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 / Shutterstock.com

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

(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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  • Indigo

    Oh, excellent! We can have a party and watch it live on Fox.

  • UncleBucky

    WWAHD. Lovely. Teacher, teacher, I know, I know! Pick me!

    “He would disembowel and skin alive anyone who disagreed with him!”

  • UncleBucky

    Only if the medical profession has finally assented to being barbaric should docs participate in executions.

    Oh, wait…. by denying health care for all, the medical profession has become barbaric.

    Never mind… ;o)

  • docsterx

    The New England Journal of Medicine just published this perspective on medical participation in the death penalty today. http://www.nejm.org/doi/full/10.1056/NEJMp1405651?query=featured_home

  • Jim Olson

    The death penalty is barbaric no matter how it is carried out. It is no deterrent. It is vengeance that only serves to assuage the public that it is doing something in retribution for heinous crimes. It is not ethical for anyone to participate. The sooner we ban the death penalty, the better for our national soul.

  • pappyvet

    Is it ethical for doctors to participate in executions? No

  • Ron Robertson

    The answer is an easy and obvious no. There are no circumstances where doctor participation is valid because the death penalty is wrong. The death penalty presupposed a perfect justice system where no one could be sentenced to death who was not guilty. Obviously, no place in the world has that quality. Even without that, it is wrong to make as part of anyone’s job the necessity to put someone else to death.

  • redfeather2010

    I am reminded of Dr. Mengele in Nazi Germany
    john at “American Liberal Times” . . ( A Liberal Blog).

  • docsterx

    This reply is a work of art.

  • Richard

    Physicians are suppose to be healers, not murderers.

  • Silver_Witch

    Yes!!!!

  • W H

    Sorry, the death penalty is just a bad idea.

    Maybe some people are deserving of death, rather than life in prison without parole. But only an entity that is both omniscient and virtuous to an inhuman extent is capable of making that assessment correctly.

    In the meantime, it also looks as though innocent people are winding up getting sentenced to death.

    Not only that, there’s a disturbing correlation between the willingness of a government to impose the death penalty and its overall barbarousness. Look at this list of countries that practiced or practice the death penalty:

    Nazi Germany
    The Soviet Union
    East Germany
    Cuba
    China
    Apartheid-era South Africa
    Saudi Arabia
    Iran

    A rogue’s gallery!

  • Indigo

    LOL! You left out my personal favorite, SDS [sudden death syndrome]. They dropped mentioning that one about 6 months ago.

  • docsterx

    That’s not entirely correct. If you see my comment above, you’ll note that doctors routinely perform abortions. Those are prohibited by the Oath. As are the others actions that are forbidden that I mentioned above.

    Our culture has changed in the centuries since Hippocrates. The Oath needs to change, too. If you look, you’ll find that there are a few different modified versions of the Hippocratic Oath available that correct the problems with the original.

    While there is a statement about “no harm” there in the Oath, you may be confusing that with the dictum, “Primum non nocere” (First do no harm) that may have evolved separately from Latin, not Greek, roots.

  • docsterx

    For the record, yes, some European drug manufacturers are withholding drugs that can be used for lethal injections because they disagree with executions. But others only did the same after pressure was exerted on them by EU governments and activists.

    I don’t think that it’s inherently true that European (or Asian) pharmaceutical firms are more ethical than US pharmaceutical firms. Both EU and Asian members of Big Pharma have had major ethical problems with drug quality control, fraud, bad data and other areas, just as US firms have.

  • docsterx

    For people who mentioned the Hippocratic Oath here’s some additional information on it.

    The Hippocratic Oath has a few sections that have routinely been sworn
    to and then ignored for decades. If everyone who tool the Oath adhered to it as written, abortions would be prohibited. As would physician-assisted suicide. And surgery, even minor surgical procedures such as suturing, would be forbidden to doctors (or others who took the Hippocratic Oath.) Medical research would probably come to a grinding halt because of the “do no harm” precept, since harm can be done (and sometimes is done) by medical research. There are other areas that are ignored routinely, as well.

    Not all physicians take it (only about half of British physicians take it, for example. Not all US medical
    grads take it.) Nor have all physicians even heard of it.

    It is more symbolic than real. It was occasionally mentioned in medical school, but no real time was spent talking about it.

    It’s not legally binding.

  • kraftysue

    Physicians helping with executions is as unethical as it was for them to
    be involved with the “extreme interrogations” which I call torture. It
    certainly violates their oath to “first do no harm”. IMO they should
    all lose their licenses if they were involved in either one.

  • 4th Turning

    I’m not sure this point was made specifically above?

    “Again, approval of the death penalty correlated with a willingness to be involved and those who approved of involvement with executions believed it would be a duty to society.”

    http://www.nytimes.com/roomfordebate/2014/04/30/doctors-in-the-death-chamber/despite-ethical-rules-many-doctors-approve-of-participating-in-executions

    (What we can expect re other ethical questions that come up before congress?)

