Is it ethical for doctors to participate in executions?

You may have heard about the recent Oklahoma execution where the “lethal” injection wasn’t rapidly lethal, and may not have caused the condemned man’s death at all.

There was another execution this year that was also problematic, to say the least.  And there have been other problems with using lethal injection as a method of capital punishment. Some can be found here, along with other forms of botched executions.

Some have suggested that doctors become more involved with the death penalty, in order to make death occur more quickly, and with the least amount of pain. But some doctors already participate in state-mandated executions, at least to a limited extent.

Take the Oklahoma exeuction; there was already a physician present. He apparently declared that the condemned was unconscious, and that permitted the injection of the remaining two drugs.

 The gas chamber at the Wyoming Frontier Prison on July 18, 2012 in Rawlins, Wyoming. Nagel Photography /

The gas chamber at the Wyoming Frontier Prison on July 18, 2012 in Rawlins, Wyoming. Nagel Photography /

(I’ve tried to find out through the author of this article, Erik Eckholm of the New York Times, if the physician actually administered the drugs himself. Eckholm replied that a spokesperson said that a physician was present at the execution, but didn’t give any further information as to his exact duties there. I asked him to be updated if he learned more. As yet, I’ve heard nothing more about the physician’s responsibilities there.)

The “cocktail” used for executions was originally proposed by a physician, Jay Chapman, a pathologist.* He suggested first using an ultrashort-acting barbiturate, then, when the patient became unconscious, a paralytic drug that would stop the condemned’s breathing. This protocol was approved by another doctor, an anesthesiologist, and subsequently went into use in Oklahoma. Some states may also add potassium to cause cardiac arrest. Usually pentobarbital is used as the barbiturate, pancuronium bromide as the paralyzing agent, and potassium chloride as the source of potassium.

Note that thiopental alone, in high enough dose, will put the person to sleep and then depress the respiratory center in the brain. He will then stop breathing in his sleep and not awaken. So the paralytic and potassium would not be necessary. However, the manufacturers of thiopental sodium and pentobarbital will no longer provide those drugs to be used for lethal injection. Other drugs have now been substituted, and the results have been as described in the links — not good.

(CNN looked at some of the problems with the drug cocktail and its use in some painful executions.)

In some states, a physician must pronounce the victim dead. In other states, a staff member of the medical examiner’s office is permitted to do so.

So, physicians, to some degree, are already involved in the death penalty. But should they be? Is it ethical for them to have any part in a process that brings about state-mandated death?

As you might imagine, opinions on this vary from one extreme to the other.

The American Medical Association (about 25% of US doctors are members) in its Code of Medical Ethics says:

A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.

Sidney Wolf of the Public Citizen’s Health Research Group, says:

It is unfortunate when any physician, through negligence or ignorance, has a role in causing the death of a patient. But it is reprehensible when a physician deliberately participates, in any way, in the intentional killing of another human being by involvement in an execution.

But Neil Farber, who is a professor of medicine at the University of California, San Diego, says:

Despite what may seem like a clear ethical and professional responsibility to refuse to cooperate with someone’s killing, many physicians not only approve such involvement, but see it as a duty.

The study that he participated in showed that many doctors would be willing to be involved in the execution of adults. Some might only be willing to certify death, but others would be willing to administer the lethal injection(s) themselves.

At least one attorney feels that physicians should be required to be present at executions. Ty Alper of the University of California Law School:

I agree with those who say that courts should require the participation of competent, qualified medical personnel – including doctors – during such procedures. Good doctors can help ensure that, if an execution is going to be carried out, the individual does not suffer needlessly.

Old illustration of a public execution in Beijing, Created by Bayard, after drawing of Vaumort, published on Le Tour du Monde, Paris, 1864.m (Old execution via Shutterstock)

Old illustration of a public execution in Beijing, Created by Bayard, after drawing of Vaumort, published on Le Tour du Monde, Paris, 1864.m (Old execution via Shutterstock)

It seems that some doctors may be willing to participate, while the majority would not, based on Farber’s paper. But does that willingness make their participation morally correct? Is it ethical for doctors to participate in executions? What about other health care professionals? Nurses, EMTs, physician assistants, nurse practitioners, paramedics can give injections — is it ethical for them to be involved? Or if the state decides that there is a need for capital punishment, should the state train and prepare workers who can successfully carry out the penalty, without involving health care personnel at all?

What do you think? Even if doctors and nurses can help to make the execution go more smoothly, and be less “cruel” (though I’m sure some would argue that dead is dead, and capital punishment is per se “cruel,” regardless of how well it goes off), is it ethical for physicians to participate in executions? Or, if the state is going to go ahead and execute people anyway, do doctors have a responsibility to ensure that the process is as painless as possible?
*Chapman in a CNN interview on possibly re-thinking his drug combination.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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