NE Journal of Medecine: Doctors Should Not Participate in Executions

There's an editorial today by three physicians in the New England Journal of Medicine. Shorter version: Regardless of what the Supreme Court decides in Baze v. Rees, physicians should not participate in executions.

This spring the U.S. Supreme Court in Baze v. Rees1 will rule on the constitutionality of the three-drug regimen currently used for lethal injection in most state executions. The Eighth Amendment to the U.S. Constitution prohibits punishment that is "cruel and unusual." The central question before the Court in Baze is whether the use of sodium thiopental, pancuronium bromide, and potassium chloride violates that constitutional prohibition.


On the issue to be resolved:

Since 1977 the Oklahoma regimen has been used in approximately 900 executions, several dozen of which have been botched because of infiltration of intravenous lines, inadequate anesthesia, drug precipitation when solutions of sodium thiopental and pancuronium bromide are mixed, and other problems. In a vivid example, an inmate in Ohio in 2006 raised his head repeatedly during the execution and said, "It don't work."

The use of a neuromuscular blocker, pancuronium bromide, as part of the protocol has been especially controversial, since it has no anesthetic properties and only paralyzes the person, which can mask inadequate anesthesia if a sufficient dose of sodium thiopental has not been administered. The person may be alert and aware and may suffocate owing to paralysis of respiratory muscles, but there will be no way to know it. Also, the subsequent intravenous administration of potassium chloride would cause excruciating pain in a conscious person, but this too would be concealed by paralysis.

The problem:

As a consequence of botched executions, the assistance of physicians and other health care professionals has increasingly been sought to provide consultation, place intravenous lines, mix and administer drugs, and monitor the results.

We are concerned that, regardless of its decision in Baze v. Rees, the Court may include language in its opinion that will turn again to the medical profession to legitimize a form of lethal injection that, meeting an appropriate constitutional standard, will not be considered "cruel and unusual punishment." On the surface, lethal injection is a deceptively simple procedure, but its practical application has been fraught with numerous technical difficulties. Without the involvement of physicians and other medical professionals with special training in the use of anesthetic drugs and related agents, it is unlikely that lethal injection will ever meet a constitutional standard of decency. But do we as a society want the nation's physicians to do this? We believe not.

Their position:

Physicians and other health care providers should not be involved in capital punishment, even in an advisory capacity. A profession dedicated to healing the sick has no place in the process of execution.

....We believe that.... all responsible members of the medical profession, when asked to assist in a state-ordered execution, will remember the Hippocratic Oath and refuse to participate. The future of capital punishment in the United States will be up to the justices, but the involvement of physicians in executions will be up to the medical profession.

I hope this editorial gets the widespread attention it deserves.

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    Exactly Right (none / 0) (#1)
    by CognitiveDissonance on Thu Jan 24, 2008 at 01:49:14 PM EST
    How can any physician in good conscience break his oath to "first, do no harm" by participating in an execution? Maybe in some future enlightened age (if we live through this one) they will have to finally completely abolish capital punishment simply because they won't be able to find anyone willing to be the executioner.

    That doctors shouldn't kill people seems (none / 0) (#2)
    by Geekesque on Thu Jan 24, 2008 at 02:07:19 PM EST
    rather obvious . . .

    vets (none / 0) (#3)
    by diogenes on Thu Jan 24, 2008 at 07:27:09 PM EST
    Simply hire a vet who has a lot of experience putting dogs, horses, etc to sleep.  No one says that whatever cocktail is used on their pets is cruel and inhuman, and there are no "oath problems" (although the Hippocratic Oath is defined by the society of the day-thus, no one takes seriously the original Hippocratic Oath's injunction to not participate in abortions).

    The American Medical Association (none / 0) (#4)
    by clio on Thu Jan 24, 2008 at 09:48:39 PM EST
    has consistently opposed any physician participation in executions and so stated in the AMA Code of Ethics years ago.  That opposition has been reaffirmed with various resolutions passed at the AMA House of Delegates in subsequent years.

    Since the AMA and I are usually on opposite sides of any issue I am glad to be able to  point out their strong and unchanged  ethical opposition to physician participation in capital punishment and to praise them for it unreservedly.

    There used to be (none / 0) (#5)
    by Nowonmai on Fri Jan 25, 2008 at 01:25:38 AM EST
    people trained to do executions, whether it was the hang man, the man who ran the gas chamber, the one setting off the electric chair.
    Doctors should not be executioners.

    hang man (none / 0) (#6)
    by diogenes on Fri Jan 25, 2008 at 06:25:22 PM EST
    These are all red herrings.  If you trained a hang man, then someone would file a lawsuit claiming that the executioner "didn't have enough professional training".  If you want to end the death penalty, then get the votes together and do it.  This is a democracy, after all.