Why be in such a hurry (to kill someone)?

Once again, I find myself straying into a political issue (although I’d argue that it’s more a human rights issue). I understand that I’m probably in the minority in this country in my opposition to the death penalty. My fellow Americans generally vote to allow it, and my vote only counts once. One area where my opinion my carry a bit more weight (or maybe not) is in the area of medical ethics. Given that the death penalty is legal in the U.S., what role should doctors play?

Troy Anthony Davis is a guy that Georgia wants dead so badly that they can’t be bothered to wait for the U.S. Supreme Court to weigh in (SCOTUS is scheduled to discuss the case on the 29th, six days after the state kills Davis).

But here’s the part that really gets me as a physician (from the Atlanta Journal Constitution):

After that, Davis is to be given a routine physical and a last meal. Davis has not requested anything special and is to be served a regular prison meal, Czachowski said. He will then be given the opportunity to record any statement he wishes to give and, an hour before his scheduled execution, will be offered a sedative, the spokesman said.

There is nothing “routine” about this medical exam. After all, the patient has a soon-to-be fatal condition; the doctor knows both how and when the patient will die. As a physician, if I know how and when someone will die, and the patient wishes to avoid this fate, I have a duty to help him. This doesn’t mean that I have a duty to help the state make it easier to kill him, or to make the process smoother. It means that I am duty-bound to help him avoid a preventable death (and no matter what the law says, it is preventable.) There is no principle of medical ethics that allows me or any other doctor to ethically participate in any facet of an execution. Doctors who do this “wet” work can try as hard as they wish to justify it but there is no escaping it—-doctors are ethically forbidden to participate in executions (beyond their other societal roles, that is, they can ethically vote to support it, condemn someone on a jury, etc.).

This certainly puts states in a bind. If a medical person isn’t supervising the execution, it may not go painlessly and smoothly. Well, that’s hardly our problem as doctors; it’s the State’s problem. Maybe this conundrum tells us something about the ultimate morality of the death penalty. It can’t be done “humanely” without a medical professional, and it can’t be done ethically with a doctor.

I’ve always suspected the real role of a doctor in executions is to make the participants (other than the condemned) feel better. After all, if you’re killing someone, and you’re not a beast of a human being, you don’t want to see them suffer, or to feel you are the agent of their suffering. A doctor’s presence removes some of the discomfort involved in killing another human being.

And places it squarely on the doctor’s shoulders (and conscience).

Think hard, my fellow doctors—are jobs so scarce? Is this what you signed up for?


Comments

  1. Marilyn Mann

    What is currently before the Court is whether or not to grant Davis’s petition for writ of certiorari (few such petitions are granted). His lawyers have asked the Court to issue a stay.

  2. minimalist

    I think you may be on to something about the doctor’s real role in an execution. That JAMA Commentary article you linked to concluded with the following passage:

    Physicians who are asked to assist in capital punishment should remember that transgressions against ethical obligations may evoke sanctions against their licenses by state medical boards and elicit disciplinary actions against membership by their medical societies.

    Shouldn’t they then get more serious about enforcing this? Start to more aggressively promote their position and remove the figleaf of respectability that the executioners try to claim.

    Seriously, even if a pro-death penalty doctor doesn’t (want to) see it as promoting suffering, you at the very least have a “treatment” that doesn’t work and is 100% fatal, and since when is that not grounds for action? Heh.

  3. My abhorrence of the death penalty actually comes from military service. Once your enemy loses the ability or the will to harm you, you lose the right to harm them.

    The idea of a group of men taking an unarmed man out of a cell and killing him nauseates me. That this is done under the color of authority makes the deed no less reprehensible.

  4. “Once again, I find myself straying into a political issue (although I’d argue that it’s more a human rights issue).”

    Are you kidding? Nowadays, this blog seems to be all about politics, and little else. The occasional post mentions this thing called “denialism,” but I’m not really sure what that is or why you let it distract you from the obvious raison d’etre of this blog: to do over again what a million other political blogs did before.

    Subscription…cancelled.

  5. AtheistAcolyte

    If, in the absence of medical doctors to oversee a medical procedure, the state regresses to execution by firing squad, and this will invariably cause pain to the condemned, wouldn’t medical supervision of a painless procedure be ethically preferable to riddling a body with bullets?

