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Views & Reviews Personal view

The price of life

BMJ 2007; 335 doi: (Published 01 November 2007) Cite this as: BMJ 2007;335:938
  1. Brendan D Kelly, consultant psychiatrist and senior lecturer in psychiatry (brendankelly35{at},
  2. Sharon R Foley, research registrar (sharonrachelfoley{at}
  1. 1Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2DETECT Service, Dun Laoghaire, County Dublin, Ireland

    On 31 January 2006 Jaime Elizalde Junior, a 34 year old Hispanic man, was executed by lethal injection in Texas. Elizalde, a welder, had been convicted of killing two men in Houston in the mid-1990s. He spent eight years on death row before being given an injection of thiopental sodium (to sedate him), pancuronium bromide (to collapse his lungs and diaphragm), and potassium chloride (to stop his heart beating). The injection cost $86.08 (£42; €60).

    In 2005 at least 2148 people were executed and another 5186 were sentenced to death in various countries around the world. Four countries were responsible for 94% of executions: China, Iran, Saudi Arabia, and the United States. A variety of methods were used, including hanging, firing squad, beheading, and lethal injection. Those put to death included adults, children, and individuals with intellectual disabilities. The prevalence of psychological distress and mental illness is high among prisoners on death row, who may have to wait for more than 20 years for their death sentence to be carried out.

    In Texas the average time spent on death row is just over 10 years, and the average age of executed prisoners is 39. Each prisoner is invited to make a last statement, which is then published, along with a photograph and details of their conviction, on the website of the Texas Department of Criminal Justice ( After viewing the website in early 2007 we did a systematic study of the themes and psychological constructs in these last statements (American Journal of Forensic Psychiatry 2007;28:7-14). We wanted to answer an apparently simple question: moments before the end of life, what does a person choose to say? We then examined the central themes and psychological constructs in all last statements made by 100 prisoners executed in Texas between April 2002 and November 2006. There was a notable similarity in dominant themes and psychological constructs evident in last statements from death row prisoners and suicide notes in the published literature. We concluded that there may be a convergence of psychological concerns at the very the end of life, regardless of circumstances of imminent death.

    Having completed our analysis, however, we were troubled by the depth of our interest in the topic and puzzled about the best way to present our results. Two specific issues presented particular concern. Firstly, what were our true motives for performing this study? To what extent should we permit our personal views about capital punishment to shape the writing of our paper? Our motives were particularly difficult to untangle. We are two practising psychiatrists living and working in one of the 122 countries worldwide that do not practise capital punishment (Ireland). No one in our families or extended families has been directly affected by capital punishment. By chance we had come across a newspaper story about death row in Texas and subsequently looked up the website of the Texas Department of Criminal Justice. At first glance we were astonished that the intimate, tragic last statements of executed prisoners were publicly available. On reflection, however, we realised that these were the last words that these prisoners would ever share, and from that perspective publication seemed not only intellectually defensible but, possibly, morally imperative. This added to our determination to complete our study.

    We printed out 100 last statements and spread them across the floor. We printed out the photograph of each prisoner along with details of their crime. Some colleagues happened on us, asked what we were doing, and immediately sat down with us. As we read through successive last statements we became increasingly intrigued, appalled, and affected. At times our study felt like an exercise in morbid voyeurism, modulated only by our increasing empathy for all involved: the victims of the crimes, the families of victims, the executed prisoners, and the families of executed prisoners, who were now doubly bereaved, having lost a family member firstly to a life of crime and secondly to capital punishment.

    We also realised that it is impossible to remove all traces of personal views from a paper dealing with a topic as emotive as capital punishment. One of us, for example, wanted to use the term “state sponsored killing” in place of “capital punishment,” but the more moderate coauthor warned (rightly) against excess emotionalism in a scientific paper. But it still seemed wrong to let such an important issue pass without comment. In the end we agreed that after our research paper was published we would write this essay to highlight the dilemmas we faced and to present in stark and—yes—emotive terms the unvarnished truth about state sponsored killing in the US and beyond.

    At the end of 2005 a total of 3254 prisoners were under sentence of death in 38 US states. Mr Elizalde was one of these prisoners, in Texas. Some months later, on the day of his execution, Mr Elizalde, like most prisoners facing execution, chose to make a last statement. And, like most last statements, his contained strong references to God, love, and hope. After thanking his friends and urging remaining prisoners to be strong, Mr Elizalde concluded his short, tragic life with these final words: “We talk about a reprieve or stay from the Supreme Court, but the real Supreme Court you must face up there and not down here. Keep your heads up and stay strong. I love you all. That is it. Stay strong. Thank you.” Thank you?

    To what extent should we permit our views about capital punishment to shape the writing of our paper?