Should Physicians Participate in Executions?
General Reference (not clearly pro or con)
Mark Bratton, Anglican and Senior Chaplain at the University of Warwick, England, and David Metcalfe, medical student at the same university, in a July, 2007 Student British Medical Journal essay titled “Doctors and the Death Penalty,” in reference to the Hippocratic Oath, wrote:
“The first principle of the Hippocratic tradition is that doctors should do no harm. Although at first sight this principle seems irreconcilable with the death penalty, doctors have historically justified their conduct in terms of ensuring a painless and humane death for the prisoner.”July 2007 - Mark Bratton, PhD David Metcalfe
Howard Markel, PhD, MD, Director of the Center for the History of Medicine at the University of Michigan Medical School, wrote in his May 13, 2004 article, “‘I Swear by Apollo’ – On Taking the Hippocratic Oath” that appeared in the New England Journal of Medicine:
“Although many scholars dispute the exact authorship of the writings ascribed to the ancient physician Hippocrates, who probably lived sometime between 460 and 380 B.C., the oath named for him is simultaneously one of the most revered, protean, and misunderstood documents in the history of medicine…
[N]early every U.S. medical school will administer some type of professional oath to its share of about 16,000 men and women who are eager to take possession of their medical degrees. Yet it is doubtful that Hippocrates would recognize most of the pledges that are anachronistically ascribed to him…
There are two highly controversial vows in the original Hippocratic Oath that we continue to ponder and struggle with as a profession: the pledges never to participate in euthanasia and abortion.”May 13, 2004 - Howard Markel, PhD, MD
The National Institutes of Health offer a 1595 Greek and Latin version of the ancient Hippocratic Oath on their website (accessed Aug. 5, 2008):
“I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract…
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
In purity and according to divine law will I carry out my life and my art.
I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.
Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.
Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.
So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.”Aug. 5, 2008 - National Institutes of Health (NIH)
Atul Gawande, MD, MPH, in a Mar. 23, 2006 New England Journal of Medicine article titled “When Law and Ethics Collide — Why Physicians Participate in Executions,” wrote:
“States have affirmed that physicians and nurses — including those who are prison employees — have a right to refuse to participate in any way in executions. Yet they have found physicians and nurses who are willing to participate. Who are these people? And why do they do it?
It is not easy to find answers to these questions. The medical personnel are difficult to identify and reluctant to discuss their roles, even when offered anonymity. Among the 15 medical professionals I located who have helped with executions, however, I found 4 physicians and 1 nurse who agreed to speak with me; collectively, they have helped with at least 45 executions. None were zealots for the death penalty, and none had a simple explanation for why they did this work. The role, most said, had crept up on them.”Mar. 23, 2006 - Atul Gawande, MD, MPH
Louis Lasagna, MD, Academic Dean of the School of Medicine at Tufts University, wrote the modern version of the Hippocratic Oath in a June 28, 1964 article for the New York Times Magazine titled “Would Hippocrates Rewrite His Oath?,” which stated:
“I swear to fulfill, to the best of my ability and judgment, this covenant:I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”June 28, 1964 - Louis Lasagna, MD
Kenneth F. Baum, MD, JD, Partner at Goldman Ismail Tomaselli Brennan & Baum, LLP, and
Julie Cantor, MD, JD, Attorney Of Counsel at Goldman, Ismail, Tomaselli, Brennan & Baum, LLP stated the following in their Apr. 30, 2014 article “Doctors Can Ease Suffering, Even in Executions,” available at nytimes.com:
“We expect physicians to offer comfort care to the dying, even if the treatment, like morphine to dampen end-stage cancer pain, will inevitably hasten death. These physicians are not killing their patients; they are comforting them in their final moments of life…
Death row inmates have certain parallels to dying patients. Death is coming. A physician can do nothing to change that. All that can be offered is professional care during the final moments of life. And that should be of comfort to the condemned…
The idea that physicians may participate in executions does not mean that they must do so. But it should be an option for those who believe that they have a duty to ease suffering and that this duty includes caring for those who will die at the hands of the state…
