Should Doctors Participate In Capital Punishment Executions?

On Jan. 7, 2008, the U. S. Supreme Court will begin hearing arguments as to whether execution by lethal injection, as currently conducted, constitutes a form of cruel and unusual punishment. These new developments, as well as the earlier Proceedings articles, prompted a number of readers to write Proceedings editors and offer additional perspectives on this provocative topic. This lively discussion among physicians, ethicists and others appears in the January 2008 issue of the Mayo Clinic Proceedings and is highlighted below.

Lee Black and Mark Levine, M.D., from the American Medical Association Council on Ethical and Judicial Affairs, author a commentary entitled "Ethical Prohibition Against Physician Participation in Capital Punishment." This article asserts that physicians must not participate in executions, as this action is contrary to the "core concept of ethics" of the medical profession.

"Although it is easy to view the provision of comfort, appropriate in some venues, as a duty of physicians, it is simply not ethical to participate in an action that has as its sole purpose the death of an individual," says Black and Dr. Levine.

Participation in prisoner executions might cause patients to have difficulty believing that their physicians are always acting in their best interests, explain Black and Dr. Levine. And merely possessing a special set of skills that would allow physicians to ensure a proper and painless execution "does not imply license to use these skills in any manner," they add.

Black and Dr. Levine remind readers that although they welcome discussion about this issue, "Physicians are healers, not executioners."

In a second commentary, Mark Heath, M.D., an anesthesiologist from Columbia-Presbyterian Medical Center, offers details about how lethal injections are administered, the effects of the medications used, problems encountered in using this method of execution, and what bearing this information has on the debate over whether execution is, in fact, a medical procedure. Dr. Heath acknowledges that his views on this issue have been influenced by his experiences serving as an expert witness in court, where he testified on behalf of condemned prisoners acting to change execution procedures.

Dr. Heath describes how administration of general anesthesia is necessary to render the prisoner insensitive to pain before staff administer the heart-arresting drug potassium chloride. He explains that this combination of drugs is necessary because injection of concentrated potassium alone would be extremely painful.

"For execution by potassium to be humane, the human central nervous system must be placed in a state such that the prisoner is insensitive to the extreme pain that would necessarily be experienced if he or she were conscious," writes Dr. Heath.

Dr. Heath also points out that prisoners currently involved in litigation on this issue want the Department of Corrections to "either discontinue the use of these two drugs or provide properly qualified and equipped practitioners at the bedside to ensure that adequate anesthetic depth is established and maintained."

Describing a botched execution that took place in Florida, Dr. Heath says it was unfortunate that this procedure was administered by "personnel who did not understand the responsibilities they were assuming" and acknowledges that he is opposed to the death penalty and to physician participation in executions.

Following these two commentaries, the journal includes six letters to the editor from a variety of sources, as well as replies from the writers who first discussed this topic in the September 2007 Proceedings issue.

Mayo Clinic anesthesiologist William Lanier, M.D., Mayo Clinic Proceedings editor-in-chief, and anesthesiologist Keith Berge, M.D., also from Mayo, note in their reply that Proceedings welcomes the opportunity to provide a forum for debating this important and timely issue.

"We physicians and other citizens now have the option of ignoring physician involvement in capital punishment executions or of facing the issue head-on, reconciling our own beliefs and speaking to the present and future of the medical profession," conclude Drs. Lanier and Berge.