    The House’s only psychiatrist, Representative Jim McDermott, Democrat of Washington, offered a more Freudian explanation: the desire for control.
    “They want to have their hands right there on the handle so they can pull it one way or another,” he said.
    As for the reason so few of them are liberal — out of the 17 medical doctors in the House, Representative McDermott is one of only four who are Democrats — he said he believed that politically conservative physicians were more likely to chafe at the direction of changes in health care

    http://www.nytimes.com/2014/03/08/us/politics/doctors-confident-in-their-healing-powers-rush-for-congress.html?_r=0

  • http://www.rebeccamorn.com/mind BeccaM

    Aye, well we know U.S. BigPharma lives for creating medicines people have to take for the rest of their lives, not “take this, in a week you’ll be cured.” And death meds are the ultimate in “one dose, you’re done, REALLY done” treatments.

  • http://www.americablog.com/ Naja pallida

    “Tell your doctor about all your medical conditions and medications, and ask if your heart is healthy enough for death. Do not take Deathagra if you are taking nitrates for chest pain, as this may cause an unsafe drop in blood pressure. Do not drink alcohol in excess with Deathagra. Side effects may include headache, upset stomach, back ache and anal leakage. Contact your physician if you continue to live for more than four hours after taking Deathagra.”.

  • http://www.americablog.com/ Naja pallida

    I agree with everyone below, the death penalty has no place in a civilized society, and no medical care practitioner has any place in participating in it.

    I just don’t understand why they’ve been messing around with strange cocktails of difficult to acquire drugs, of questionable efficacy to begin with. It sounds to me like people without proper (any) training are grasping at straws. Like the only medical information they have is a fifty-year-old copy of Physicians’ Desk Reference, with a few pages missing. When any anesthesiology resident could probably come up with an effective procedure, with commonly available drugs. The idea that we allow executions to be carried out by incompetent fools is beyond barbaric. Even in the days of beheading, an executioner’s reputation was based entirely on how efficient he was at ending the accused’s life. We pick random people who run prisons, to enact procedures dreamed up by bureaucrats.

  • Indigo

    Right. And if I understand the back story correctly, those are European drug companies. America companies apparently do not make the recommended drugs because it is not cost effective to market them.

  • Indigo

    I have a designated soapbox for that issue. :-)

  • http://www.rebeccamorn.com/mind BeccaM

    The elephant in the room, which never seems to enter into the discussion, is to ask why exactly these drug companies, pressured by citizens and governments of other countries, decided to cut off access to these ‘death by lethal injection’ drugs.

    It’s because they know that participating willingly in America’s death penalty regime is inherently immoral, unethical, and barbaric.

  • jomicur

    I’m quite aware of all that. None the less, the Hippocratic Oath embodies the principles doctors are supposed to stand for and revere (more so than just paying for their next luxury golf weekend). It used to be summarized popularly as “Do no harm,” which is clearly a concept the doctors under discussion here have rejected. I have a clear memory that our family doctor when I was a kid, back before the dawn of recorded history, had an embroidered sampler hanging on his wall with the words “DO NO HARM” on it. Try and find that in any doctor’s office today. The second coming of the messiah will happen before you have any luck.

  • Mark_in_MN

    Well, it does provide a sense of urgency to the drama that our hero or heroine detectives solve the case correctly, so that an innocent person isn’t hung.

  • Mark_in_MN

    I’d have to answer that it is not ethical for physicians, or other health care professionals, to part in executions. But that answer is based on my assessment that executions are not ethical or moral, not for any reason associated with what might be called medical ethics, much less an universally applicable body of ethical positions applicable to all physicians and patients.

  • The_Fixer

    This would be a moot point if there were no death penalty. The death penalty is barbarism, and so-called civilized societies are supposed to be antithetical to barbaric practices. That’s why they call it civilization.

    It seems to me that the physician’s job (and from the physicians that I’ve met, passion) is supposed to be that of saving lives and making the quality of the patient’s life better. Assisting in taking a life is not either of these things, unless the sole purpose of such is to stop needless suffering in hopeless situations.

    So, No. I think that I understand the motivation of physicians who choose to participate. But don’t agree with it.

  • docsterx

    Just playing Devil’s Advocate:

    The Hippocratic Oath has a few sections that have routinely been sworn to and then ignored for decades. Not all physicians take it (only about half of British physicians take it, for example. Not all US medical grads take it.) Nor have all physicians even heard of it. It is more symbolic than real and isn’t legally binding.

  • http://www.rebeccamorn.com/mind BeccaM

    Yeah… It’s like asking, “Is there a humane way to torture someone and utterly break them, so that we don’t have to call it torture anymore, because that particular word bothers people.”

    Evil is evil, for fuck’s sake. If we’re going to commit acts of evil, we should own it and be properly ashamed as a country, a culture, and a people.

  • cole3244

    even as a young adult i have always been opposed to the death penalty no exceptions, its not because of empathy for the accused its that all systems (humans) are fallible and biased in one way or another.

  • http://musephotos.wordpress.com/ GarySFBCN

    Back atcha: Is it ethical for a physician assist with euthanasia for someone in pain, elderly and lingering?

