surgical anesthesia with TP. It is true that muscle relaxants are often, but not always, necessary to assure optimal tranquility of a lightly anesthetized surgical patient16, but that consideration is nullified by the extremely rapid and profound depressive effect of a lethal bolus of TP which would even negate the clinically dangerous laryngospasm of parasympathetic nervous imbalance known to accompany routine TP induction for surgery.17 The rapidity of cardiovascular collapse and ensuing death after lethal TP injection makes the use of KCl solution to stop the heart of no real

value. A massive intravenous dose of TP alone is enough.

Some opponents of capital punishment complain that TP for lethal injection represents misuse of an agent specifically designated as a medicament.23 But does this constitute an infraction beyond the accepted use of antibiotics or hormones in domesticated animal to fatten the yields (and profits) of the meat and poultry industries? In fairness the critics should also indict theriatricians who "put down" doomed animals with intravenous injections of sodium pentobarbital; solution26---surely not a "medical" purpose. And how about the use in humans of anesthetic agents for purely elective cosmetic surgery?26 Or to facilitate the "execution" (euphemistically called an abortion) of an unfortunate fetus which just happened to be the wrong sex? If the misguided critics still insist that such use in the latter examples is legitimate for the amelioration of psychological duress resulting from the questionable feminine concern over a less than attractive flat chest, or from the disappointing fruit of unbridled passion, would they dare insist that the use of the same ameliorating means for the indubitably real psychological burden of an individual facing total and meaningless personal extinction is any less legitimate? Hardly likely!

Intravenous TP is the most rapid acting of the three agents. An adequate dose will produce tranquil and complete unconsciousness well within 10-15 seconds.22 Observations during execution in the gas chamber reveal that as a rule the effects of HC become apparent within one minute, and death ensues in three to five minutes. I am not aware of any reported death due to direct inhalation of 100% CO concentration, but it is reasonable to assume that the time required for such an execution would at least equal the interval for HC. In any case, there can be no doubt about the significant difference in speed of effect between intravenous TP and the inhaled gases.

The only real drawback with TP executions is the necessity of a truly skilled and experienced phlebotomist to administer the injection. True morality, compassion, and common sense would demand that the procedure be entrusted to those, medical or lay, having the greatest competence, which in most instances means physicians themselves or their highly skilled technologists. Unfortunately authoritative and dictatorial medical organizations have denounced and prohibited physician participation in lethal injection4; and although they strongly and deceitfully deny such action to be unethical, they stop short of branding it a censurable offense. Their stance is ultimately indefensible, and only serves to calm the ambivalent emotionalism of those physicians who intimidate or even threaten with loss of licensure colleagues willing and extremely able to perform the injections.7 On the other hand, execution with HC or CO is less demanding of special skills and is within the capability of any normal layman.

Disadvantages are reversed when considering ease of performance. In addition to the necessity of restraining a subject in the gas chamber, special care is required in sealing it against leaks, in starting the lethal HC chemical reaction under the seated subject, and in evacuating the chamber of all traces of HC gas at the end of the procedure. Because TP is so fast, generally there really is no need for any restraints or special concern once the injection is completed. However, CO takes more time, and restraining straps or sheets sometimes would probably be necessary. Also, the integrity of the mechanical set-up of tank, tube, and mask would require close monitoring of the entire procedure, a factor of less concern if some kind of CO-chamber is devised and used.

Safety of the immediate environment must also be considered. TP is absolutely no threat to any person or thing, no matter how sloppily it's handled. CO, too, is relatively safe with reasonable alertness for possible leaks. Evidence from well-documented studies on workers in heavy vehicular traffic and in tunnels21 indicates that even small leaks of CO in a well-aerated room would not constitute a significant danger to life or health. This factor is not involved in the use of a well constructed chamber for the deadlier HC gas. Leaks of the latter can be detected by its tell-tale odor of bitter almonds, whereas CO is beyond detection by any human sense organ. TP is the unquestionable choice here.

The same is true from an aesthetic standpoint, that is, what an onlooker might observe during an execution. Reactions of the subjects could be guessed at fairly accurately from knowledge of the basic pharmacological properties of the three agents. Extensive laboratory and clinical experience with TP leaves no doubt about its superiority for the induction of a deep, coma-like state.22 On the other hand, inhalation of the deadly gases usually produces antecedent physical signs. Whereas individuals who regain consciousness after accidental CO intoxication while asleep may recall nothing other than the nothingness of dreamless sleep, others poisoned with CO while awake usually complain of mild dizziness and headache before lapsing into unconsciousness.21 In the HC gas chamber, inmates have been observed to gasp, twitch, writhe, and struggle. The lethal effects of HC were dramatically demonstrated to us in medical school. I recall vividly the violent convulsions of a rabbit about 45 seconds after having been given a lethal dose by gastric tube of a sodium cyanide solution,--and the cyanide effect is much faster as HC gas. In sharp contrast, years ago I witnessed the "putting-down" of a cancerous cat using intravenous and slower-acting pentobarbital solution. With eyes wide open, the animal almost imperceptibly went limp within four seconds, without a twitch, gasp or sigh.

In fairness, one minor observable advantage of the gases should be pointed out: the generally pleasing, almost life-like, even pinkish postmortem complexion in some light-skinned subjects. In the case of HC it is due to the engorgement of veins with bright red blood saturated with oxygen, which the poisoned tissue cells cannot utilize.1 A similar appearance after CO poisoning results from the very high concentration of postmortem cherry-red carboxyhemoglobin in vessels of the skin and mucous membranes.21 In live victims of CO that color is often obscured by the pronounced cyanosis and pallor of extreme anoxia, signs which also may characterize the less agreeable skin color after death by barbiturate overdose.

Physiological responses to predictable pharmacological actions engender objective states which are beyond measurement. The gases kill essentially by internal asphyxiation, rendering inhaled oxygen inaccessible to, or unusable by, cells of tissues and organs. In the red blood cells the ability of oxygen to combine with hemoglobin is 10 times that of CO, but dissociation of the former proceeds 2,200 times faster. Therefore the affinity of CO for hemoglobin is 220 times stronger than that of oxygen.21 Furthermore, CO inhibits the dissociation of oxyhemoglobin and thereby reduces accessibility to the body's cells of the available oxygen.21And only negligible amounts can be dissolved in plasma. The net result is a kind of extracellular asphyxiation of tissues. The lethal block is a step farther, in the cells proper in the case of HC which has a high affinity for any chemical constituent having trivalent iron (Fe II).2 Almost all the iron in hemoglobin is in the reduced (Fe I) form, therefore immune to the attack of HC and capable of delivering oxygen to cells. However, the key cytochrome oxidase enzymes which facilitate the use of oxygen for energy production within the mitochondria of cells contain Fe II and are rapidly inactivated by HC to stop all energy reactions through otherwise intact mechanisms.2 This is intracellular asphyxiation.

HC really acts in a more complicated two-step process by first becoming attached to protein (albumin) before passing on to bind with the cytochrome oxydases.28 Because most of the data on the binding has been obtained from in-vitro laboratory experiments, they may not correlate with what actually takes place in a living body.28 HC also binds readily with other crucial enzymes containing molybdenum, zinc, and copper to broaden and further complicate its role in the mechanism of death.

In the final analysis, the symptoms caused by massive doses of HC or CO are those of hypoxia. The weakness and dizziness due to high concentrations of CO mentioned earlier may, on occasion, not occur.21 Carboxyhemoglobin concentration of 30-50% leads to peripheral dilation of vessels and to faster heart and respiratory rates. Intermittent convulsions may ensue when the concentration reaches 50-60%, followed by severely depressed heart and lung function at 60-70%, and inevitable death when it surpasses 70%.21

HC is especially dangerous, because lethal amounts are very rapidly absorbed into the blood stream when inhaled.2 Both the cardiovascular (CV) and central nervous (CNS) systems are especially sensitive to HC, the brain exquisitely so.28 A concentration of only 0.2-0.3 mg of HC per liter of inspired air (or 200-300 ppm) will kill rapidly by asphyxia due to poisoning of the CNS and its bulbar respiratory center.1 A massive dose usually produces so-called apoplectic death during which the victim convulses and cries out loudly before falling unconscious.2 For a brief period all electrical activity in the brain disappears, but very soon reappears with markedly depressed amplitude. The heart also shows depressed amplitude on the electrocardiograph (ECG), but it keeps beating after the brain finally becomes electrically "silent."28

