Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-29T11:23:48.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Determination of Death in Execution by Lethal Injection in China

Published online by Cambridge University Press:  30 May 2018

NORBERT W. PAUL ,
ARTHUR CAPLAN ,
MICHAEL E. SHAPIRO ,
CHARL ELS ,
KIRK C. ALLISON  and
HUIGE LI
Get access Rights & Permissions [Opens in a new window]

Abstract:

Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal injection (cessation of heartbeat, cessation of respiration, and dilated pupils) neither conform to current medical science nor to any standard of medical ethics. In practice, death is pronounced in China within tens of seconds after starting the lethal injection. At this stage, however, neither the common criteria for cardiopulmonary death (irreversible cessation of heartbeat and breathing) nor that of brain death (irreversible cessation of brain functions) have been met. To declare a still-living person dead is incompatible with human dignity, regardless of the processes following death pronouncement. This ethical concern is further aggravated if organs are procured from the prisoners. Analysis of postmortem blood thiopental level data from the United States indicates that thiopental, as used, may not provide sufficient surgical anesthesia. The dose of thiopental used in China is kept secret. It cannot be excluded that some of the organ explantation surgeries on prisoners subjected to lethal injection are performed under insufficient anesthesia in China. In such cases, the inmate may potentially experience asphyxiation and pain. Yet this can be easily overlooked by the medical professionals performing the explantation surgery because pancuronium prevents muscle responses to pain, resulting in an extremely inhumane situation. We call for an immediate revision of the death determination criteria in execution by lethal injection in China. Biological death must be ensured before death pronouncement, regardless of whether organ procurement is involved or not.

Keywords

execution by lethal injectionprisonersorgan procurementorgan harvestingmedical ethicsChina
Type
Special Section: Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Issue 3 , July 2018 , pp. 459 - 466
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Delmonico, F, Chapman, J, Fung, J, Danovitch, G, Levin, A, Capron, A, et al. Open letter to Xi Jinping, President of the People’s Republic of China: China’s fight against corruption in organ transplantation. Transplantation 2014;97(8):795–6.CrossRefGoogle ScholarPubMed

2. Caplan, A. The use of prisoners as sources of organs––an ethically dubious practice. American Journal of Bioethics 2011;11(10):1–5.CrossRefGoogle ScholarPubMed

3. The Transplantation Society. Policy & Ethics. n.d.; available at https://www.tts.org/index.php?option=com_content&view=article&id=11&Itemid=223 or https://archive.is/E2ZvB#selection-935.0-935.598 (last accessed 18 July 2017).

4. World Medical Association. WMA Statement on Organ and Tissue Donation. 2012; available at https://www.wma.net/policies-post/wma-statement-on-organ-and-tissue-donation/ or https://archive.is/up3Xt#selection-1049.0-1049.321 (last accessed 18 July 2017).

5. Paul, NW, Caplan, A, Shapiro, ME, Els, C, Allison, KC, Li, H. Human rights violations in organ procurement practice in China. BMC Medical Ethics 2017;18(1):11.CrossRefGoogle Scholar

6. Malone A. China’s hi-tech ’death van’ where criminals are executed and then their organs are sold on black market. Dailymail. 2009; available at http://www.dailymail.co.uk/news/article-1165416/Chinas-hi-tech-death-van-criminals-executed-organs-sold-black-market.html (last accessed 18 July 2017).

7. Zhao Y. Discussion on the issue of lethal injection standardization [in Chinese]. Journal of Yunnan University Law Edition [in Chinese] 2011;24(4):114–8.

8. See note 5, Paul et al. 2017.

9. Allison, KC, Caplan, A, Shapiro, ME, Els, C, Paul, NW, Li, H. Historical development and current status of organ procurement from death-row prisoners in China. BMC Medical Ethics 2015;16(1):85.CrossRefGoogle Scholar

10. Huang, J, Mao, Y, Millis, JM. Government policy and organ transplantation in China. Lancet 2008;372(9654):1937–8.CrossRefGoogle Scholar

11. World Medical Association. Chinese Medical Association reaches agreement with World Medical Association against transplantation of prisoners’ organs. 2007; available at http://www.wma.net/en/40news/20archives/2007/2007_07/ or https://archive.is/asKLR (last accessed 18 July 2017).

12. Pondrom, S. The AJT Report: China abandons international meeting, appears to continue practice of using prisoner organs for transplant. American Journal of Transplantation 2014;14:1952.CrossRefGoogle Scholar

13. See note 9, Allison et al. 2015.

14. Kerr L, Collins-Perrica D. Organ transplantation in China: concerns remain. Lancet 2015;385(9971):856.

15. Lavee, J, Jha, V. Organ transplantation in China: concerns remain. Lancet 2015;385(9971):855.CrossRefGoogle ScholarPubMed

16. Li, H, Shapiro, ME, Els, C, Allison, KC. Organ transplantation in China: concerns remain. Lancet 2015;385(9971):855–6.CrossRefGoogle ScholarPubMed

17. Trey, T, Sharif, A, Singh, MF, Khalpey, Z, Caplan, AL. Organ transplantation in China: concerns remain. Lancet 2015;385(9971):854.CrossRefGoogle ScholarPubMed

18. Allison KC, Paul NW, Shapiro ME, Els C, Li H. China’s semantic trick with prisoner organs. BMJ. 2015; available at http://blogs.bmj.com/bmj/2015/10/08/chinas-semantic-trick-with-prisoner-organs/ (last accessed 18 July 2017).

19. Trey, T, Sharif, A, Schwarz, A, Singh, MF, Lavee, J. Transplant medicine in China: need for transparency and international scrutiny remains. American Journal of Transplantation 2016; 16(11):3115–20.CrossRefGoogle ScholarPubMed

20. Juan S. Government seeks fairness in organ donor system for inmates. China Daily USA. 2014; available at http://usa.chinadaily.com.cn/epaper/2014-03/07/content_17331138.htm or https://archive.is/LVEGi (last accessed 18 July 2017).

21. See See note 9, Allison et al. 2015.

22. Bai J. Cessation of using organs from executed prisoners will not cause organ shortage [in Chinese]. People’s Daily. 2015; available at http://society.people.com.cn/n/2015/0128/c1008-26461244.html or https://archive.is/zc8bf#selection-627.3-627.65 (last accessed 18 July 2017).

23. Zhang Q. China Organ Transplantation Development Foundation: the use of prisoner organs has become history [in Chinese]. Beijing Youth Daily. 2015; available at http://big5.ce.cn/gate/big5/wap.ce.cn/szsh/201503/04/t20150304_4719641.html or https://archive.is/Jvguy#selection-291.2-291.83 (last accessed 18 July 2017).

24. Tatlow DK. China bends vow, using prisoners’ organs for transplants. The New York Times. 2015; available at http://www.nytimes.com/2015/11/17/world/asia/china-bends-vow-using-prisoners-organs-for-transplants.html (last accessed 18 July 2017).

25. Tatlow DK. Transplant chief in china denies breaking vow to ban prisoners’ organs. The New York Times. 2015; available at http://www.nytimes.com/2015/11/26/world/asia/china-organ-transplants-prisoner-donations-huang-jiefu.html (last accessed 18 July 2017).

26. China Organ Transplantation Development Foundation 1. Organ Transplantation Q&A 2016; available at https://archive.is/N3e3T (The original website has been modified; This is the archived content) (last accessed 18 July 2017).

27. Tatlow DK. Debate flares on China’s use of prisoners’ organs as experts meet in Hong Kong. The New York Times. 2016; available at http://www.nytimes.com/2016/08/18/world/asia/debate-flares-on-chinas-use-of-prisoners-organs-as-experts-meet-in-hong-kong.html (last accessed 18 July 2017).