  • http://www.rebeccamorn.com/mind BeccaM

    No, it is not ethical.

    Then again, I feel that capital punishment is inherently unethical, immoral, and barbarous. And worse, as applied in America, it has been horrifically racist in practice.

  • Monophylos Fortikos

    There’s something fundamentally grotesque about this discussion. It shouldn’t even be happening. It reminds me of the nightmarish quality of discussion about torture and how properly to go about it.

  • Silver_Witch

    You said it so much more eloquantly than I – thank you Indigo.

  • caphillprof

    No

  • Silver_Witch

    My only thought is that we should not execute people at all. That brings us down to the level of animals and barbarians. The death penalty should not be in place anywhere in the U.S., especially since the death of the convicted person can NEVER be undone if there were a mistake or evidence to prove the condemned innocent. What silliness to even consider killing another being.

  • emjayay

    Well, we could hang people and no doctors needed.

    It’s interesting that (entirely from watching some recent British dramas and detective shows set in the 40′s and 50′s – they love the England of those periods, and of course so do I) Britain apparently hung people left and right back then not that long ago, then completely turned around on that.

    Hopefully we’re just a few decades behind. Well, more like half a century.

  • 4th Turning

    he transferred to theconcentration camp service in early 1943 and was assigned to Auschwitz. There he saw the opportunity to conduct genetic research on human subjects. His subsequent experiments, focusing primarily on twins, were unscientific and had no regard for the health or safety of the victims. Mengele was also a member of the team of doctors assigned to do “selections”: new arrivals deemed able to work were admitted into the camp, and those deemed unfit for labor were immediately killed in the gas chambers. Mengele left Auschwitz on 17 January 1945, shortly before the arrival of the liberating Red Army troops.

    Assisted by a network of former SS members, Mengele sailed to Argentina in July 1949. He initially lived in and around Buenos Aires, but fled to Paraguay in 1959 and Brazil in 1960 while being sought by West Germany, Israel, and Nazi hunters such as Simon Wiesenthal so that he could be brought to trial. In spite of extradition requests by the West German government and clandestine operations by theMossad (the Israeli intelligence agency), Mengele eluded capture. He drowned while swimming off the Brazilian coast in 1979 and was buried under a false name. His remains were disinterred and positively identified by forensic examination in 1985.

  • jomicur

    It appears that the Hippocratic Oath has become nothing more than a quaint relic of a better age, sort of like the Constitution. Oh well, they were nice ideas while they lasted…

  • Strepsi

    No. This is one of the cornerstone differences of Canada and the U.S. We do not see capital punishment as compatible with a civilized democracy. Ever. Period.

  • marknc

    Exactly. The correct answer needs no embellishment.

  • http://heimaey.us/ heimaey

    If their role is to save lives that are savable, which it is, then the answer is a simple no.

  • Bill_Perdue

    “It is just being vindictive against someone who committed a heinous crime.” Or didn’t commit any crime at all as is so often the case, especially in a criminal system infested with racist cops, prosecutors and judges.

    “When in Gregg v. Georgia the Supreme Court gave its seal of approval to capital punishment, this endorsement was premised on the promise that capital punishment would be administered with fairness and justice. Instead, the promise has become a cruel and empty mockery. If not remedied, the scandalous state of our present system of capital punishment will cast a pall of shame over our society for years to come. We cannot let it continue.” -Justice Thurgood Marshall, 1990

    http://www.deathpenaltyinfo.org/death-penalty-black-and-white-who-lives-who-dies-who-decides

  • Indigo

    Since we are already an openly barbaric state, replete with gun-totting barbarians and narcissistic law officers, state-sponsored murder is the rule of barbaric law by which we live. Apart from the pious exhortations of delicately post-barbaric citizens, there is full public endorsement of all kinds of behaviors unacceptable in civilized nations. What is the role of the clergy in a barbaric nation? what is the role of educators in a barbaric nation? what is the role of lawyers in a barbaric nation? what is the role of medical doctors in a barbaric nation? Until civilizing forces and strong personalities who take human rights seriously are active in government, there is only one actual question in play, given that we recognize that we are in fact a barbarian nation, and that active question should be a bumper sticker widely displayed: What would Atilla the Hun do?

  • Bill_Perdue

    The ‘lesser evil’ theory is equally invalid in medicine and politics.

  • bkmn

    Most of those who advocate for the death penalty do so on the basis that it deters crime. It does not. It is just being vindictive against someone who committed a heinous crime.

  • Mike_in_the_Tundra

    I’m saying no, because I’m opposed to the death penalty. It’s hard to believe that many places in our country have the death penalty. Of course, I believe there may be good reasons for physician assisted suicide.

  • goulo

    “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?”

    That kind of argument is used to justify participating in all kinds of evil. “Sure, X is evil, but think how much more evil it would be if I didn’t directly help them do X.”

    Most civilized countries no longer have a death penalty. There seems much more of a responsibility to help abolish it in the US, rather than to help executions continue.

  • Bill_Perdue

    No.

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