From a subjective standpoint, TP is by far superior. It is one of the "ultra-fast- acting" barbiturate drugs which in relatively low doses act as hypnotics in producing a pleasant state of drowsiness.8 In increasingly larger doses they become sedatives which put subjects into a state resembling normal sleep, followed by deep anesthesia, then toxic coma, and finally death.15 Speed and duration of action of barbiturates are directly proportional to the degree of their lipid solubility. TP is 11 times more soluble than secobarbital of the merely "fast-acting" group.15A single intravenous TP dose of 3.5-4.0 mg per kilogram of body weight brings on unconsciousness in 10 seconds, and a brief sub-lethal dose, 90% of the TP is removed from the blood as it passes through highly vascular organs such as brain, heart, and liver.8 Due to minimal dissociation and to extensive plasma binding, only negligible amounts of TP are excreted by the kidneys. Its high solubility/partition coefficient ratio enables TP to cross the blood-brain barrier quickly and easily either way. The major part of the dose received by the brain is very soon redistributed via the blood stream to other less vascular tissues like muscle, to end up in the storage of avascular fatty deposits which thereby permit early recovery from a single sub-lethal dose.8 Constriction of vessels in the brain and the heart tends to delay this sequence and to prolong depression of those organs.22 The larger the initial dose of TP, the higher its plasma and brain concentrations at which consciousness returns (accounting for so-called acute tolerance.)8 Therefore, a lethal dose must be big enough to cause metabolic inactivation, mainly in the liver, less in the brain, and not at all in muscle, at a rate of 10-15% per hour, too slow to be of consequence in this regard.22 In view of all its other advantages, TP is the ideal agent as far as potential biological damage is concerned. Despite its potent pharmacological action, there is no evidence that a single lethal intravenous dose of TP, competently administered, will result in identifiable cellular or tissue injury. However, although TP itself is a weak acid, a 2.5% solution of its sodium salt is quite alkaline (pH 10) and can be a severe irritant if handled carelessly.12 Anyone responsible for injection of the lethal dose must have the utmost skill, and this represents the only criterion on which TP falls short of the gases as the best means of execution. Leakage of TP into subcutaneous tissues, or its accidental injection into an artery causes excruciating pain.12 Only in the hands of those less experienced and less well-trained than physicians would it be reasonable to expect the possibility of incompetence transforming this otherwise most humane execution into one of the cruelest. Despite their emotional reticence, there is no justifiable reason for physicians to refuse to perform the requisite flawless injections,19 especially when permitted do so.9

The anoxia resulting from the concentrations of HC and CO high enough to induce unconsciousness will necessarily result in tissue damage. This is especially true for brain and heart which are very vulnerable to oxygen deprivation. In cases of death from CO poisoning almost all organs reveal small foci of hemorrhage and necrosis.21 Changes in the brain caused by HC predominate in the white matter, consisting of demyelinization and more frequently of frank necrosis. These are considered to be a direct result of histotoxic anoxia rather than merely a secondary consequence of edema or altered neuronal function.28

This egregious advantage of TP is of extraordinary importance at a time when organ transplantation is almost routine surgical practice, and when the demand for organs will hopelessly outstrip supply for the foreseeable future.24 In striving to impart a modicum of positive significance to otherwise meaningless impending death, many condemned men plead to be allowed to donate their healthy organs during the process of execution by the conventional anesthetized surgical procedure.3,6,10,13,20 Currently there is an incipient campaign in the U.S. aimed at motivating state legislatures to modify their death penalty laws accordingly18,--to enable transplant teams to prepare comfortably for, and leisurely carry out, the life-saving procedures for the culling of robust organs from sturdy and often young adult bodies which must by law be destroyed, instead of having to depend upon strictly fortuitous organ procurement from "brain-dead" donors whose body parts may not have escaped the subtle ravages of fatal disease or trauma. In at least one state such a bill was actually drafted5, but antipathetic pressure from medical and correctional authorities forced its withdrawal before the scheduled committee hearing I had planned to attend.25

TP rightly belongs at the top of any list of desirable means for executing human beings. All its other superb features are capped by offering the only hope of transforming a totally negative death into a positive, truly priceless life-gift, setting the stage for a miraculous and hitherto impossible exchange of life and death.

Table I

Criteria CO HC TP

Materials -- ---- -

Cost -- ---- -

Speed ---- ----

Personnel - - ----

Performance -- --- -

Environment -- ---- 0

Objective Effects -- ---- -

Subjective Effects -- --- -

Biological Damage --- --- 0

TOTAL -20 -30

References

1. Arena JM: Cyanide. In Haddad IM, Winchester JF: Clinical Management of

Poisoning and Drug Overdose. WB Saunders Co., Philadelphia, 1983, 744-47.

2. Arena, JM: Poisoning, 4th ed., Chas. C. Thomas, Springfield, IL, 1979, 153-4.

3. Bishop A: Personal letter to author, Apr 1984.

4. Bolsen B: Strange bedfellows: death penalty and medicine. JAMA 248:1982, 518-9.

5. California Senate Bill No. 1968, 16 Feb 1984.

6. Carey J: Personal letter to author, Mar 1984.

7. Carrell B: Execution controversy faces physician. AMA News, 21 Jan 1983, 37.

8. Churchill-Davidson HC: A Practice of Anesthesia. WB Saunders, Philadelphia, 1979, 746-770.

9. Curran WJ, Casscells W: The ethics of participation in capital punishment by

intravenous drug injection. NEJM 302:1980, 226-30.

10. Davis F: Personal letter to author, Jan 1984.

11. Devlin MM: Execution by lethal injection and the role of the physician. JAMA 248,1982, 3031.

12. Dornette WHL: Legal Aspects of Anesthesia. FA Davis, Philadelphia, 1972, 303-9.

13. Evans J: A condemned man's last wish: organ donation and a "meaningful" death.

Hastings Center Report, Feb 1979, 16.

14. Gold AH: Mammary prostheses, in: Rubin LR: Biomaterials in Reconstructive

Surgery, CV Mosby, St Louis, 1983, 552-63.

15. Goth A: Medical Pharmacology, 10th ed. CV Mosby, St. Louis, 1981, 303-11.

16. Greene NM: Anesthesia, in: Schwartz SI, ed.: Principles of Surgery, 3rd ed.: McGraw

Hill, NY, 1979, 482-6.

17. Guerra F: Thiopental forever after, in: Aldrete JA, Stanley TH ,eds.: Trends in

Intravenous Anesthesia. Yearbook Med. Publ., 1980, 143-51.

18. Kevorkian J: Capital punishment or capital gain, J. Crim. Law, Criminol., Pol. Sci., 50: 1959, 50-1.

19. Kevorkian J: Medicine, ethics, and execution by lethal injection, Med Law, 4:1985, 307-313.

20. Kevorkian J: Personal interviews with three condemned men on death row in San

Quentin, CA, April 1984.

21. Klassen CD: Nonmetallic environmental intoxicants, in: Goodman & Gilman:

The Pharmacological Basis of Therapeutics. Macmillan, NY, 6th ed., 1980, 1641-3.

22. Kortilla K: Pharmacokinetics of intravenous nonnarcotic anesthetics, in: Aldrete JA,

Stanley TH,eds.:Trends in Intravenous Anesthesia.Yearbook Med. Pub.1980,13-21.

23. Kristovich S: Quoted in "Appeals Court puts lethal injection on hold", AMA News,

20 Oct 1983, 14.

24. Overcast JD, Evans RW, Bowen LE, et al: Problems in the identification of potential

organ donors. JAMA:251, 1984, 1559-62.

25. Pitts K: Letter to author, 20 Apr 1984.

26. Scott WN, Ray PM: Euthanasia, in: UFAW Handbook on the Care and Management

of Laboratory Animals. 5th ed., Churchill Livingstone, NY, 1976, 168.

27.Weiner DB: The real Dr. Guillotin. JAMA, 220:1972,.

28. Way JL: Cyanide intoxication and its method of antagonism. Ann Rev Pharmacol

Toxicol 24:1984, 451-81.

29; Youmans WB, Siebens AA: Respiration, in: Brobeck JR, ed.: Best & Taylor's

Phisiological Basis of Medical Practice, Williams & Wilkins, Baltimore, 9th ed.,

1973, 6

Apologia I

(My response to Circuit Court No. 90-390963 AZ)

Preliminary Order of Injunction

17 August 1990

Your Honor: I will present evidence to prove that all of the findings of this Court as set forth in the preliminary injunction are false and without rational justification.

The first charge states my willingness to continue using my device or some other modality to implement a "rational policy of planned death." That statement is misleading by being incomplete. In the first place, my willingness is conditioned primarily through a sense of obligation to patients who themselves deem their continued existence to be intolerable,--- an obligation which transcends anyone's merely personal and often maudlin sentiment or emotions. Secondly, a willingness and obligation not only to continue, but also to expand use of some such modality as a legitimate and honorable component of the armamentarium of ethically revitalized and thereby a more complete medical profession. Only by reinstituting and universally implementing this unique and long neglected medical service can the profession even begin to assume its rightful responsibility in promulgating and practicing a rational policy of planned death,---just as it eventually was compelled to do with its long neglected responsibility regarding a rational policy of planned birth.

The Court's second charge; namely, that the device can be quickly and easily acquired, assembled, and used, is only partially correct. The Court's subtly ulterior implication of uncontrolled use of such a device by anyone is misleading, because only duly qualified medical personnel are specially licensed to prescribe and use the necessary chemicals.

The third charge,--that publicity about my action and crusade may attract others interested in committing suicide--is improper, irrelevant and immaterial. That's like saying that publicity about a heart transplant surgeon's actions may attract others interested in having a heart transplanted, whether or not justified. What the Court omits here is the key word need. No matter who is interested, the only potential candidates are those who are interested and who need it; and that decision is the sole responsibility of patients and the duty of medical doctors and surgeons. This charge is merely obfuscating conjecture on the part of the Court. From my actual experience of having been the only physician to openly offer and practice the euthanasia of medically-assisted suicide, I can offer factual evidence to refute the Court's purely fanciful opinion.