    At which point, we’ve gone back to where we were. Without the abolition of the death sentence (on which I’m not disagreeing with you in the slightest), shouldn’t doctors be participating in the least painful method, lest more painful, clumsy methods be used? I realize this sounds sort of like extortion, but such is the way of the legal system.

  6. Excellent points and discussion that MUST go further, please! Thank you all!

    Perhaps some or all of you would attend the below-mentioned picket tomorrow – tuesday – or would contact/speak with other medical professionals at “the company” that performs Georgia’s state killing?:

    from latest URGENT action alert by GFADP Georgians for Alternatives to the Death Penalty
    http://www.gfadp.org

    10am – picketing of Rainbow Medical Associates at their building –
    2840 Emerald Drive, Jonesboro, GA 30236.
    Rainbow Medical is paid $18,000 per execution. They are a private
    company that provides the physicians, nurses, pharmacists and other
    implementers of Georgia’s executions, despite the employee’s
    professional sworn commitment to the Hippocratic Oath (“do no harm”)

    Please meet near 2840 Emerald Drive, outside Rainbow’s driveway or
    carpool from Poncey-Highlands. Carpooling meet-up site: 9am – Manuel’s Tavern, 602 N. Highland Ave. (corner of North Ave.), Atlanta, GA 30307

    ***

    I hope you can and will!! And please, please carry this forward. We must stop this perversion of medical knowledge, and licensing!

  7. Paul Murray

    “There is nothing “”routine” about this medical exam. After all, the patient has a soon-to-be fatal condition;”

    True, but the fatal condition is not a medical one. How about sports doctors? Their patients are about to get concussed and bruised – what’s their ethical responsibility?

    Perhaps the solution is for the execution doctor to exercise his responsibility, to – on medical grounds – order that the injection (or electrocution) must not proceed *on the grounds that it will kill his patient*. That puts responsibility firmly back where it belongs. Will the state continue with this procedure, having been forbidded to do so by the condemned’s physician on medical grounds?

    And as for human rights not being a “political” issue, it’s a nice orwellian trick of them, isn’t it, to equate a word meaning “to decide on what the government should do with its power” with “something dirty that nice people don’t do”. Of course human rights is political.

  8. There was an interesting documentary about the death penalty on British TV a while back. It featured a British conservative politician searching for the most humane method of execution. The most chilling thing is the reaction at the end of Robert Blecker, the pro death penalty activist after a ‘humane’ solution was offered.
    Its in five parts on youtube.
    http://www.youtube.com/watch?v=Do9VLZCHlN0

  9. “If a medical person isn’t supervising the execution, it may not go painlessly and smoothly. Well, that’s hardly our problem as doctors; it’s the State’s problem.”

    I disagree and disagree strongly – it is not the state’s problem – it is the condemned’s problem. Recent evidence suggest that problems with the administering the cocktail of drug used in a lethal injection has resulted in several prisoners being conscious (while under a paralytic agent) when the Potassium Cholride is adminsitered. This results in the condemned dying a horribly painfull death. It’s possible that incorrect preparation or adminstration of the knock-out drug (Sodium thiopental) by poorly trained staff may result in an agonising and far from humane death.

    Many people may not cry over the painfull death of a death row inmate, but I’d argue that a plethora of evidence suggests a non-zero chance of many death-row inmates being wrongfully convicted of crimes, meaning that not only are we putting innocent people to death, but putting innocent people to a horribly painfull death.

    So what’s a doc to do? I wish I had an answer, but I don’t. But the needless suffering caused by non-medically trained personel in lethal injection executions points out that there may be some room to insert a medical practitioner. Since at the hour of execution, the condemned is well… condemned, one could argue that by helping with the execution, one is reducing the chance of needless suffering.

    Is this ethical? Once again, I wish I had an answer. Since I don’t work in medicine, I’m not competant to make a call. That said, I don’t see things being quite so black and white as Pal does… but he has alot more experience in medical ethic than I do.

    Just for the record I should point out that I find the death penalty abhorrent, barbaric amd I oppose it in every way, even for those convicted beyond doubt of the more heinous crimes.

  10. A guy who murders the family of a 14 year old girl, rapes her on top of their bodies and then murders her is not going to get a whole lot of sympathy from me about a few minutes of pain before he dies.

