Is Participation in Executions Ethical for Medical Professionals?

“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.”

“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.”

“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.”

“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.”

“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.”

“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.”

“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.”