Letters and phone calls to me from many apparently healthy and ailing elderly men and women reveal that simply the unencumbered guarantee of availability of competent assistance for medically justified suicide relieves their mental panic and thereby improves what quality can be enjoyed in their remaining lives. It is mental panic, perhaps intermittently fleeting, which they find intolerable, and eventually drives them to commit suicide in solitude and in sometimes brutal ways. As one chief of geriatrics in a major New York hospital put it, "There's a much greater awareness of...incurable disease, and people know they're going to become helpless, and costs are going to be great."1

Especially in the case of the often forlorn elderly, contrary to the baseless opinion of this Court, I know that my new service will reduce substantially the incidence of unnecessary or untimely suicide. The question here, then, is which approach serves objective jurisprudence and human welfare better: the Court's vacuous and wholly emotional opinion, or my extensive real-life experience? I can tell you how Hippocrates would have answered this question. In his treatise entitled The Law, he states: "There are indeed two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant."2 In our own time, Justice Holmes said that "our system of morality is a body of imperfect social generalizations expressed in terms of emotion. To get at its truth, it is useful to omit the emotion and ask ourselves what those generalizations are and how far they are confirmed by fact accurately ascertained."3

In charge no.4 the Court cites a local patient suffering from multiple sclerosis who contacted me for assistance in ending her torturous life. The charge is woefully incomplete; almost 50 suffering patients have pleaded with me by letter and by telephone, to help end their suffering from various causes ranging from terminal cancer to emphysema, crippling arthritis, and incapacitating neurological diseases. The requests came from many of our states, as well as from countries as far away as Russia, Italy, Japan, and Australia. The Italian patient was so desperate that she had already purchased an airline ticket to Detroit, despite the fact that there had been only initial contact without my personal consultation or commitment. All of this demonstrates beyond question the seriousness of patients' desires and motivation, and the dire necessity for my new service which the Court so callously ignores.

The fifth charge is especially onerous: that I accepted a patient outside of my specialty as a pathologist, and that I am not trained or certified in apposite specialties such as gerontology, oncology, neurology, and psychiatry. Firstly, a pathologist is a physician qualified and in certain circumstances authorized and even obligated to diagnose, evaluate, and treat patients. The mention of psychiatry is totally superfluous, because as I have repeatedly stressed to this Court and to the media, at the present time only patients afflicted with obviously physical diseases or trauma can be candidates for my services, and only after an immediately mandatory psychiatric evaluation. In most cases even the laity can ascertain mental competency. As was the case with Janet Adkins' Alzheimer's disease, it is usually family members who first make the diagnosis.

In every case I demand copies of the patients' medical records, and advise and encourage them to exhaust every potentially beneficial form of therapy before they can hope for my help; and despite their reluctance to do so, or their distrust of their own

personal doctors, their dissipating mental panic enables them to postpone the idea of suicide and go on with the current therapeutic regimen. That was true with Janet Adkins who had tried the latest experimental treatment without benefit, and who then faced a repugnant decline to an ignoble end as a victim of an undeniably terminal disease—very slowly and agonizingly terminal.

As a duly licensed medical doctor in this state, I am authorized by law to pursue a general practice. By thus having tried to impugn my competence with the Court's mere opinion implying disparagement of a certified pathologist's competence, the Court has insulted, perhaps unwittingly, all dedicated, reputable, and unquestionably competent general or family practitioners as well all pathologists. After all, any rational adult, doctor or not, can verify adequate mental competency of an understandably anxious or even depressed patient facing the horror of inescapable and agonizing death wrought by terribly crippling disease. At such times who needs a specialist?

The sixth charge states that I admitted having used a "death machine" or device , and that I know it is not accepted medical practice. I resent the Court's presumption in claiming to know exactly what I do and do not know. Contrary to the Court's ill-advised guess, I know that euthanasia and assisted suicide are acceptable medical procedures—not in the United States at present, but certainly in a comparably, and perhaps much more civilized country, the Netherlands, and endorsed by a large majority of that nation's unarguably ethical, compassionate, and competent medical community. Indeed that is doctor-mediated euthanasia which requires that the doctor does the actual intravenous injecting of the lethal substances. My new service is even less vulnerable to criticism or moral censure, because I merely supply the means for, and medical supervision of, the merciful suicide. It has already been declared to be ethical in the United States by a distinguished group of American doctors4.

According to the International Code of Medical Ethics of the World Medical Association5, "any act or advice which could weaken physical or mental resistance of a human being may be used only in his interest." Now, it cannot be denied that my assistance to help a suffering patient end his or her agony with finality entails the reduction of physical resistance definitely and exclusively in his or her interest. And in 1981 the Judicial Council of the American Medical Association stated that "ethical standards of professional conduct may exceed, but are never less than nor contrary to, those required by law.6 The fact that my action with regard to Janet Adkins exceeded ethical standards required by law does not, in and of itself, impugn the ethical nature of the benevolent act. On the contrary, in exceeding the narrow legal standards it actually gains in ethical stature. The AMA's Judicial Council continued: "For human reasons, with informed consent a physician may do what is medically necessary to alleviate severe pain...but he should not intentionally cause death."6 I did what was necessary to relieve Janet Adkins' severe pain in the form of excruciating mental anguish devoid of significant or purely psychiatric or physical origin; and I did not intentionally cause her death I merely made it as humanely, painlessly, and quickly as possible for her to cause her own death. My action did not infringe the Council's stipulation.

Furthermore, and of paramount importance, the Court's sixth charge failed to take account of fundamental historical and spacio-temporal aspects of bioethics. According to Ludwig Edelstein, the world's preeminent expert with respect to the old Hippocratic Oath7: "In antiquity...if the sick felt that their pains had become intolerable, if no help could be expected, they often put an end to their own lives. This fact is repeatedly attested and not only in general terms. Even the diseases are specified which in the opinion of the ancients gave justification for a voluntary death (Aristotle). Moreover, the taking of poison was the most usual means of committing suicide, and the patient was likely to demand the poison from his physician who was in possession of deadly drugs and knew which brought about an easy and painless death (Tacitus, et al). On the other hand, such a resolution naturally was not taken without due deliberation....The sick wished to be sure that further treatment would be of no avail, and to render this verdict was the physician's task....If the latter, in such a consultation (with the patient and his friends), confirmed the seriousness or hopelessness of the case, he suggested directly or indirectly that the patient commit suicide (Pliny)....Men could and did go on living in spite of all their suffering, Yet the fact remains that throughout antiquity many people preferred voluntary death to endless agony. This form of 'euthanasia' was an everyday reality."

Edelstein continued (page 13): "Ancient jurisdiction did not discriminate against suicide; it did not attach any disgrace to it, provided there was sufficient reason for such an act. And self-murder as a relief from illness was regarded as justifiable, so much so that in some states it was an institution duly legalized by authorities." (Aristotle)

"Platonists, Cynics, and Stoics...held suicide permissible for the diseased...The Aristotelian and Epicurean Schools condoned suicide...Pythagoreanism, then, remains the only philosophical dogma that can possibly account for the attitude advocated in the Hippocratic Oath. For indeed among all Greek thinkers the Pythagoreans alone outlawed suicide and did so without qualification (Phaedo)...And even in later centuries the Pythagorean School was the only one represented as the sole opponent to suicide (Phaedo)....It seems safe to state this much: the fact that in the Hippocratic Oath the physician is enjoined from aiding or advising suicide points to an influence of Pythagorean doctrines."

"It stands to reason, then, that the Hippocratic Oath, in its abortion clause no less than in its prohibition of suicide, echoes Pythagorean doctrines...In no other stratum of Greek opinion were such views held or proposed in the same spirit of uncompromising austerity....Far from being the expression of the common Greek attitude towards medicine or of the natural duties of the physician, the Oath rather reflects the opinions which were peculiarly those of a small and isolated group."

Edelstein concludes: "I can say without hesitation that the so-called Oath of Hippocrates is a document uniformly conceived and thoroughly saturated with Pythagorean philosophy, that the Oath is a Pythagorean document, ...a Pythagorean manifesto, and not the expression of an absolute standard of medical conduct. (page 64; emphasis added).

Edelstein's authoritative work effectively discredits the Court's charge in the first paragraph under charge 7, that abetting suicide is not acceptable medical practice. To be accurate the Court should have added the words "throughout most of the civilized world".

But it was an accepted and very prevalent practice in the ancient, surely civilized Greco-Roman world. Changing socio-political, geographical, and economic circumstances of life through long spans of history will understandably result in many honorable practices inexorably fluctuating between use and disuse; but that conditional activity cannot permanently nullify their inherent and tenuously intermittent acceptability enhanced by the people's avowed need for them, as currently demonstrated by almost every public poll.

Today it is only the Netherlands that, like the ancient classical civilizations, openly acknowledges, accepts, and implements the practice as completely ethical medical practice. The subsequent Middle and Dark Ages presaged our present situation in which the acceptance vanished because of high-blown clerical sophism tenuously based on the often silly dicta concocted by the pretentiously secret, tobacco-smoking, ancient pagan sect called Pythagoreanism, the incredibility of which as a legitimate source of sound medical ethics can be discerned from some of its outlandish rules: for example: "Not to abstain from beans; not to pick up what has fallen; not to touch a white cock; not to break bread; not to step over a crossbar; not to stir the fire with iron; not to eat from a whole loaf; not to pluck a garland; not to sit on a square measure; not to eat the heart, not to walk on highways; not to let swallows share one's roof; when the pot is taken off the fire, not to leave the mark of it in the ashes, but to stir them together; do not look into a mirror beside a light; and when you rise from the bedclothes, roll them together and smooth out the impress of the body."21 And that somewhat lunatic pagan sect is supposed to be the honored source of the ethics guiding the profession!