Physician involvement in lethal injection can make capital punishment less grotesque, more palatable, and even routine. But so long as the state uses the tools of the physician to kill its citizens, those who wish to step in to ensure that executions are, at the very least, competently handled should have the option to do so. Anything else is death penalty politics at the expense of the condemned. And no matter where you come out on capital punishment, no one should be sentenced to a botched execution.”Apr. 30, 2014 - Kenneth F. Baum, MD, JD Julie Cantor, MD, JD
Bruce E. Ellerin, MD, JD, Doctor of Oncology Radiation at Sierra Providence Health Network in El Paso, TX, in a July 6, 2006 response letter to the New England Journal of Medicine regarding an article titled “When Law and Ethics Collide — Why Physicians Participate in Executions,” by Atul Gawande, MD, offered the following:
“Accepting capital punishment in principle means accepting it in practice, whether by the hand of a physician or anyone else. If one approves of capital punishment in principle (as I do), then one must accept its practical consequences. If one finds the practice too brutal, one must either reject it in principle or seek to mitigate its brutality. If one chooses the latter option, then the participation of physicians seems more humane than delegating the deed to prison wardens, for by condoning the participation of untrained people who could inflict needless suffering that we physicians might have prevented, we are just as responsible as if we had inflicted the suffering ourselves.
The AMA [American Medical Association] position should be changed either to permit physician participation or to advocate the abolition of capital punishment. The hypocritical attitude of ‘My hands are clean — let the spectacle proceed’ only leads to needless human suffering.”July 6, 2006 - Bruce E. Ellerin, MD, JD
Robert Truog, MD, Professor at Harvard Medical School, in a Jan. 18, 2008 New England Journal of Medicine interview titled “Perspective Roundtable: Physicians and Execution,” stated:
“If I think of the kind of a hypothetical where you have an inmate who is about to be executed and knows that this execution may involve excruciating suffering, that inmate requests the involvement of a physician, because he knows that the physician can prevent that suffering from occurring, and if there is a physician who is willing to do that, and we know from surveys that many are, I honestly can’t think of any principle of medical ethics that would say that that is an unethical thing for the physician to do.”Jan. 18, 2008 - Robert Truog, MD
John Hood, President of the John Locke Foundation and Publisher of CarolinaJournal.com, in a Sep. 26, 2007 Lincoln Tribune.com article titled “Judge Is Right on Execution Ethics,” wrote:
“Remember, no doctor is compelled to be present at an execution. Those who choose to do so believe that it is ethical… To punish them, it must be proved that medical ethics and presence at an execution are impossible to reconcile. But that’s clearly not true…
At an execution, the state clearly has the right to take the murderer’s life. But it does not have the right to torture him, either by imposing excessive pain or by failing to complete the execution swiftly. The presence of a doctor is a guard against those eventualities.
The fact that a doctor is present doesn’t make that doctor the executioner. Indeed, the protection against cruel and unusual punishment would seem to require that a doctor be present.”Sep. 26, 2007 - John Hood
David Waisel, MD, Associate Professor of Anesthesia at Harvard Medical School, in a Sep. 2007 Mayo Clinic Proceedings article titled “Physician Participation in Capital Punishment,” wrote:
“I argue that poorly done executions needlessly hurt the condemned and that, in the case of lethal injections, the problems center not on the specific drugs chosen but on establishing and maintaining intravenous access and assessing for anesthetic depth.
I argue that it is honorable for physicians to minimize the harm to these condemned individuals and that organized medicine has an obligation to permit physician participation in legal execution. By participation, I mean to the extent necessary to ensure a good death. This includes designing protocols both in general and for specific condemned persons and participating in the performance of these protocols, up to and including gaining intravenous access and giving drugs.”Sep. 2007 - David Waisel, MD
Ardis Dee Hoeven, MD, Chair of the American Medical Association at the time of the quote, stated in a May 2, 2014 article “State Mandates for Physician Participation in Capital Punishment Violate Medical Ethics,” available at ama-assn.org:
“No matter how one feels about capital punishment, it is disquieting for physicians to act as agents of the state in the assisting, supervising or contributing to a legally authorized execution. Physicians are fundamentally healers dedicated to preserving life when there is hope of doing so. The knowledge and skill of physicians must only be used for care, compassion and healing. To have the state mandate that physician skills be turned against a human being undermines a basic ethical foundation of medicine – first, do no harm.
