DEAR DR. ROACH: I recall reading articles about prisoners who suffered horribly for minutes prior to dying, while undergoing a death sentence that was imposed on them for committing particularly serious crimes. Is there a medical reason as to why such prisoners can’t be put under a deep sleep before undergoing the death sentence procedure? — A.D.D.

ANSWER: Although I have also read and been horrified by the reports of suffering among death-row inmates, it is unethical for physicians to take any part in state-sanctioned killing. A physician’s role is to heal.

While I understand your humane desire to relieve people’s suffering, physicians should not place any intravenous lines, prescribe or administer lethal drugs, or provide advice on how to kill a prisoner, even if the goal is to reduce suffering. This is the position of the American Medical Association, the American Psychiatric Association, and the American College of Physicians. I am in complete agreement with this ethical guideline.

DEAR DR. ROACH: I wear a smart watch, and a few times now, it has alerted me that my heart rate is below 45 bpm. This has only occurred when I’m in my recliner, relaxing and starting to nod off.

I am a 61-year-old male who jogs 3 miles approximately three days a week. I also do “chair exercises” at the local senior citizen center twice a week. When I am out for a jog, my heart rate averages in the 140s-150s, so I don’t feel like I am pushing myself too hard.

Should I be concerned if/when my resting heart rate falls below 45 bpm? Other times when I’m in the recliner watching TV or just reading, it has hovered in the low 50s. When is a low heart rate too low? I should probably mention that I’m 6 feet, 3 inches tall and weigh 190 pounds. — T.M.

ANSWER: In general, a low heart rate is too low when it is causing symptoms such as fatigue, lightheadedness or fainting. Heart rates in the 40s are not unusual for trained athletes, especially when they’re asleep, so I would not be concerned at all in your case.

I have had patients with the same story, except that the heart rate gets into the 30s and, on one occasion, the 20s. Even though these patients did not identify any symptoms, my cardiology colleagues still advised a pacemaker for this extremely slow heart rate.

After the pacemaker was placed, the patients did note that they felt a lot better. It turned out that they thought they were just getting old when, in fact, it was the slow heart rate that was keeping them from doing the things they wanted to do. It just happened so slowly that it was hard to notice.

It is true that as we get older, many different parts of the body don’t work the same way they did when we were younger. But a physician should think twice — or even three times — before blaming a patient’s symptoms just on their age.

Finally, even though your weight is appropriate for your height, a slow heart rate during sleep should make a physician think about obstructive sleep apnea. People of any age and size can get sleep apnea. The STOP-Bang (Snoring, Tiredness, Observed stop of breathing during sleep, high blood Pressure, BMI over 35, Age greater than 50, Neck size greater than 40 centimeters, and the male Gender) score can help identify your risk for sleep apnea. If you meet three or more (especially over five) of these criteria, a sleep study should be considered.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved