In the newest issue of JAMA, two authors affiliated with the AMA offer their opinions on physicians’ role in implementing the death penalty via lethal injection. Hint: they don’t approve of it.
The article says that unlike other methods of execution, lethal injection “has elements of medical practice: insertion of intravenous lines, intravenous injection of medicinal drugs, and monitoring vital signs.” Small wonder then, that 35 of the 38 states that allow the death penalty either require or permit physician participation in executions.
Typically the identity of physicians who participate in executions is held confidential by state authorities. Even if they are made known, licensing boards in death penalty states have trouble taking any action against physicians who participate in executions. Since the boards deal with illegal activities, they can’t crack down on physicians who participate in executions that are legal.
But medical societies have more wiggle room. AMA prohibits involvement of physicians in executions, saying that it goes against the physician’s role as a healer. As the authors put it, “any form of participation in causing death by lethal injection is unethical because it violates the physician’s role, thereby undermining trust….the penal system, not the medical profession, is responsible for finding a way to perform executions.”
Obviously this issue has a certain degree of timeliness, given the Supreme Court’s recent agreement to hear challenges to lethal injection on the grounds that the process often gets so mucked up that it constitutes cruel and unusual punishment. But I think the JAMA piece is right in addressing it as a big-picture best practices question. This is primarily a moral question.
And it’s a tough one, even for physicians who might support capital punishment in the criminal justice system. Just because they believe that murderers should die, it doesn’t follow that they feel criminals do or do not deserve a demise that is as painless as possible. Supporting capital punishment and consenting to having a hand in it are two very different things.
So imagine you’re a doctor and the state has asked you to preside over
an execution that will go on with or without a physician present.
What’s your medical duty—to try to ensure that things go smoothly and
spare the inmate unnecessary pain, or abstain from attending because
your presence would mean you were participating in taking a life? Which
choice is truer to the physician’s duty to be a healer?
I’m very curious as to what the Health Beat readership—especially our
MDs—think about this question. Keep in mind I’m not asking if you
support or object to the death penalty as a criminal justice policy
(although that’s likely to influence your position); the real question
here is one of ethics and medical obligation: where do you think the
line should be drawn? Do doctors have a right to refuse participation
in procedures that cause harm, even if they’re the law? Or should
doctors be doing all they can to make sure that, within the boundaries
of the law, harm is minimized?
I’ll start things off: I think the AMA is right, and not just because
of its professional imperative to make sure that doctors are trusted.
The logic that doctors should feel obligated to make the death penalty
as painless as possible makes sense in the short-term, because it
reduces the risk of avoidable harm to the executed, but in the moral
sense it’s unsustainable. First, we know that our death penalty system
is imperfect. A 2000 Columbia University study showed that 65 percent
of death penalty cases are overturned on appellate review. Hundreds of
convicts have been exonerated by DNA testing. A physician can never be
100 percent sure that he is not putting an innocent person to death—and
if you think harming a murderer is medically unethical, harming an
innocent is even worse.
Second, I think that it’s hard to say that doctors should heal only
within the confines of the law. You can imagine a situation where the
law is incredibly unfair, to an extent where it is the doctor’s duty
not just as medical expert but as a citizen to resist its
implementation. It’s true that the Hippocratic Oath says that doctors
shouldn’t violate the morals of their community. But what the heck does
that mean in this case—that because the death penalty exists, it
represents a community value? Call me cynical, but I don’t think that
the trajectory of our laws is a bee-line from the peoples’ hearts to
the legislators’ finger tips.
Third, the argument that doctors who don’t participate in the death
penalty are allowing unnecessary suffering when the execution is
botched doesn’t hold much weight because there are millions of
suffering people not getting treatment from doctors today. In other
words, you can’t say doctors are negligent for the care they’re not
giving without addressing all of the care they deny, omit, or just
never get around to providing for everyone, not just people in death
So there you have it. Thoughts?