Is Participation in Executions Ethical for Medical Professionals?
General Reference (not clearly pro or con)
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
Carlo Musso, MD, emergency physician and founder of Correct Health, in a Mar. 8, 2019 New York Times OpDoc, “Death Row Doctor: Why I Take Part in Executions,” by Lauren Knapp, available at youtube.com, stated:
“My role in execution is one of end-of-life. Instead of a carcinoma, that individual’s dying of a court order. But he’s still dying. We’re trained, you know, do no harm, preserve life whenever there’s any hope of doing so. The concept of the Hippocratic Oath and everything we stand for in medicine. Medical organizations have strongly worded opposition to physician participation in execution. And believe me, I’ve read them and I understand them. I just don’t agree with them. I’ve almost had two different careers, an emergency medicine career and a correctional medicine career. If you were to ask me during residency or even shortly residency that I’d be working in a jail or prison, I wouldn’t have thought, you’re crazy. There’s just no way. But indeed that’s where my career path took me. Shortly after I had started working in corrections, particularly when our company started growing, I got a phone call from the Department of Corrections about helping out with the execution process, which here in Georgia is lethal injection. Sometimes in life you have to take the bad with the good, and as part of being a leader, as part of being a totality of a health care solution. I called them back and said, well, let me go witness one. Watching a heart monitor, I kept looking for paddles to try to defibrillate the individual. I mean, it was almost like a reflex. The one thought I had over and over again was, if it were me there or a family member, would i want somebody like me there. And the answer was yes. Absolutely. I would want somebody like me there if I had a family member who had done something horrible and ended up on death row.
I’m not a advocate for capital punishment. If it’s ultimately arbitrary and very expensive and not necessary. But that’s not — that doesn’t impact what I do and why I do it…
Quite frankly I’d love to hang up my cleats and not do this anymore. As long as there’s a need and as long as they’re going to continue to perform executions in Georgia, then I think those individuals on death row deserve to have a physician present at the time of their death. Perception is reality. If most people believe in capital punishment, that’s our reality today. The medicalization of execution I think does impact public perception. Does that make us more comfortable with capital punishment? Probably.”Mar. 8, 2019
Sandeep Jauhar, PhD, MD, cardiologist, in an Apr. 21, 2017 article, “Why It’s O.K. for Doctors to Participate in Executions,” available at nytimes.com, stated:
“Though I oppose capital punishment as a matter of principle, as a doctor I believe physician presence at executions is consistent with our mandate to alleviate suffering…
The A.M.A.’s position is principled and respects a long history of bioethics in this country. However, it is not practical. States that do not require physician presence typically use other medical professionals, such as emergency medical technicians or paramedics, to insert IV lines and possibly mix the drugs. Barring doctors from executions will only increase the risk that prisoners will unduly suffer…
Discouraging physician participation, as the American Medical Association does, will not lead to a ban on capital punishment or lethal injection. If anything, it will lead only to the reinstatement of more brutal forms of execution that do not require medical expertise, such as electrocution or death by firing squad. A few states have already decided to use these methods as possible alternatives.
Doctors have a duty to alleviate suffering. No one would object to a doctor’s providing comfort — spiritual or narcotic — to a terminally ill patient at the hour of death. It is not a stretch to think of death-row inmates who have exhausted their appeals as having a terminal disease with 100 percent mortality… Participating in executions does not make the doctor the executioner, just as providing comfort care to a terminally ill patient does not make the doctor the bearer of the disease.”Apr. 21, 201
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
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
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
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
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
L. Elizabeth Armstrong, affiliate faculty in Colorado Christian University’s School of Science and Engineering, in a Sep. 7, 2021 article, “The prisoner’s dilemma: The role of medical professionals in executions,” available at blogs.bmj.com, stated:
“[M]edical involvement on any level intrinsically violates the ethical principles of autonomy, beneficence, non-maleficence, and justice – compromising the foundations of the medical system.
Assuming the inmate is a patient, it is impossible to respect his or her autonomy. Clinicians ought only to provide treatment with informed consent, and patients can only give that consent if they are, in fact, patients, and freely weighing that decision. An inmate sentenced to die does not have this capacity or agency. The procedure furthermore violates the principles of beneficence and non-maleficence, by ending a patient’s life: practitioner participation or intervention cannot be considered therapeutic or curative. The end is death, not as a palliative measure or to prevent suffering, but as a punishment. (Equally, studies show the more medicalized lethal injection procedure is in and of itself is flawed—both in its design and implementation. Clinicians ought not to perform a procedure which does not have a high chance of succeeding in its desired ends.) And one only has to look at the statistics surrounding the death penalty to find it unjust: people on death row are not getting their just due from the medical system, many are not getting their just due from society as this punishment is prescribed disparately, and still more are condemned to death while innocent…
The Hippocratic Oath outlines that a medical practitioner has obligations to all people regardless of their status as a patient. It furthermore states that medicine will only be applied for the benefit of the sick, and that is inappropriate for a clinician to ‘play God.’ With these tenets in mind, it would be a violation of the bioethical framework and the ethical obligations of the profession, to participate in executions.”Sep. 7, 2021
The American Medical Association, in an undated guide, “Capital Punishment: Code of Medical Ethics Opinion 9.7.3,” available at ama-assn.org and accessed on Sep. 8, 2021, stated:
“Debate over capital punishment has occurred for centuries and remains a volatile social, political, and legal issue. An individual’s opinion on capital punishment is the personal moral decision of the individual. However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.
Physician participation in execution is defined as actions that fall into one or more of the following categories:
(a) Would directly cause the death of the condemned.
(b) Would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned.
(c) Could automatically cause an execution to be carried out on a condemned prisoner.
These include, but are not limited to:
(d) Determining a prisoner’s competence to be executed. A physician’s medical opinion should be merely one aspect of the information taken into account by a legal decision maker, such as a judge or hearing officer.
(e) Treating a condemned prisoner who has been declared incompetent to be executed for the purpose of restoring competence, unless a commutation order is issued before treatment begins. The task of re-evaluating the prisoner should be performed by an independent medical examiner.
(f) Prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure.
(g) Monitoring vital signs on site or remotely (including monitoring electrocardiograms).
(h) Attending or observing an execution as a physician.
(i) Rendering of technical advice regarding execution.
and, when the method of execution is lethal injection:
(j) Selecting injection sites.
(k) Starting intravenous lines as a port for a lethal injection device.
(l) Prescribing, preparing, administering, or supervising injection drugs or their doses or types.
(m) Inspecting, testing, or maintaining lethal injection devices.
(n) Consulting with or supervising lethal injection personnel.”Sep. 8, 2021
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
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
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
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
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