    But this guy is arguably innocent and everyone knows it. Yet Georgia officials, the governor, the court, prosecutors (of course) … all of them refuse to act or even delay. And the Supreme Court refuses to hold a hearing BEFORE his scheduled death. What are they gonna say afterwards? Oops? As far as I’m concerned, if they execute a man for whom there is reasonable doubt of his guilt, and who later is determined to have been innocent then ALL of them are guilty of (at minimum) negligent homicide and (preferably) first degree murder.

    It should be impossible to apply a death penalty in any case that is entirely circumstantial. Impossible.

  11. There are two excellent books describing the problems with the death penalty: Wendy Kaminer’s “It’s All the Rage” and Barry Scheck’s “Actual Innocence.”

    I recall, several years back, that a man on death row in Texas was too psychotic for them to kill!? The authorities wanted him sufficiently medicated so that he could be killed. As I recall, no doctor there would do it (which impressed me); but an out-of-state doctor offered to help. I do not recall the outcome.

  12. There is nothing “”routine” about this medical exam.

    What the heck are they looking for in the exam anyway? (Well, you were scheduled to be executed tomorrow, but your blood pressure is 200/120 and we’ll have to take care of that first and do a work-up for secondary causes so that you can die perfectly healthy. The execution can be postponed and performed as an outpatient…)

    After all, the patient has a soon-to-be fatal condition

    Soon to be fatal, but generally extremely treatable. The condemned, after all, probably has good cardiac, renal, and hepatic function. His or her immune system, lungs, and gastrointestinal tract are probably working reasonably well. Brain function may be a little arguable, but that’s hardly a lethal condition, usually. All that has to happen for the person in question to live another 10, 20, or more years is simply for the state to not inject a lethal chemical into their veins. Just don’t do anything incredibly stupid and their bodies will take it from there. And these screw-ups can’t even handle that!

  13. A guy who murders the family of a 14 year old girl, rapes her on top of their bodies and then murders her is not going to get a whole lot of sympathy from me about a few minutes of pain before he dies.

    You mean like that guy (or was it those guys) in Iraq a while ago? I don’t think that they got the death penalty. In fact, they might well have gotten a medal for their actions.

    And, as others have pointed out, the false positive rate for convictions is quite high. Would you be satisfied with a 1 in 7 false positive rate, when false positives were fatal, in any other situation?

  14. As far as the whole “medical exam” thing goes… are you kidding me? Get a doctor or even a CRNA to administer the lethal injection, but why waste time doing a history and physical on a “dead man walking.” It’s like doing a complete physical exam on a terminal hospice patient who’s death is imminent. What’s the point? What are you POSSIBLY going to find something on a physical exam or in the patient’s history that’s going to change the outcome or in any way prevent pain and suffering? Just anesthetize him and kill him. Pretty simple, isn’t it?

  15. I think that a doctor should be able to choose to not administer the physical exam for a soon to be executed prisoner based on ethics to the exact same extent that a Pharmacist can choose not to administer drugs which may cause a human life to end.

  16. One can’t oppose the death penalty because of its “brutality”; it won’t make one bit of difference politically whether or not a death penalty victim dies peacefully in a drug-induced sleep. People die every day in horrible ways, and making death penalty subjects more comfortable before execution will not alter political realities. The sole reason for opposing the death penalty is that it can never be determined with 100% certainty that all death penalty subjects are guilty of the crimes charged. No matter how careful the litigation and how certain the evidence, with the death penalty, in time, innocent people will die. The only responsible alternative to the death penalty is incarceration for life without possibility of parole (absent new exculpatory evidence).

  17. Touchy subject, but well addressed. Thanks for sharing.

  18. William the Coroner

    Something I have thought about, and touches on my area of expertise (time to death, pain and suffering) and research.

    I disagree, I can think of a couple of methods that would cause instant death without pain or suffering. Hanging, when done in the manner the UK used to do it MOSTLY worked. A large enough projectile transecting the brainstem will (think 12 ga. slug) kill quickly.

    The problem though, is the quick painless deaths are oogie, and all the others provide a less oogie, more deniable (wasn’t me that killed him, I had the blank, dummy switch, etc) but may not be certain.

    Personally, if you’re gonna do it, do it. If you can’t stand to do it with out making it nice and clean, don’t.