The mores of the times and current public need have forced the AMA and its lackey "ethicists" to admit defeat when they endorsed and tried to save face with the creation of a "modern updated" Oath which, in connection with euthanasia, timidly (and most likely deceitfully) states: " Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life." (Of course, all doctors and all human beings definitely have the power to kill, and admit that they often do, through unintended negligence and accidents which are irrelevant); "This awesome responsibility must be faced with great humbleness (sic) and awareness of my own frailty." Talk about gingerly pussy-footing---to avoid bluntly admitting that "on occasion it is my duty to purposefully end a life of a hopelessly and irremediably suffering patient who pleads for such relief."

Two other chief secular factors also accounted for the vanishing mentioned above. The first was arbitrary fiat decreed by feudal lords who felt that they had to prevent suicide in order to maintain enough manpower of serfs to preserve the economic and military integrity of their fiefdoms. The second was a perceived need to maintain adequate human populations during a time of devastating pestilence. The latter was also critical for the Catholic Church bent on increasing its power and influence through numbers. Yet the Church is ambivalent, if not hypocritical, or outright dissembling, because over four centuries ago, Sir Thomas More, an ardent Catholic, in his book, Utopia, unequivocally advocated both euthanasia and assisted suicide.8 More wrote: "but if a person suffers from a disease which is incurable and continually excruciating, the priests and magistrates come and urge him...not to hesitate to die when life is such a torment, but...to deliver himself from the scourge and the imprisonment of living or let others release him...for by death he would lose nothing but suffering....Those who are moved by these arguments either starve themselves to death of their own accord or through the aid of an opiate die painlessly. If a man is nor persuaded to this course, they do not force him to it against his will, nor do they lessen their care of him. To choose death under these circumstances is honorable." (emphasis added)

Thus, the Church's deceit and hypocrisy are plain to see, and emphasized in its toleration of the establishment in Florida, by a wealthy Catholic businessman, of a Catholic law school headed by the Michigan prosecutor who fervently, even fanatically, tried to imprison me! And to compound the travesty, which also impugned the character and integrity of now Saint Thomas More, with incredibly brazen gall they named it "The Thomas More Law Center!

Deceit and hypocrisy indeed, no less brazen than that now evident in the Court's attitude and behavior.

The Court is grievously wrong in the second paragraph of charge 7: as already stressed, I did not cause anyone's death. Janet Adkins caused her own death. Furthermore, the Court demeaned itself by adding the meaningless and inappropriate banality that "nothing is more permanent than death". That ploy simply underscores the totally emotional basis of the Court's stand. As already mentioned, Justice Holmes emphasized that an emotional approach to any legal or ethical problem is unjustifiable at best (pp 70-1).3 It is worth repeating here that my stand necessitated a politely dispassionate approach devoid of emotionalism

In the third paragraph of charge 7 the Court feebly tried to justify imposition of its injunction "in order to protect the life of this population, to preserve public health, safety, and welfare;" and because "the state has a public policy against suicide". The lingering strong influence of the afore-mentioned Dark Ages mentality is obvious here. By what stretch of the imagination did Janet Adkins' suicide threaten the life of this population? Doctor-assisted suicide is a one-on-one affair between doctor and suffering patient. The sporadic and entirely voluntary self-elimination of individual lives taken collectively might have meant something to the total population during those Dark Ages; but in today's environment of exploding populations, that is a ludicrous concept. Furthermore, the voluntary self-elimination of mortally diseased lives, taken individually or collectively, can only enhance the preservation of public health and welfare. Again, stripped of overpowering emotions, the Court's attitude and pronouncements become unworthy of a true, common-sense arbiter of justice.

In paragraph 2 the Court sees irreparable harm in my action. What does the Court mean by that? Where is the harm? Certainly there is not, and could not be, physical harm to anyone else other than Janet Adkins. The only physical effect she experienced consciously were the mild stings of a hypodermic needle, and that cannot be deemed to be significant harm, in view of the millions of times it is perpetrated on human beings every day. Certainly there was no harm for Janet Adkins in painlessly, quickly, and unconsciously experiencing her own subjective death. Nobody else can comment on or evaluate that experience. It is undeniable that as a general rule no sane, rational human being voluntarily seeks harm; and Janet Adkins was rational. Where, then, is the harm perceived by the Court? It can only be a sort of psychical harm in the "wounded" minds of the prosecutor, his agents, and the judge whose irrational injunction is written evidence of the Court's own abstract psychical debility.

Justice William O. Douglas made this point better:9 "Those who construct a political system on the basis of their 'truth" create totalitarianism. Those who passionately believe in democracy...leave room for all searchers of "truth" and never impose by law one doctrine, one creed, one dogma, one faith on anyone....Truth is not a goal, for in most areas no one knows what truth is. The search is for a way of life that offers the individual the greatest possible opportunity for fulfillment." This Court would deny Janet Adkins and all other agonized patients that opportunity.

Justice Douglas continued with keen insight: "There are always watchmen who rally the city fathers, the state legislature, or the board of education to fasten their religious or philosophical codes onto the community moral code,...who have thereby mutilated freedom and left society paralyzed with prejudices that hamper free inquiry" This Court's injunction does just that. Finally, Justice Douglas laments the fact that "everyone who proselytizes one creed or faith is apt to have a list of heretics whom he pursues and whom he would crush, if he could. The true sponsors of the Free Society are those who defend the advocates of creeds they despise. If there is someone at the controls who, as censor, refuses to let some ideas to be expressed, if prosecutors are free to pursue promoters of offending ideas, the newspaper prints...only the news that fits the owner's party line, the debate and discussion become truncated and the people become a captive audience. It is not surprising that that is our condition today."

And it is not surprising that that is the condition with respect to my action and the Court's unjustified reaction. It is not surprising that despite numerous polls which show overwhelming approval and endorsement of my action by a majority of the public at large, the Court has joined forces with the minority wellspring of political power in the form of newspaper editorial writers and designated spokesmen for organized medicine to act as the censors Justice Douglas denounced.

Despite the fact that suicide is no longer a mortal sin or deemed to be illegal, the Court presumptuously arrogated to itself the right to proclaim an unofficial state policy against suicide (charge 7, paragraph 3). This is merely another manifestation of its emotional outrage, for the word "suicide" does not appear anywhere in the Index of Codified Laws of the State of Michigan. If there is no official and legal state policy, whence the authority for arbitrary proclamation of such a policy from a source of indubitably inferior jurisdiction—other than pure whimsy? The coercive force of such a machination would be negligible at best. In this action the Court appears to have exemplified and magnified through governmental bodies Einstein's admonition that "the attempt to combine wisdom and power has only rarely been successful and then only for a short while."10

Contrary to the Court's contention, it is the absence of my new service which threatens public health, safety, and welfare. The recent murder-suicide of a local elderly couple in Oakland County cited by the Court is a case in point and underscores a developing crisis which must be dealt with. I can state without fear of rational contradiction that had my service been legitimately and freely accessible to that tragic couple, neither victim would have died at that time. From extensive experience I know that I could have persuaded Mrs. Gear to undergo further treatment by her own doctor, or at least to wait for further consultation before taking any violent action. As a consequence there would have been no need for her husband to commit suicide because of a combination of overwhelming guilt and the fear of strident and inescapable prosecution for having been compelled to murder his ailing wife. Whereas my actions would have reduced the inevitable tragedy to only a single instance of justifiable suicide, the Court unwittingly and brashly assumed the guilt of involuntary manslaughter by virtue of having (unnecessarily) forced the involuntary murder of Mrs. Gear committed basically involuntarily by her trapped husband. And the Court's guilt will increase exponentially as long as its immoral injunction continues the barbaric compounding of such unnecessary, devastating, and easily preventable tragedies. It should not be forgotten that the Court's undeniable guilt is shared by organized medicine's appalling, even criminal indifference.

Despite legal and philosophical or religious restraints, there has always been a great need and demand for doctor-assisted suicide and euthanasia. The immortal Dr. William Harvey, physician to kings, died in 1658, it is said from the effects of opium he had taken with suicidal intent to escape the torment of acute pangs of gout.11 On a boat trip from Bermuda to New York in April, 1910, an ailing Mark Twain beseeched his business partner to kill hum and put him out of his misery from intense pain due to chronic heart disease.12 At the age of 83 and after 33 operations and 16 years of suffering from cancer of the jaw, Dr. Sigmund Freud Committed suicide by an overdose of morphine with the help of his personal physician.13 At the suggestion and with the approval of the royal family, King George V, suffering the agony of terminal pneumonia, was put to death in

1936 by a lethal combination of morphine and cocaine injected by his physician, Lord Dawson (also a member of Parliament).14 In a letter dated 14 July 1813, Thomas Jefferson wrote: "received the first supply of capsicum...the poison plant....It seems far preferable to the venesection of the Romans, the hemlock of the Greeks, and the opium of the Turks...Could such medicament be restrained to self-administration, it ought not to be kept secret. There are ills in life as desperate as intolerable, to which it would be the rational relief, for example, the inveterate cancer".15 The Court evidently disagrees with Jefferson by insisting that the relief is not rational and that the means should be kept secret.

