Complicit in killing

Florida recently performed the first U.S. execution involving an anesthetic called etomidate. The execution prompted a rebuke from the company that invented the drug: Janssen Pharmaceuticals (now part of Johnson and Johnson) is not currently among the drug’s eight producers, but stated, “We do not support the use of our medicines for indications that have not been approved by regulatory authorities.”

The company’s objection can’t be simply that execution is an off-label use for the drug, since off-label prescriptions (using a drug for reasons not officially sanctioned by the Food and Drug Administration) are common. A 2008 Stanford study found that doctors often prescribe Janssen’s anemia drug Procrit for off-label uses. Almost 10 years later, those uses remain popular, though they are still officially unapproved.

The anti-death-penalty group Reprieve collects on its website comments from drug companies, each expressing shock and horror that products conceived for healing are instead used for harm. The companies say they will refuse service to any customer or reseller linked to executions: Reprieve stated that with Pfizer’s 2016 decision to prohibit use of its drugs in executions, “all FDA-approved manufacturers of all potential execution drugs … have blocked their sale for use in executions.” While I find some of Reprieve’s commentary silly from a medical standpoint—yes, certain anesthetics hurt briefly during injection; no, that doesn’t mean I’m torturing my patients by giving them anesthesia—its argument that drug companies should refuse to participate in killing intrigues me.

But, following that logic, why stop with executions?

Neither surgical abortions nor medical (pill-based) abortions take place without the help of drugs. Our pharmaceutical industry has now decided that condemned felons merit protection from its products. It claims it will not stop at verbal complaints but will even go to court, as McKesson Corp. did in April in an attempt to stop executions in Arkansas. So, let’s encourage the drug industry to stop the killing—by refusing service to any facility that performs abortions.

Since drugmakers have decided to ban sales of their products for a particular legal purpose … they can no longer claim neutrality.

Drug companies that object to such an abortion boycott cannot complain they’re the equivalent of “common carriers”—a term the technology world uses to describe a neutral party that transports data or products without making ethical judgments about them. (The Postal Service is a good example of a common carrier, as are phone companies.) Since drugmakers have decided to ban sales of their products for a particular legal purpose—execution—simply because they disapprove of it, they can no longer claim neutrality.

Hospitals would surely complain that a no-abortions policy would interfere with legitimate uses of the drugs in question, since drugs used for abortions are also used in nonabortive medical procedures. But we can take the same position as the European Union, which bans exports of any drug found to be used for lethal injection: The end user must guarantee that the drug will not be used for killing. (This EU ban explains why the United States no longer has a source of the anesthetic sodium thiopental, which previously came from Italy and was used in U.S. executions.)

If a given hospital wanted to re-establish the flow of medication, it could do so simply by stopping abortions. Then the drugs would be available for the kind of medical care that heals instead of kills.

Idealistic? Absolutely. But surely Reprieve itself would have thought its own position to be equally idealistic only a few years ago. I never would have imagined a day when a drug company would sue to control how its products are used. That day is now here.

McKesson and Janssen declined to comment for this article.