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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 - David Metcalfe 
Mark Bratton, PhD 

Daniel N. Lerman, JD, PhD, in an Aug. 2007 Georgetown Law Journal article titled "Second Opinion: Inconsistent Deference to Medical Ethics in Death Penalty Jurisprudence," wrote:

"Of the thirty-seven death penalty states using lethal injection, seventeen require the presence of a physician, and eighteen allow physician assistance. Only two states, Kentucky and Illinois, forbid physician participation or presence in executions."

Aug. 2007 - Daniel N. Lerman, JD, PhD 

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 

PRO (yes)

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 

During Taylor v. Crawford case litigation, a Jan. 31, 2006 Court Order issued by the US Western District Court of Missouri concluded:

"Plaintiff argues that the defendants will violate his right to due process of law by executing him by using a physician to carry out the essential steps in the execution in violation of the physician’s medical ethics.

Other courts have addressed this and found that it does not violate the physician’s code of ethics to participate in an execution... The Court finds that this is likely the way Missouri courts would also rule on the issue.

Indeed, if physicians were not involved in supervising and administering the drugs, it is likely that inmates would claim that it was cruel and unusual punishment because Department of Corrections personnel, without any medical training, were administering the drugs...

After considering the evidence and testimony which was presented during the evidentiary hearing... The Court... does not find that Missouri physicians who are involved in administering the lethal injections are violating their ethical obligations nor that the procedure is violative of the Thirteenth Amendment.

Jan. 31, 2006 - Taylor v. Crawford - Court Order (28KB)  
Taylor v. Crawford (16KB)  

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 

CON (no)

The American Medical Association (AMA), in a July 17, 2006 press release titled "AMA: Physician Participation in Lethal Injection Violates Medical Ethics," stated:

"The American Medical Association is troubled by continuous refusal of many state courts and legislatures to acknowledge the ethical obligations of physicians, which strictly prohibit physician involvement in a legally authorized execution.

The AMA's policy is clear and unambiguous — requiring physicians to participate in executions violates their oath to protect lives and erodes public confidence in the medical profession. A physician is a member of a profession dedicated to preserving life when there is hope of doing so. The use of a physician's clinical skill and judgment for purposes other than promoting an individual's health and welfare undermines a basic ethical foundation of medicine — first, do no harm.

The guidelines in the AMA Code of Medical Ethics address physician participation in executions involving lethal injection. The ethical opinion explicitly prohibits selecting injection sites for executions by lethal injection, starting intravenous lines, prescribing, administering, or supervising the use of lethal drugs, monitoring vital signs, on site or remotely, and declaring death.

As the voice of American medicine, the AMA urges all physicians to remain dedicated to our ethical obligations that prohibit involvement in capital punishment."

July 17, 2006 - American Medical Association (AMA) 

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."

Winter 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