The validity of the Court' injunction is highly questionable for several reasons. Its imposition alone is vulnerable to criticism, in that such action is tantamount to legislation by the courts. And that is improper, according to legal experts. In his latest book, Robert Bork, an acknowledged authority on constitutional law, laments our "new, growing, and dangerous culture striving to make the courts fundamentally activist in nature, and...legislating rather than interpreting law—or, 'politicization' of the courts....It is a matter of who governs us and how, about our freedom to make our own moral choices and about the difference that makes in our daily lives and in the lives of generations yet to come".16 According to Justices Powell and Frankfurter (1951)17, "History teaches that the independence of the judiciary is jeopardized when the courts become embroiled in the passions of the day and assume primary responsibility in choosing between political, economic, and social pressures." Justice Cardozo concluded that "it is not the lawgiver that makes the law; the folk-spirit does it. The lawgiver has only to write down what the spirit of the people dictates."18 In acting as an unauthorized lawgiver, the Court ignored this warning, and worse yet, the dictates of the folk-spirit.

Cardozo continued: "...Human actions and human decisions precede the rules and principles that, at any moment in time, constitute the formal 'law'(p. ix)...Jurisprudence has never been able, in the long run, to resist successfully a social or economic need that was strong and just". The Court would be well advised to heed his words.

Finally, in 1965 Dr. Jacob Robinson, Special Consultant on Jewish Affairs to the chief counsel of the U.S. at the 1947 Nuremberg War Crimes Trials, wrote that "to deposit...any unsolved problem resulting in lacunae in laws into the lap of a trial judge is universally considered to be an unsuitable method of filling gaps in the law. It is certainly inappropriate to demand of a court that it pass judgment without any assistance from existing law".19

Accordingly, I choose to believe the folk-spirit and the consensus of these unimpeachable sources on the philosophical basis of law, and to asperse the validity of the Court's injunction. Rather, I invoke the written testimony of Justice Holmes, for whom "the foundation value in the Constitutional ideal was the proposition that all organized private and public power over men's wills had legitimacy only as it served individual life".3 And I also invoke the opinions of Einstein, for whom "conscience supersedes the authority of the law of the state" (p.36); and I would add, certainly supersedes the authority of a court to impose an injunction where no law exists. Furthermore, Einstein continued: "There is nothing divine about morality; it is a purely human affair" (p.40)...Where life and death are at stake, rules and regulations go by the board (p.94)—and baseless injunctions do, too.

My actions seem to be quite consistent with Einstein's rules of correct conduct; for he states that "in the long intervals I have expressed an opinion on public issues whenever they appeared so bad and unfortunate that silence would have made me feel guilty of complicity" (p.35)...A man's ethical behavior should be based effectually on sympathy, education, and social ties and needs; no religious basis is necessary. Man would indeed be in a poor way if he had to be restrained by fear of punishment and hope of reward after death. It is therefore easy to see why the churches have always fought science and persecuted its devotees." (p.39)

If an injunction or law is to bar the practice of assisting a justifiable suicide, then it behooves legislators and courts at least to exempt the necessary exception of medically justified assistance. This approach was endorsed when, in connection with a 1968 Congressional hearing for creation of a commission to adjudicate ethical implications of medical research, Senator Walter Mondale stated, "I think the medical profession has a right to ask us to give it the resources and the elbow room it needs to fulfill its function,...and that (doctors) must understand that society must know not only what they are doing, but also the implications of their efforts"(p.1104).5 I ask no more than that of this Court.

Medical testimony at the same hearing by the famous surgeon, Prof. Owen H. Wangensteen5, corroborates my suggestion to leave the matter of apposite ethics entirely to the doctors involved. The surgeon continued: "Senator, I would urge you with all the strength I can muster to leave this subject to the conscionable people in the profession who are struggling valiantly to advance medicine. We are living through an era in which the innovator is often under suspicion, being second-guessed by self-appointed arbiters more versed in the art of criticism than in the subject under scrutiny. We need to take great care lest the wells of creativity and the spring of the mind of those who break with tradition are not manacled by well-intentioned but meddlesome intruders. I would urge you to leave these matters in the hands of their proponents, the persons who are actually doing the work. They know more about all this than any of us possibly could. They have wrestled with the problem day and night, almost invariably over many years. Theirs are not overnight judgments or convictions...Discussion should not be restrained, but legislative action, never!" (p.311, my emphasis).

"If you are thinking of theologians, lawyers, philosophers, and others to give some direction here for the ongoing development in this field, I cannot see how they could possibly help. I think it is about like peeling an apple. The fellow who holds the apple can peel it best. I cannot conceive of 20 people holding an apple, and a man trying to get in there to peel it." (p.1108)

In imposing the injunction to block my efforts to establish what might be called medical death control, this Court embarked on the identical erroneous course of action that society took with regard to Margaret Sanger's benevolent efforts a couple of generations ago to establish the now indispensable practice of medical birth control. It is appropriate, then that I end this testimony with her own terse and very accurate assessment.20 "Shall we fold our hands and wait until a body of sleek and well fed politicians get ready to abolish such slaughter (abortion)? Shall we look upon a piece of parchment (law) as greater than human happiness, greater than human life? I shall attempt to nullify the law by direct action and attend to the consequences afterward."

"Shall we who respond to the throbbing pulse of human needs concern ourselves with indictments, courts, and judges, or shall we do our work first and settle with these evils after?"

Tragically, for many years she had to endure the scorn and vituperation of her benighted colleagues in an obviously less than noble profession, the vitriolic outrage of incredibly hypocritical religiosity which doubtlessly lamented the demise of its super-punishment called "auto-da-fe," and of vengeful imprisonment before inevitable success proved Sanger right.

It should be pointed out that the Court appears to be biased through association with members and institutions of the medical profession, legislating its views through biased injunctions. In so doing, the Court acts legislatively in violation of the separation of powers doctrine in both federal and state constitutions. Finally, there is nothing in the rules of the State Board of Medicine, nothing in statutes regulating the medical profession, and nothing in statutes prohibiting my conduct in like cases.

Therefore, this preliminary injunction should be immediately vacated; and I took the first step to symbolize it by brashly lifting my copy high and ceremoniously burning it on the steps of the state building in Detroit, Michigan,--- flicking the ashes into the air as an expression my utter contempt for the ignoble court and the corrupt judge who serves as its servile lackey.

References

1.The Detroit Free Press, 19 July 1989, p.6A.

2. Hippocrates: Ancient Medicine and Other Treatises. Henry Regnery, Chicago,

1949, p.123.

3. Hurst, J W: Justice Holmes on Legal History, Macmillan, NY, 1964.

4. NEJM, vol. 230: 30 Mar 1989, 844-49.

5. Katz, J: Experimentation with Human Beings. Russell Sage Foundation, NY,

1972.

6. Current Opinions of the Judicial Council of the AMA, 1981.

7. Edelstein, L: The Hippocratic Oath. Text, Translation, and Interpretation. Johns

Hopkins Press, Baltimore, 1943.

8. More, T: Utopia. Appleton-Century-Crofts, NY, 1949.

9. Douglas, W O: Freedom of the Mind. Doubleday, Garden City, NY, 1964.

10. Einstein, A: Ideas and Opinions. Bonanza, NY, 1954.

11. Nimmo, W P: Clergymen and Doctors. Curious Facts and Characteristic

Sketches. J B Lippincott, Philadelphia (No date).

12, The Detroit News, 10 Nov 1988, p1.

13. Cant, G: Deciding when death is better than life. Time, 16 July 1973, p.37.

14. Watson, F: The death of George V, History Today, 36:Dec 1986, pp. 21-30.

15. Koch, Adrienne:The Life and Selected Writings of Thomas Jefferson. Modern

Library, NY, 1944, p.629.

16. Bork, R H: The Tempting of America. The Free Press, NY, 1990.

17. Krantz, S: Supplement to the Law of Corrections and Prisoners' Rights. West

Publ. Co., St. Paul, MN, 1977, p.28.

18. Cardozo, B: The Growth of the Law. Yale Univ. Press, New Haven, 1924.

19. Robinson, J: And the Crooked Shall Be Made Straight. Macmillan, NY, 1965.

20. Sanger, M: My Fight for Birth Control. Farrar & Rinehart, NY, 1931, pp.94-95.

21. Russell, B: A History of Western Philosophy. Simon & Schuster, NY, 1945, 31.

Apologia II

(My rebuttal to the Michigan State Legislature)

Tuesday, 26 February 1991

I have repeatedly claimed that you legislators, lawyers, clerics, and physicians are helping to keep this hostage society in the continuing Dark Ages. I will now give you the proof of it, and the evidence in which you will see yourselves in the dark past.

In case some of you don't know who Andreas Vesalius was, I'll start with the fact that he is considered to be the esteemed and honored "father of anatomy, who established the scientific basis of the discipline early in the 15th century.1 "He found anatomy a superstition; he left it a rational science."(p. 153) His monumental book with superb illustrations, De Humani Corporis Fabrica, today is a rare classic. "To produce material for his artistic plates, Vesalius was a habitual haunter of gibbets. He bribed dead-house keepers, and on more than one occasion became a grave robber; because, like me, he was scientifically, not morbidly, obsessed with death.

Vesalius was forced to leave Padua after his book was published...Like Copernicus and like Galileo, and like all those who fought against dogma and ignorance, he was blocked, denounced, scorned, and hated."5(p. 47) And like Vesalius, my refusal to give up "controversial" research dealing with experiments on willing anesthetized condemned men during their execution forced me to leave the University of Michigan and to be subjected to the same vilification. "After 1556, the church no longer opposed dissection of human cadavers, and every medical school offered regular anatomic dissections" (pp. 47-8) How many more centuries is it going to take before religious and medical opposition allows scientists to deal with death without intimidation? Dark Ages indeed!

