The Wage of a Borrowed Profession

Someone is being paid for the use of a needle. What service, precisely, does this payment purchase for the society that provides it? On Thursday the answer in Tennessee was nothing. The state’s execution team, assembled to place an intravenous line in Christa Pike and carry out a sentence of death, did not succeed. Whatever one thinks of that sentence, a public office was funded, staffed, and convened to perform one act, and the act was not performed.

The obvious argument here is the abolitionist one, and I shall not make it. The question I wish to put is narrower and, I think, more uncomfortable for both sides. What is the function of an execution team, and what makes a payment to its members a fair return rather than a tribute exacted in the name of a service that cannot be inspected?

A profession, properly understood, is an arrangement by which a body of people is granted income, standing and a degree of trust on condition that it subordinates its own gain to a defined purpose and polices its own competence against that purpose. The physician is paid well. Society accepts this because the payment comes bundled with obligations: a duty to the patient, a body of standards, licensing that can be withdrawn, and liability when the standards are breached. The income is legitimate because it is the visible half of a bargain whose other half is accountability.

The execution team occupies the outward form of this arrangement and almost none of its substance. It handles cannulas and catheters; it borrows the vocabulary, the instruments and the reassuring sterility of the clinic. It does so, notably, in order to present death as a medical procedure rather than a violent one. Yet it serves no patient, since the person on the table is not one. It answers to no professional body, because the medical professions have largely declined to lend it their members. And it faces no malpractice suit of the ordinary kind, because the law of malpractice presupposes a duty of care, and here the duty runs in the opposite direction.

This is why the claim made by Pike’s lawyer and the medical experts, that the team’s conduct would be malpractice in any other setting, is both contested and beside the deeper point. The state may fairly reply that an execution is not a clinical encounter and cannot be judged by clinical rules. That reply should be accepted, for it concedes everything. If the team is not practising medicine, the state is paying for the appearance of medicine: the legitimacy of a profession without the profession’s discipline. It is buying the costume and not the craft.

The strongest defence deserves a hearing. The defender says the team’s function is not medical but judicial. It carries out a lawful sentence passed by a court, and its members undertake grim work that someone must do if the law is to mean what it says. On this view the failure was an operational lapse in a legitimate office, regrettable but no more damning than a surgeon’s bad afternoon. I do not think the analogy survives contact with the institutions. When a surgeon fails, there is a record, a review, a colleague with standing to ask what went wrong, and a patient’s family with a remedy. Whether “apparent incompetence” is the right description of Thursday is genuinely disputed, and I do not presume to settle it. But that it must be argued over in public by lawyers, rather than examined by any body competent to examine it, is the whole of my complaint. An office whose failures can be neither measured nor answered for has detached its income from its function, and that is the precise condition of wealth that serves nothing.

One must picture the scene to understand what this abstraction costs. A woman lies strapped to a table with her arm extended. Strangers in borrowed clinical dress search her skin for a vein that does not yield, while officials wait behind glass for a procedure to begin. Every person in that room is drawing a public salary. Only one of them is bearing the consequences of the work being done badly, and she is the one person in the room who was never offered a choice in the matter.

There is something almost comic, in the bleakest register, about the bookkeeping of it. The state will presumably settle its accounts for Thursday as it settles them for any other working day: hours logged, supplies drawn, personnel compensated. Somewhere in Nashville an invoice for a lethal injection that did not take place will be stamped as paid, and no line on it will record what was purchased.