  19. minimalist

    I am not a physician, but I imagine that one reason for the pre-execution physical might be to help make sure there won’t be an adverse reaction to the anesthetic. Given that the whole figleaf revolves around “making sure the execution is humane and painless”, accidentally killing the inmate with a painful heart attack or allergic reaction to the anesthetic kind of undermines that.

  20. warning: geekiness ahead (sorry, it seemed a good parallel)

    I’m not sure that making executions “cleaner” doesn’t make them easier for people to justify it. Reminded me of this old Star Trek episode:

    http://en.wikipedia.org/wiki/Eminiar_VII

    “The landing party soon discovers that the entire war between the two planets is completely simulated by computers which launch wargame attacks and counterattacks, then calculate damage and select the dead. When a citizen is reported as “killed”, they must submit themselves for termination by stepping inside a disintegration booth. Anan 7 informs Kirk that the simulated attacks and following executions is the agreed system of war decided by both sides in a treaty with Vendikar. A conventional war was deemed too destructive to the environments and societies of both planets.”

  21. I too have long wondered on the fascination with ensuring a “humane” death.

    Whiskey. Tango. Foxtrot.

    How exactly is a few minutes of even excruciating pain remotely comparable to being dead the rest of your life? I remember a “botched” execution 10 or 15 years ago, in which the voltage was set wrong or something, and smoke was coming off the prisoner’s head before he died. There was much to-do in the papers. ZOMG! We nearly set him on fire before we killed him.

    Anyway, if we really wanted a painless death, anyone who’s had cryogenics or confined spaces training will tell you it’s very very easy. Suffocation by oxygen deprivation is completely painless and happens without warning. Small sealed room, K-bottle of dry nitrogen, and a regulator. Turn the knob and wait.

    So no, I don’t think we (as a society) truly want a painless method for the death penalty, or we’d do it that way. I mean c’mon, we used poison gasses for years, don’t tell me nobody considered nitrogen. No, we want the appearance of being civilized and humane about it, but we still needs us at least a little spectacle. Apparently it’s not about deterrence after all, is it?

  22. I certainly believe that the way the death penalty is admimistered today is borderline insane, especially with the differences between states. Hard to believe the criminals in Texas need that much more killin’ than those in other states. The statistics on the race of the executed are depressing at best.

    But every time I’m ready to come down fully against the death penalty, some @$$hole comes along who just can’t be dealt with any other way.

    A few years ago it was Timothy McVeigh. Killing kids to make a political statement is an act that deserves death. Knocking off Mohammed Atta sounds like a good idea, since he’s the only living 9/11 hijacker we managed to put our hands on, but even that could be a triumph for his martyrdom-glorifying ideology.

    So I see the necessity for the death penalty, but I would like to see it much more rare, and more uniformly applied across the country.

  23. Well okay, let’s talk about Timothy McVeigh, Frodo. Sure, he deserves death. Many that live deserve death. And some die that deserve life. Can you give it to them? Then be not too eager to deal out death in the name of justice…

    My question is what do you achieve by killing a McVeigh? It doesn’t unkill the people he killed. The death penalty clearly didn’t stop him, so it’s not an effective deterrent (as further shown by any number of more statistically sound studies). So really its only purpose is to make us feel better by being able to pump our fists in the air and go “Hah! We showed you!”

    And I contend that making ourselves feel good is never an acceptable reason to kill someone.

  24. “Knocking off Mohammed Atta sounds like a good idea”

    Uhh, he’s dead. I think you mean either Khalid Sheikh Mohammed or Ramzi Binalshibh.

  25. Let’s put executions on television! I’m sure the ratings would be swell! Now there’s a reality television show with something worth tuning in for!

    The whole notion of humane execution is, of course, ethical insanity. I’ve opposed the death penalty since I was old enough to understand that the courts are anything but unbiased or infallible. The evidence that is turning up daily of wrongful imprisonments and executions should have a chilling effect on this country’s continued blood-lust, but then one might think that the number of accidental shootings and shootings of by-standers, and shootings of the victims of crimes, etc., would give pause to a few people who fight tooth and nail against any sort of firearms control. And basically neither of those things seems likely.

    So putting executions on television seems like the perfect solution. If after a few dozen or so have been shown (preferably in hi-def, of course), there’s no general outcry for repealing the death penalty permanently, at least we’ll know where we stand. Auckland, here I come.