Without a doubt many of you know who Dr. Edward Jenner was,--his astute work as a general practitioner led to smallpox vaccination and eventual disappearance of a deadly intermittent pestilence. "At his local county medical society meeting, one doctor said, 'I confess to grave doubts as to my colleague's competence if he is willing to clothe the superstitions of milkers and herdsmen in the mantle of scientific investigation," (referring to Jenner's sharp recognition of the connection between the relatively innocuous cowpox virus which he learned would prevent deadly smallpox).4 (pp.100-102... "Another surgeon rose: 'I agree entirely with the views of the preceding speaker...I move that Mr. Jenner be sternly rebuked and warned not to pursue his dangerous researches further on pain of being expelled from this organization.' There was a burst of applause." I hope you readers now understand why I don't belong to any medical organization, for I wouldn't last long as a member.

"Jenner was stunned. He had expected the report to receive some criticism from the more conservative members. But he had not anticipated such a violent onslaught." Judge Alice Gilbert's harangue and injunction against me springs to mind here.

"No colleague would help Jenner in his research."(pp.100-102). And at first none would help me. "Now he (Jenner) would have to go on alone. He did not shrink from the prospect for he had gotten into the habit of working by himself over the years. While outside help might have enabled him to reach his goal sooner, he actually preferred the independence of working alone." (I hope you now also understand why individuals like Jenner and me are derided as "mavericks" coerced into becoming lone rangers who appear to be "dangerous" rebels.

"Most of the surgeons were polite in rejecting his plan, but several seemed to look upon him as some sort of eccentric. A few even stared down their noses as if to ask, 'Who is this presumptuous country surgeon who is convinced he has found the answer to a puzzle (smallpox) that has eluded the best medical brains for decades?' For the first time in his life Jenner could understand why John Hunter had raged so at some of his medical colleagues. The solid wall of indifference was disheartening." (p.146) I learned it earlier, in the late 50's, when I was working with condemned criminals for voluntary organ donation at execution. I was never despondent, because I had one advantage over Jenner: several centuries of historical perspective which I am now trying to impart to you.)

"The opposition of a small vocal segment of the medical profession proved to be more effective....They made every attempt to belittle the importance of the discovery" (p.154) In my case, that opposition is from the very vocal, powerful, and sanctimonious American Medical Association in collusion with the even more powerful and sanctimonious religious hierarchy to which the benumbed physicians have timidly ceded their ethical code.

Vesalius was at once denounced as an imposter and heretic...greeted upon every hand with calumny and vituperation, with prejudice gaining and the law beginning to frown."(p.154, 5). By interfering with conventional thought, Vesalius had made many enemies, and repercussions were soon to follow. The next year he was carried before the Inquisition on the charge of dissecting a living body," and therefore compelled to make an act of penitence."

The famed Dr. William Harvey, discoverer of blood circulation, fared little better. Harvey lost much of his reputation and many of his patients owing to the attacks of his colleagues, who spread it abroad that he was little better than crack-brained.2 (p.117)

Here's a short paragraph from page 85 of a book on medical history3 (p.85). "Christian teaching emphasized the earlier belief that sickness and disease were punishments that fell on man for his sins. There was nothing he could do about this but atone by fasting and prayers. Against this dogmatism the rational clinical teaching of Hippocratic medicine was ineffective; in fact, a rational approach to ill health was considered sacrilegious and a direct criticism of the Great Physician, God. The human body, being a divine creation, could not be subjected to the impious hands of the dissectors, and so its study at first hand was condemned as a crime against God and man"...Much prejudice had to be broken down before human dissection became a common part of training in surgery." (p. 103).

Not many people are aware of another travesty against humanism. According to another historical account1 (P.272): "Convention had made it an insult to the Deity to assist a woman in labor. This was a crime which always drew the extreme penalty in medieval Europe. In 1521 Viethes, a Hamburg physician, was arrested for attempting to mitigate the pains of a woman's labor. By nature Viethes was generous and kind, and his patient, a frail woman, begged for relief. Her entreaties reached the heart of this good man, and he complied with her request. Immediately the wheels of the law began to turn, and a conviction was soon obtained for the crown. A few weeks later an unusual light shone over Hamburg. They were burning Dr. Viethes...But did not this spirit die with the Middle Ages, you ask?" Unfortunately, you don't ask. That is why I am telling you this now. And that is why a couple of generations ago in the 20th century Margaret Sanger, too, struggled vainly to tell you. This is an ugly example of what unspeakably absurd barbarity can develop out of such mentality; and this august legislature is on the verge of doing it again.

I'll close with these words of Margaret Sanger herself, directed primarily to my medical colleagues.7 (p.95) "Shall we fold our hands and wait until a body of sleek and well-fed politicians get ready to abolish the cause of human misery (abortion)? Shall we look upon a piece of parchment (law) as greater than human happiness, greater than human life? Shall we who respond to the throbbing pulse of human needs concern ourselves with indictments, courts, and judges, or shall we do our work first and settle with these evils after?" Evils indeed, which any true physician would denounce and demolish. Where are the true physicians? Probably the same place they were when the compassionate Dr. Viethes was roasted alive.

"We must recapture the most fundamental idea in our jurisprudence—the rule of law. Our laws must be fair, based on common sense and easily understood by the citizens who are expected to live under them;...and they must be molded to the needs of society and not to any group's arbitrary standard." 6 (p.28, emphasis added)

Let no reader think that it is arrogance which compels me to equate my situation with that of those giants of medical history. I use their examples not as an implied presumption of equal historical stature, but rather because of common circumstances; and, like them, I know I am right. And, like them, time will vindicate me and disgrace my detractors. And in case you're wondering what my future plans are: simply to emulate Vesalius. And to quote Margaret Sanger, I shall attempt to nullify immoral laws (which, by the way, are illegal through infringement of the precious but unused Ninth Amendment in our Constitution) by direct action and attend to the consequences afterward.

References

1.Atkinson, D T: Magic, Myth, and Medicine. The World Publ. Co., Cleveland, 1956.

2.Chauvois, L: William Harvey: His Life & Times. Philosophical Library, NY, 1957.

3. Leff, S and Leff, V: From Witchcraft to World Health. Macmillan, NY, 1957.

4. Levine, I V: Conqueror of Smallpox. Julian Messner, Inc., NY, 1960.

5. Silverberg, R: The Great Doctors. G. P. Putnam & Sons, NY, 1964.

6. Crovitz, G: How law destroys order, National Review, 11 Feb 1991, p.28.

7. Singer, M: My Fight for Birth Control. Farrar & Rinehart, Inc, NY, 1931.

Great Minds Comment from the Grave

As a kind of "virtual seance," I submit the following "testimony" in the "Court" of pure reason and true justice to rebut that of authoritative individuals in various professional disciplines concerned with the now politicized issues of physician-assisted suicide and euthanasia---(for which I have coined the medically more scientific and accurate name of "patholysis," the elimination of suffering.

Einstein1 replies to state governors and legislators: "For nothing is more destructive of respect for the government and the law of the land than passing laws which cannot be enforced. Lincoln, too, stated that "the best way to get a bad law repealed is to enforce it strictly." Einstein further said that "the state should be our servant and not we its slaves....Political leaders or governments owe their position partly to force and partly to popular election. They cannot be regarded as representatives of the best elements, morally or intellectually, in their respective nations (all emphasis added)....The government is itself an evil insofar as it carries within it the tendency to deteriorate into tyranny."

To judges, prosecutors, politicians, and theologians, he opines that "an autocratic system of coercion soon degenerates. For force always attracts men of low morality....

A man's ethical behavior should be based effectually on sympathy, education, and social ties and needs; no religious basis is necessary....Man would indeed be in a poor way if he had to be restrained by fear of punishment and hope of reward after death. It is therefore easy to see why the churches have always fought science and persecuted its devotees....For apart from the knowledge which is offered by accumulated experience and from the rules of logical thinking, there exists in principle for the man in science no authority whose decisions and statements could have in themselves a claim to "truth."

To me and to the general public, Einstein says: "Only the individual can think and thereby create new values for society, nay, even set up new moral standards to which the life of the community conforms....External compulsion can, to a certain extent, reduce but never cancel the responsibility of the individual." In the Nuremberg trials this idea was considered to be self-evident. Whatever is morally important in our institutions, laws, and mores can be traced back to interpretation of the sense of justice of countless individuals. Institutions are in a moral sense impotent unless they are supported by the sense of responsibility of living individuals."

"In long intervals I have expressed an opinion on public issues whenever they appeared to me so bad and unfortunate that silence would have made me feel guilty of complicity....In talking about human rights today, we are referring primarily to the following demands: protection of the individual against arbitrary infringement by other individuals or by the government....There is, however, one other human right which is infrequently mentioned but which seems destined to become very important: that is the right or the duty, of the individual to abstain from cooperating in activities which he considers wrong or pernicious....The Nuremberg trial of the German war criminals was tacitly based on the recognition of the principle that criminal actions cannot be excused if committed on government orders; conscience supersedes the law of the state." James Madison agreed that conscience is the most sacred of all property.

To politicians and the clergy Einstein says: "In many cases a leader, or a ruler, or a privileged class whose position rests on other factors combines priestly functions with its secular authority in order to make the latter more secure; or the political rulers and the priestly caste make common cause in their own interests...That primitive religions are based almost entirely on fear and the religions of civilized peoples purely on morality is a prejudice against which we must be on our guard."