28. See note 26, China Organ Transplantation Development Foundation 2016.

29. See note 7, Zhao 2011.

30. Liaoning Daily. Liaoning being the first province parting from shooting by switching completely to lethal injection [in Chinese]. China Daily. 2009; available at http://www.chinadaily.com.cn/dfpd/2009-12/10/content_9154119.htm or https://archive.is/p8r3r (last accessed 18 July 2017).

31. Li K. The US lethal injection debate and its revelation to China [in Chinese]. Social Scientist [in Chinese] 2010;2010(5):65–8.

32. Zhuang X. On injection death penalty [in Chinese with English abstract]. Journal of Southwest University of Science and Technology [in Chinese] 2005;22(4):24–7.

33. See note 6, Malone 2009.

34. Li X. Pharmacology of drugs used in execution by lethal injection [in Chinese]. 2009; available at http://xuewen.cnki.net/CPFD-YYWS201011002048.html or http://cpfd.cnki.com.cn/Article/CPFDTOTAL-YYWS200911001183.htm (last accessed 18 July 2017).

35. See See note 7, Zhao 2011.

36. Zimmers TA, Sheldon J, Lubarsky DA, Lopez-Munoz F, Waterman L, Weisman R, et al. Lethal injection for execution: chemical asphyxiation? PLoS Med 2007;4(4):e156.

37. Hu Q. Analysis of problems in execution of lethal injection by judicial police [in Chinese]. Intermediate People’s Court of Lu’an City. 2010; available at http://www.lafy.gov.cn/view/2781.html or https://archive.is/lPNRN (last accessed 18 July 2017).

38. XKB.com.cn. Deciphering lethal injection [in Chinese]. 2001; available at http://health.sohu.com/50/31/harticle15393150.shtml or https://archive.is/aiv9d#selection-983.2-995.84 (last accessed 18 July 2017).

39. Mao L. Eye-witnessing injection execution in Wuhan [in Chinese]. People’ Daily. 2002; available at http://www.people.com.cn/GB/paper83/8140/769688.html or https://archive.is/BF78q#selection-313.4-313.122 (last accessed 18 July 2017).

40. See note 37, Hu 2010.

41. Wikipedia. Legal death. 2017; available at https://en.wikipedia.org/wiki/Legal_death#Medical_declaration (last accessed 18 July 2017).

42. Koniaris LG, Zimmers TA, Lubarsky DA, Sheldon JP. Inadequate anaesthesia in lethal injection for execution. Lancet 2005;365(9468):1412–4.

43. See note 36, Zimmers et al. 2007.

44. See note 37, Hu 2010.

45. See note 37, Hu 2010.

46. PLoS Medicine Editors. Lethal injection is not humane. PLoS Med 2007;4(4):e171.

47. See Note 42, Koniaris et al. 2005.

48. See note 36, Zimmers et al. 2007.

49. See Note 42, Koniaris et al. 2005.

50. Koniaris LG, Goodman KW, Sugarman J, Ozomaro U, Sheldon J, Zimmers TA. Ethical implications of modifying lethal injection protocols. PLoS Med 2008;5(6):e126.

51. See note 46, PLoS Medicine Editors 2007.

52. See note 31, Li 2010.

53. See note 31, Li 2010.

54. See note 31, Li 2010.

55. Cai X. On injection death penalty problems and perfection [in Chinese]. Windows of Law [in Chinese] 2011;2011 Dec(12):12–3.

56. See note 55, Cai 2011.

57. See note 7, Zhao 2011.

58. See note 36, Zimmers et al. 2007.

59. See note 50, Koniaris LG, et al. 2008.

60. See note 7, Zhao 2011.

61. See note 31, Li 2010.

62. See Note 32, Zhuang 2005.

63. See note 37, Hu 2010.

64. See Note 32, Zhuang 2005.

65. See note 37, Hu 2010.

66. Huang J, Millis JM, Mao Y, Millis MA, Sang X, Zhong S. Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transplantation 2015;21(4):419–22.