  26. Putting aside, just for a moment, the more fundamental (and necessary) discussion about whether the death penalty is ethical for certain crimes. I think the stories we hear about prosecutorial misconduct and coerced testimony should have instigated a moratorium on the death penalty in this country a long time ago. An interesting story about the lack of thoroughness in police investigation is here.

    If you are going to kill someone, you better make damn sure they fucking did it in the first place. I don’t think that’s an unreasonable request. When I hear someone like Nancy Grace never lost a case, frankly, it scares me.

    As to whether or not doctors should or should not assist in executions- why? I see no point in enlisting doctors in the first place. I admit I have no experience here, but killing people is not a skill you need extensive schooling for. I like to think doctors treat people for illness. Period. If they’re running around doing something else, I’m not entirely that’s in the license society grants them to otherwise manipulate the systems of human beings.

  27. doctorofwhat

    LSU Medical School Alum to be involved in GA execution, story from LSU’s Daily Reveille –
    http://www.lsureveille.com/lsu_medical_school_alum_to_be_involved_in_ga._execution_4_17_p.m.

    An LSU School of Medicine alumnus is involved in a potential execution tonight in Georgia.

    Dr. Carlo Russo, a 1986 graduate, is the president of Rainbow Medical Associates, a limited liability company contracted with the Georgia Diagnostic and Classification Prison in providing medical physicians to oversee state executions.

    “Dr. Larry Hollier, Chancellor of LSU Health Sciences Center New Orleans, says that Dr. Carlo Musso is a graduate of the LSU School of Medicine and an active member of the LSU Medical Alumni Association,” LSUHSC said in a statement to The Daily Reveille. “We do not know anything about a case in Georgia and therefore cannot provide any information about it.”

  28. Hey, I just devised an easy answer to the ethical issues entailed in the death penalty, which I shall proceed to detail:

    Abolish it.

    Anyway, Troy Davis’ execution has been suspended until the 29th, which should work out somewhat better�

  29. I have no idea why they just don’t use CO, or even just Nitrogen alone (To make it a bit safer for the witnesses). Anoxia is by all accounts painless and relatively quick.

    And it is pretty low tech – pretty easy to not involve medical folks at all.

    (BTW, I am personally opposed to the death penalty, but if you *are* going to do it, do it not “cruel or unusual” -ly

  30. doctor of what

    I don’t think most people know that vetrinarians in the USA bar the death cocktail used for humans, considering it inhumane for animals. So what kind of doctor says ok to putting a person to death when there are less cruel and unusual ways?

  31. Tsu Dho Nimh

    I have serious problems with the death penalty. A high school classmate spent several years on death row in the 1970s or a brutal murder he did not commit.

    He was framed by the real murderers who claimed to have seen him running from the scene, and railroaded by the cops because … it was an election year, he was Hispanic, he was a big, strong enough to have done what was done to the body, admitted to having walked that route, and they had a heavy work load. So what if he didn’t have any blood on his mostly white work clothes, or any damage to his hands and the victim was very bloody and put up one heck of a fight. They had witnesses.

    Eventually the real perps were caught when they did something and the victim’s wallet was found hidden under the floor in their house. Unlike Texas, Arizona has no problem with realizing the witnesses lied and they released him.

    But he was one appeal and a few months away from the gas chamber.

  32. But the needless suffering caused by non-medically trained personel in lethal injection executions points out that there may be some room to insert a medical practitioner.

    No. There is not. It is utterly against the oath physicians take and against the physician’s code of ethics. Period. This is one of the few areas of medical ethics where things really are pretty darned close to black and white.

  33. Anyway, if we really wanted a painless death, anyone who’s had cryogenics or confined spaces training will tell you it’s very very easy. Suffocation by oxygen deprivation is completely painless and happens without warning.

    Painless it may be, but not necessarily that quick. At least, unconsciousness is nowhere near instantaneous; it could be a minute or more before consciousness is lost. It’s also certainly not without suffering, as this means of death is in essence suffocation. Victims will breathe very rapidly and begin to panic before they are rendered unconscious. I’m not even sure I like it that much for lab mice, having watched their euthanasia on many occasions using CO2. I think you’re confusing slow suffocation, in which the oxygen supply is slowly depleted, with rapid displacement of oxygen with an inert gas.

