The Fence Around the Needle

There is a fence that runs between the physician and the executioner. It is old, older than any statute in Tennessee, and the reformers of the last century found it inconvenient. They wanted the gallows replaced with something that looked less like a gallows, and the only thing in modern life that looks gentler than death is medicine. So they borrowed medicine’s furniture: the gurney, the cannula, the steady hand at the inner elbow. Before we agree that this was progress, we ought to ask why the fence was there, and what happens to a man who climbs over it carrying only half his luggage.

On Thursday, Tennessee’s execution team failed to carry out the lethal injection of Christa Pike. The IV team could not do the one thing it was assembled to do. Pike’s lawyer and the medical experts consulted afterward have said, in effect, that what happened in that room would be called malpractice anywhere else. The state’s defenders will reply, and they will be right, that the charge is a category error. Malpractice is something done to a patient, and Christa Pike was not a patient. Nobody in that room was trying to make her well. You cannot negligently fail to heal a person you are there to kill.

That reply is the strongest thing that can be said for the state, and I wish to give it its full weight, because it carries a confession. If the work is not medicine, then the state has no business wearing medicine’s clothes. It cannot use the needle because the needle looks merciful and then hide from the standards that come with it. A man who borrows a surgeon’s coat for the dignity of the thing has no right to complain when he is judged as a surgeon. The defenders want the procedure to look clinical to the public and to count as non-clinical in an argument. Those cannot both be true.

Here is the paradox, and it resolves the moment you stop looking at the gurney and start looking at the fence. The professional bodies of medicine keep their members out of the execution chamber, and the reformer finds this squeamish. Let the doctors in, he says, and there will be no more fumbling, no more failures, no more Thursdays like this one. He has not asked why the fence was built. It was not built to protect the condemned. It was built to protect everyone else: the frightened child in a hospital in Memphis, the old woman in a clinic in Knoxville, every person who has held out an arm to a stranger with a needle and trusted that the stranger’s whole training, oath and habit pointed one way. A healer is valuable because his hand cannot be hired for the opposite purpose. Take away that impossibility and you have not added a skilled executioner. You have subtracted a trustworthy doctor, and the loss falls on people who have never been near a death row.

So the fence stands, as it should, and the state builds its imitation clinic just outside it. The people it staffs that clinic with are, by design, not the people medicine would send. I do not know why this particular team failed. “Apparent incompetence” is a contested description, and there are other possibilities: a hard vein, a body that did not cooperate, a procedure whose ordinary difficulties nobody had honestly described in advance. But even the most charitable explanation brings us to the same spot. The state has built a job that demands a clinician’s skill and forbids a clinician’s presence. It is like requiring a priest to perform the wedding and then forbidding any priest to attend. What you get is a man in a borrowed collar, reading the vows from a card, and the marriage goes wrong in ways that no real priest would have allowed.

The older methods were terrible, and I do not miss them. But they were at least honest about what they were. A rope never pretended to be a remedy. The modern method’s peculiar cruelty comes from its disguise. It has the vocabulary of healing and none of the craft, so when it fails, it fails in a costume that makes the failure look like neglect instead of what it really is, a contradiction.

Tennessee has two honest choices. It can admit that it is not practising medicine and give up the costume, or it can admit that it cannot do this cleanly and give up the act. What it cannot honestly do is keep a woman lying on a gurney while strangers in borrowed scrubs search her arm for a vein, and call the search humane.