The American Medical Association is troubled by continuous refusal of states to acknowledge the ethical obligations of physicians that strictly prohibit involvement in capital punishment. The AMA’s policy is clear and unambiguous – requiring physicians to participate in executions violates their oath to protect lives and introduces deep ambiguity into the very definition of medical care.
Oklahoma and other states that continue to authorize lethal injections must honor the well-established principle of medical ethics that prohibits physician participation in capital punishment.”May 2, 2014 - Ardis Dee Hoven, MD
The Society of Correctional Physicians (SCP), in a “President’s Message,” in the Winter 2008 issue of the Journal of Correctional Health Care, offered the following:
“The Society of Correctional Physicians hopes that the Court recognizes that these ethical principles (not be involved in any aspect of execution of the death penalty) are vitally important, and that correctional physicians should not be made a part of the legal apparatus for conducting an execution.
Along with the AMA, SCP believes that physicians should not participate in executions except to the extent of signing a death certificate. Execution should not be performed as part of a physician managed medical process, and pretending that physician involvement can be ‘demedicalized’ by legislative and/or judicial fiat is naive at best…
The executioners should be specially trained members of the criminal justice system, whether prison security staff or court personnel.
Outside groups should not try to increase the burden of ‘dual loyalty’ ethical conflicts above those that are already inherent in medical practice. It is important that we as correctional physicians take a stand on these crucial ethical issues.”2008 - Society of Correctional Physicians (SCP)
The California Medical Association (CMA), in a Feb. 16, 2006 press release titled “California Medical Assn. Objects to Physician Participation in Executions,” stated:
“The CMA has for decades sought to end physician participation in capital punishment, including seeking legislation banning such actions by physicians and other health care professionals.
CMA believes that a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not participate in legally authorized executions. Regardless of its method of delivery, capital punishment is not a medical task, does not require medical skills and the use of a physician’s medical skills for this non-medical task is inappropriate and a breach of one of the medical profession’s most important ethical boundaries.
CMA believes that physician participation in capital punishment threatens the public’s trust of physicians. This trust is central to the physician-patient relationship.”Feb. 16, 2006 - California Medical Association (CMA)
The American Society of Anesthesiologists (ASA), in an Oct. 18, 2006 statement titled “Statement on Physician Nonparticipation in Legally Authorized Executions,” offered the following:
“1) Execution by lethal injection has resulted in the incorrect association of capital punishment with the practice of medicine, particularly anesthesiology.
2) Although lethal injection mimics certain technical aspects of the practice of anesthesia, capital punishment in any form is not the practice of medicine.
3) Because of ancient and modern principles of medical ethics, legal execution should not necessitate participation by an anesthesiologist or any other physician.
4) ASA continues to agree with the position of the American Medical Association on physician involvement in capital punishment. ASA strongly discourages participation by anesthesiologists in executions.”Oct. 18, 2006 - American Society of Anesthesiologists (ASA)
Arthur L. Caplan, PhD, Chair of the Department of Medical Ethics at the University of Pennsylvania, in a Sep. 2007 Mayo Clinic Proceedings article titled “Should Physicians Participate in Capital Punishment?,” wrote:
“An argument for technical expertise does not justify medicine’s acceptance of physician involvement in executions […] Physicians who participate… in executions in states that permit capital punishment for morally bankrupt reasons, even from motives of mercy toward the condemned… are complicit in the unethical killing of sometimes helpless, hapless, and vulnerable persons.”Sep. 2007 - Arthur L. Caplan, PhD