  34. I don’t think most people know that vetrinarians in the USA bar the death cocktail used for humans, considering it inhumane for animals. So what kind of doctor says ok to putting a person to death when there are less cruel and unusual ways?

    Indeed. Having recently had the very sad and painful experience of having to have my beloved dog put to sleep for metastatic and incurable cancer, while holding the dog for the euthanasia procedure I was amazed at how fast the veterinary cocktail worked. My dog was unconscious before the vet had even finished injecting all of the euthanasia cocktail and dead within seconds after that.

  35. Black Americans are jailed at the rate of three thousand per hundred thousand whereas South Africa managed to preserve apartheid by imprisoning 729 black males per 100,000.
    Paul Kennedy, “Preparing for the Twenty-first Century.”

    Georgia and her Southern sister states consistantly rank in the lowest quartile for quality of life issues like access to healthcare and educational opportunities. The one area in which these states excell all others is in assisting a growing number of unfortunate, and all too often minority, citizens in shuffling off their mortal coil.

  36. YouSupport AbortionDoctors

    Wow, another holier than though supporter of baby killers.

    You support doctors who perform abortions.

    And stem cell research.

    After all, if aborted fetal hearts lower cholesterol, why not market them after obtaining the appropriate FDA approval.

    You have no rhyme or reason to your viewpoints, other than “how can I justify the typical leftest stances with selective recitation of what I learned in medical school.”

  37. Orac,

    please excuse me for being thick, but your answer was less than illuminating. Could you please elaborate?

    YouSupport AbortionDoctors

    Your are trolling. Your rant is off topic and has nothing to do with the current thread. If you want to contribute, contribute something usefull. Otherwise go away.

  38. YouSupport AbortionDoctors,

    You are an unmitigated waste of a human being.

    Dear God, all the abortions in all the world, and you miss this asshole.

  39. Just for the record, if I knew what an “abortion doctor” was, I could tell you whether or not I support them. I’m certainly proud of my OB/Gyn colleagues who perform needed procedures in the face of physical threats and intimidation.

  40. I clicked on the link to the amnesty site, where Mr Davis’ picture can be found. Imagine my total lack of surprise on discovering that the man condemned to death in Georgia on the flimsiest of evidence is black. Or am I being all cynical and British about this?

  41. The sole reason for opposing the death penalty is that it can never be determined with 100% certainty that all death penalty subjects are guilty of the crimes charged.

    It’s not the sole reason. It’s not even close to the best reason.

  42. First, apologies for my post & run.

    Second, sorry for mixing up my terrorists. I was thinking of Sheikh Mohammed, not Atta.

    Lastly, Johnny asked “My question is what do you achieve by killing a McVeigh?” (not that he waited for MY answer, but…)

    What you accomplish is that he’s out of the public awareness. He’s not writing books in prison and stating his lack of remorse. He’s not serving as a living role model. And most of all, there is absolutely no possibility of him ever rejoining a free human society that he forfeited his place in.

    If it makes some other right-wingnut double-clutch before he pulls his own trigger, great, but amy deterrence is just a bonus.

  43. Marilyn Mann

    I see the U.S. Supreme Court issued a stay of execution on 9/23. The stay will dissolve automatically if the Court declines to consider the case.

  44. Death is poor deterrence for people with a martyr complex. The threat of death is constantly implicit in the profession of espionage, for example. Did the world’s spies disappear? No.

    The death penalty similarly cannot deter the heinous crimes of serial killers, who are compelled by mental defect (whether or not it’s acknowledged by the court) to go out and kill.

    The Death penalty is only a truly deterrent force when applied to more minor crimes, where the payoff is well below the acceptable risk level, but even then people will still offend, just ask the Taliban.

    The idea that it is acceptable to kill people just to “get them out of the way” in this perverse and often baffling out-of-sight-out-of-mind mentality is shortsighted and immoral. The death penalty serves little real purpose beyond revenge as it is applied. Even though I feel that the death penalty may apply effectively to certain crimes, 99.9999% of the time I can guarantee you it has no significant effect. People are still getting executed in Texas, right? Or is it that they just haven’t had time to kill all of the bad apples off? Is it the Supreme Court’s fault for enforcing those pesky rules of evidence?

    Ah denialism, do you know no topical bounds?

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