Jefferson had earlier stressed this point: "In every country and in every age the priest has been hostile to liberty; he is always in legion with the despot, abetting his abuses in return for protection of his own."

Finally, the opinions that really count now echo through me from the graves of preeminent and highly esteemed physicians:

At the age of 83, after 33 operation while suffering for 16 years from cancer of the jaw, Dr. Sigmund Freud concluded that "now it is nothing but torture...and makes no sense any more".2 His physician, Dr. Max Schur, reported that, "When he was in agony, I gave him two centigrams of morphine. I repeated this dose after about 12 hours. He lapsed into a coma and did not wake up again." He died with dignity at his chosen time.

Lord Dawson, a Member of the English Parliament and physician to King GeorgeV, reported his experience: "The King was too tired, for it must be remembered he had carried on to the end of his road....(I)t was evident that the last stage might endure for many hours, unknown to the patient but little comporting with that dignity which he so richly merited and which demanded a brief final scene. Hours of waiting just for the mechanical end when all that is really life has departed only exhausts the onlookers and keeps them so strained that they cannot avail themselves of the solace of thought, communion or prayer. I therefore decided to determine the end, and myself did the injection of ¾ gr. of morphia and shortly afterwards one gr. of cocaine into the distended jugular vein....This is something which belongs to the wisdom and conscience of the medical profession and not to the realm of law...so-called euthanasia on which almost silently agreement now exists."3

The famous Dr. William Harvey, physician and anatomist who discovered how blood circulates, died in London in 1657 at the age of 80, "it is said from the effects of opium which he had taken with suicidal intent to escape the suffering from painful gout4."

Dr. Walter C. Alvarez, a leading physician, philosopher, teacher, and medical columnist, said and wrote a generation ago, "I still think that that poor man, with his terrible pain, should have had a legal right to commit suicide, and that I should have had the right to get him the drug for which he had begged....I feel that this problem of voluntary or obviously logical euthanasia can and should be left in the hands of us physicians5."

My final statement and unalterable position

In his letter, dated 16 May 1953, to a teacher who refused to testify (about theoretical physics) before a Congressional committee, Einstein wrote: "The reactionary politicians have managed to instill suspicion of all intellectual efforts into the public by dangling before their eyes a danger from without. Having succeeded so far, they are now proceeding to suppress the freedom of teaching and to deprive of their positions all those who do not prove submissive, i.e., to starve them."6

"What ought the minority of intellectuals to do against this evil? I can only see the revolutionary way of non-cooperation in the sense of Gandhi's....Every individual who is called before one of the committees ought to refuse to testify, i.e., he must be prepared for jail and economic ruin; in short, for the sacrifice of his personal welfare in the interest of the cultural welfare of the country."1

However, this refusal to testify must not be based on the well-known subterfuge of invoking the Fifth Amendment against possible self-incrimination, but on the assertion that it is shameful for a blameless citizen to submit to such inquisition, and that this kind of inquisition violates the spirit of the Constitution.

Now I, Dr. Jack Kevorkian, am being repeatedly called before one of those evil committees facetiously dubbed "courts of justice." I am a blameless citizen steadfastly committed to the re-implementation and unconditional preservation of the basic human rights, explicitly guaranteed by the hitherto unused and forgotten, perfectly understandable Ninth Amendment in our Constitution: the right of any mentally competent adult to request medical assistance to curtail intolerable and irremediable pain or incapacitation; and the right of qualified and competent physicians to comply with that request and provide the needed assistance. Such rights were long ago guaranteed by the Founders, and always available and honored in the more genuine democracy of ancient Hippocratic Greece.

Because I know that Einstein was much wiser than are any of the critics who infest those evil committees, I choose to heed his admonitory counsel. I choose to adopt the legacy of high moralists such as Thoreau, Gandhi, Martin Luther King, Nelson Mandela, Susan B. Anthony, and Margaret Sanger, a legacy which reinforces the wisdom of my own conscience in refusing to cooperate with socially criminal behavior, mandated by our cryptic totalitarian state, which infringes and makes a mockery of, the highest law of the land specifically designed, worded, and inserted by James Madison himself. Therefore, I will always disregard any arbitrary apposite injunction or decree such as that inflicted on me by any "morally"outraged judge such as the dishonorable Alice Gilbert, and more recently the immoral and thoroughly corrupt "judge" Jessica Cooper.

Finally, in accordance with the dictum of the 1947 Nuremberg Tribunal cited above by Einstein, I vow that my conscience will always supersede the " law" of any atavistic state.

References

1.Einstein, A: Ideas and Opinions. Bonanza, NY, 1964.

2.Edwards, T: The New Dictionary of Thoughts. Classic, NY, 1936.

3. Krantz, S: Supplement to the Law of Corrections and Prisoners' Rights, Sec.2,

chap. 6, West Publ. Co., St. Paul, 1977, 28.

4. Koch, A and Peden, W: The Life and Selected Writings of Thomas Jefferson.

Modern Library, NY, 1944, 629.

5. Ogden HVS (ed): Utopia. Appleton-Century-Crofts, NY, 1949, 57.

6. Anonymous: Twain pleaded for death. The Detroit News, 19 Nov 1988, 1.

7. Cant, G: When death is better than life. Time, 16 Jul 1973, 37.

8. Watson F: The death of George V. History Today, 36: Dec 1986, 21-30.

9. Nimmo, W P: Clergymen and Doctors: Curious Facts and Characteristic

Sketches. J B Lippincott, Philadelphia, (no date), 37.

10. Alvarez, W C: Death with dignity. The Humanist, Sep/Oct, 1971, 12-14.

Prologue

When people inquire as to what kind of work I do, I reply, "bioethical research." Their usual reaction is another perplexed, often tacit question: "What in the world is that?"

How can one define ethical research, or is there such a thing to begin with? For most, if not all, of our current horde of "bioethicists" and their hastily contrived hospital ethics committees, that kind of research boils down to hair-splitting pedantry over clichés arbitrarily consecrated into sacred maxims--- In short, no talk of anything smacking of taboo or threatening to "rock the societal boat."

For me, real bioethical research does nothing but rock the boat, and, better yet, capsizes it. So you might easily guess what my answer is to the query of this book's title---emphatically not taboo! That is the only sure way to really honest morality. As a result of my own unbridled bioethical experience, I now practice obitiatry and patholysis according to very strict, truly ethical self-imposed guidelines---when permitted to do so by an ethically debilitated society and an even more debilitated medical guild hopelessly enamored of the irrational taboos concocted by hopelessly misguided (and cruel) secular legislation dictated by purely fictive theological fantasy.

Circumstances have made me an arch "taboo-buster"as an unlikely crusader to do only what is irrefutably right and profoundly important. By definition (in Webster's New Universal Unabridged Dictionary) the word "taboo" is derived from the Tongan "tabu," and used as a noun, adjective, and verb. "Among primitive tribes it denoted a sacred prohibition put upon certain people, things or acts which makes them untouchable, unmentionable; as the highly developed system or practice of such prohibitions; or any social prohibition or restriction that results from convention or tradition." As Abraham Lincoln put it, "A prohibition law strikes a blow at the very principles upon which our government was founded. Prohibition goes beyond the bounds of reason in that it attempts to control a man's appetite by legislation, and makes a crime out of things that are not crimes." O.W.Holmes, Jr., came to the same conclusion: "Pretty much all law consists in forbidding people to do some things they want to do." Political scientist Jeremy Bentham's agreement was even terser: "Every law is an infraction of liberty." There is no doubt that taboos are ideal tools of enslavement, reinforced with the invincible coercive power of our tyrannically dictatorial supreme court.

For me it boils down to a lifelong commitment to destroy the ultimately murky mystical basis of taboos that foster the man-made laws shackling the influence of humanity's natural and entirely secular moral existence in this world ruled by that often implacable "hanging judge" called Nature. As a physician I feel uniquely privileged in being able and qualified to promulgate and mollify some of the harshest "injunctions" passed by that judge onto us pathetically puerile creatures stumbling through a short, totally desultory, and bewildering respite from, and ultimately back to, a dreaded immemorial extinction.

Professionally I can live better with myself during that short respite in thus contributing to the restoration of a little of the sheen to Hippocrates' once noble caduceus, to chip away a bit of the ugly patina encrusted on it in the morass of hypocrisy excreted by his wayward scions.

My "taboo-busting" rampage began in 1958 and unexpectedly progressed through a checkered, somewhat improvised medical career into involuntary retirement---a propitious form of complete independence during which I realized from the beginning that such "taboo" activity in this meretricious society would ultimately lead to a period of imprisonment. And that experience surprisingly proved to be exceptionally fortuitous for the propagation of my "crusade" in behalf of that much more rational secular morality.

The various medical taboos I attacked have been assembled here in the form of an anthology of my articles grouped into parts as related controversial taboos in the following pages. I hope that you find them interesting, somewhat instructive, and especially thought-provoking and worthwhile.

Table of Contents

Prologue...............................................................................................1

Part I: Evolution of "Death Control" and Extraction of the Benefits from Death..................2

The fundus oculi and the determination of death................................................3

The eye in Death....................................................................................16

Rapid and accurate determination of circulatory arrest.......................................24

Capital Punishment or capital Gain?................................................................................ 29

My first death row interview at the old Ohio Penitentiary in Columbus....................30

Review of my first book on this issue, in the Jour. Of the A.M.A (JAMA).................31

The fundus oculi as a postmortem clock.........................................................32

The last fearsome taboo: medical aspects of planned death...................................45

Medicine, ethics, and execution by lethal injection............................................ 60

Retribution through the death penalty: "impossible research"................................67

A brief history of experimentation on condemned and executed humans...................69

Execution worthy of man...........................................................................81

Part II: Judging the Plan....................................................................................88

A broad demographic spectrum of opinions on the overall plan and its documents.......89

Interviews with, opinions of, and petition from inmates at San Quentin........................108

Professional and lay opinions reported from the state of Georgia..........................112

Opinions from transplant surgeons and two Nobel laureates................................115

An opinion from noted historian Arnold Toynbee............................................121

Part III: Clinical Value of Human Cadaver (Corpse) Blood..........................................122

Transfusion of postmortem human blood........................................................123

Transfusion of human corpse blood without additives......................................131

Survival of cadaver red cells in healthy human recipients.................................138

Direct body-body human cadaver blood transfusion........................................142

Part IV: Commercialization of human body parts......................................................146

Marketing of human organs and tissues is justified and necessary........................147

A controlled auction market is a practical solution to the shortage of

transplantable organs.....................................................................156

The first (and only) case of patholytic procurement of transplantable kidneys.........167

PartV: Bioethical Considerations........................................................................174

A modern inquisition................................................................................175

8

Moral infraction of heterotransplantation (xenografting) due to ethical phobotaxis......177

Profane wasting of unavoidable homicide by our irrational "civilization.......................188

The long overdue medical specialty: Bioethiatrics........................................... 191

Physicians for Mercy..............................................................................195

Part VI: Apologias.........................................................................................196

I......................................................................................................197

II................................................................................................... 206

Great minds comment from the grave.......................................................... 212

Part VII: Patholytic procedure and documents........................................................ 213

A fail-safe model for justified medical patholysis (euthanasia or assisted suicide........214

Certification of Patholysis

Case no.________ Name _________________________________ Sex___ Age____ DOB___________

Address______________________________ City______________ County ________________ Zone____

Primary diagnosis ________________________________ Other Diag. __________________________

Patient's physician (print name) ____________________________ (Sign)__________________________

Site of procedure (underline): Hospital Clinic Office Home Other ____________________________

Obitiatrist (print name) ____________________________ (signature) ____________________________

Date of procedure____________ Site (county, city, zone) _______________________________________

Witnessed by (print + sign name)_______________________________ Date ___________Time________

Funeral home______________________________ Address _____________________________________

Option preferred by patient (mark X in circle): Lethal injection by a physician

Lethal injection by self-activation of a special device

Medical experiment(s) during patholysis under general surgical anesthesia

Organ donation during and/or immediately after completion of patholysis under general anesthesia

Medical experiment(s) and organ donation during and after patholysis under general anesthesia

Organ(s) offered (Mark X): Heart L. lung R. lung Only part of a lung

Liver Only part of the liver

L. kidney R. kidney Pancreas Only part of pancreas

Part of the intestinal tract (specify part)___________________________________________

Patient's signature____________________________________ Date _____________ Time__________

If patient is incapacitated, next of kin may sign (print name + signature) ___________________________

___________________________

Date______________ Time_________

Or, a proxy may sign:__________________________________

Proxy's address_______________________________________ Date ______________ Time_________

(Copy to County Clerk's office)

The First Case of Patholytic Procurement of Transplantable Kidneys

A 45 year old Caucasian male contacted me by phone in May 1997, having suffered terribly for 20 years due to paralysis from a gunshot to the back of his neck to damaging the spinal cord at C-6,7 level. In a series of letters to me, written by his 70 year old mother, both he and she pleaded for my help to end his life of torment. Below are slightly enlarged copies of their letters which depict their severe afflictions. In addition, they complied promptly with my request to furnish his medical records for my review. The records formed a packet almost an inch in thickness. We decided that he certainly qualified for our services, and they made arrangements for his difficult transportation from a distant state to Michigan where the patholytic procedure was carried out.

This patient very quickly assented to my suggestion that he might be able to donate kidneys for a couple of needy patients. He was glad to have the opportunity to do so. In June 1997 a surgical team composed of another physician and myself aided by an experienced operating room nurse and a medical technician, contrived a suitable sterile "operating room" supplied with all necessary sterile attire, equipment, and solutions to perform the postmortem nephrectomies within minutes after the running electrographic tracing showed complete cessation of electrical activity. The healthy-appearing kidneys were removed fairly quickly without any damage and prepared immediately for transportation according to UNOS policy and specifications.

Unfortunately, the endeavor was criticized in the press. The typical reaction of the medical and surgical organizations was an absolutely refused to even inspect the kidneys, let alone use them. That forced me to comply with the prosecutor's demand that I surrender the well packed kidneys to a local funeral home to be buried with the donor's body. It was painful for me to remove the organs from their icy container and hand them over, firm, intact, glistening smooth light pink to gray, to the mortician for burial and senseless destruction. It was for me an extraordinarily forceful example of the deadly power of foolish taboos born of abysmal mysticism in which the medical profession continues to wallow. The unreasoned rejection of freely available and priceless human organs might thus have unnecessarily cost the lives of two anonymous and hopelessly anguished patients....Shades of Jenner and Semmelwies!

After publication of my article advocating the establishment of an Internet worldwide auction market for transplantable human organs a little more than a decade ago, I set up a domain called "Viscus," with the intention and hope of perhaps stimulating interested individuals to join in working to arrange for the plan's realization. Unfortunate circumstances prevented my further efforts further in this regard, and the "Viscus" domain expired. Nevertheless, the idea may still be of interest to readers.

Below is probably the easiest and most concise way to explain the plan's operation in adequate detail, summarized in a document suggested as a sort of "flow chart"of transactions and functions among bidders, offerings, transplant centers, hospitals, and reputable fiduciary institutions. There is no doubt that the scheme will save many lives now squandered, and probably will be deemed profitable, experientially as well as financially, in some major way to all parties involved.

Part I: Taboo no. 1: Birth control and abortion.

Unplanned Action=Unwanted Chaos

In a skewed birth/death equation medicine's role

Is to limit population to a sustainable goal;

For birth-control's benefits, "gutsy" Margaret Sanger

Had to endure the doctors' moral languor,

As I endure now for the benefits of death-control.

Part II: Taboo no. 2: Exploiting the benefits of "necessary" killing:

Unthinking people commit tragic mistakes

Saying legal- and self-killing only murder makes;

But Augustine disagreed

And blamed as doers of the deed

Society's laws and customs that form the mind-set it takes.

Part III: Taboo 3: Using blood taken from corpses to treat afflictions:

We learned that Russian doctors had been using for many years

Blood taken from cadavers, and that mollified our fears;

So following their lead

We enhanced value of the deed

As a battlefield transfusion to save military careers.

Part IV: Taboo no. 4: Commoditization of human body parts:

(It's Patently Unfair!)

The human body and its parts, deemed sacred or divine,

Are taboo if bought or sold, but as gifts just fine;

Now, in every case of transplantation

The essential factor is organ donation,

For which all are well paid---except the donor who's the most condign!

Part V: Taboo no. 5: Bioethical considerations:

Mystical taboos can disorder an orderly soul

Deranging its primarily conscionable role

To induce inertia when one should act,

Or unreasoned reaction which in fact

Can derail common sense and ruin lives once whole.

Part VI Taboo no. 6: My rebuttals:

1. To our jurisprudential system, and especially the judges and their courts: What we're told doesn't really

match reality, because America is a confederation of make-believe justice, ineptly performed.

Most people consider our courts to be "cool",

At least that's what we've always been taught in school;

And it makes perfect sense,

Since the courts' omnipotence

Is "frozen" in-just-ice, and obvious to any fool.

From first-hand experience I have known, not guessed,

That our jurisprudential structure is as Jefferson, too, confessed:

Dictatorially despotic and hopelessly depraved

And far from being reformed or even being saved

By any constitutional means being therefor assessed.

_____________________

2. To our national and especially state governments: America is also an incipient but cryptic totalitarian

"state," furtively performed.

America is a make-believe democracy

With a constitutional flaw few can see;

It took a keen mathematical mind

Like Kurt Goedel's piercing kind

To envision the dictatorship the U.S. will be.

Part VIII: The end of paralyzing taboo-mongering: a laudable goal.

I am proud of being a "wanna-be taboo-buster---even a clumsy one. By letting a free mixture of reason, common sense, and down-to-earth experience guide me, Dr. Georges Redding, and other courageous colleagues through many episodes of direct hands-on patholysis, we have evolved an almost fail-safe way to practice it, indeed as close to perfect as can legitimately be claimed. The concept now needs the fine-tuning and burnishing of other capable and interested physicians, surgeons, general practitioners, and researchers to advance it prudently a step nearer perfection. Human welfare needs and certainly deserves it, practiced competently, honestly, and with the dignified transparency demanded by a complete, long overdue code of apposite bioethics. Hippocrates would have asked for no less.

That is the spirit with which my colleagues and I invite you to join the unstoppable process which most likely will become reality in the very near future.

Please help to liberate from the tyranny of taboo the full spectrum of medical art and science for every human being---a calling which concerns every aspect of humanity from birth of a zygote through its end in death of a person and into the enigma of extinction. Help thereby to restore some of the nobility the profession once claimed for itself. My necessarily limited research and experience herein recounted is my picayune contribution to that end.

.



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