Doctors and the death penalty

To me this seems like a no-brainer, but, hey, it takes all kinds. The current Supreme Court case regarding lethal injection brings up several points relevant to medicine (another discussion of which is available in the New England Journal of Medicine—my take is somewhat more…direct)…

Here’s the scoop: doctors have no business taking part in executions in any way whatsoever. It really is that simple. Doctors can ethically support the death penalty as citizens (I don’t), but participation violates the fundamental precepts of our profession.

The problems are thus: lethal injection is complicated. It involves several steps, each of which can go wrong. First, a barbiturate is administered to sedate the patient. This is done for humane reasons. Next, a paralytic is injected. This is done to ease the discomfort of those witnessing the execution. The idea is horrific. To kill someone in the name of the state is serious business. If it disturbs us, perhaps we need to rethink the whole idea, but giving the prisoner a drug to make us feel better and to potentially make him suffer more is abhorrent. After that, potassium chloride is injected. This burns like hell, but not for long—the pain of the injection is quickly overtaken by the pain of your heart stopping.

If the sedative is administered incorrectly, steps one and two leave a paralyzed person, unable to breathe but fully conscious, who then can feel the potassium injected.

If the potassium is injected incorrectly, it may injure the tissue around the IV, causing extreme pain, without killing the patient. If too little potassium is given, the pain can endure for a long time.

The whole process is brutal, which is where the doctor comes in. To ensure each step of the process goes correctly, a medical professional is needed. A good anesthesiologist or CRNA could easily do it. But to do so would ethically disqualify them from ever practicing again. They will lose their souls as physicians.

Some have argued that since the condemned is to die anyway, it is a doctor’s duty to ensure it is painless.

Bullshit. If a doctor is required, then his participation is what allows the execution, making the doctor the moral equivalent of an executioner.

I don’t agree with the death penalty; I think it’s useless and barbaric. I can, however, understand those who do support it. But I cannot abide any health care professional who participates, and neither should you.


  1. PalMD,
    I am with you 100%. Our first rule of business as docs is to do no harm. NO WAY is the right position on this one- sure won’t catch me there, brother.

  2. I agree. The biggest problem with the death penalty is that it requires one human to kill another for no good reason.

    It isn’t self-defense because the person is already incarcerated. The only possible reason relates to generating feelings of vengence. To me, that is not a good enough reason.

  3. secretwave101

     /  January 9, 2008

    IMHO, the only people who should have the right to oppose the death penalty are those who have endured a capital-punishment crime against their loved one.

    If they oppose it, they shouldn’t have the right to impose that moral standing on anyone else. Severely offended people should always have the right to demand ultimate recompense.

    I applaud the State that is willing to step in and assure that the process is fair, safe and relatively quick. While it is true that the condemned may suffer, it is at most a few-minute process that is nothing compared to the suffering s/he has brought upon those afflicted. Rarely does the State pursue the death penalty when the victims do not ask for it. State management of the victim’s desire for revenge is the best way to prevent cyclical violence.

    Should doctors be there? Of course. It’s no different than doctors easing unnecessary suffering in palliative care or terminal cancer. Outside forces have decreed how and when a person is to die (a state-owned /operated machine can push the drugs if you insist on academic distinctions), the doc just makes sure that the process goes as well as possible. Doctors aren’t required for an execution. They are required to keep an execution humane.

  4. Norma

     /  January 9, 2008

    Thank You! I learned a lot. This information is very thought provoking.

  5. CanadaGoose

     /  January 9, 2008

    “Next, a paralytic is injected. This is done to ease the discomfort of those witnessing the execution.”

    Horrible. The death penalty is barbaric and even if done “mercifully” it kills the guilty and the innocent alike. Right now Texas leads the US in executions AND in the number of death row prisoners exonerated by DNA evidence. It’s as if they’re in a hurry to execute as many as possible before they can be found innocent.
    As for the victim’s desire for “revenge” — I am glad to live in a nation of laws. I’ve been a victim of crime and like most people when victimized, I would have cheerfully exacted some severe punishment on the offender. I’ve also entertained fantasies of shooting some rude drivers. But when I’m not fulminating at people I disapprove of, I’m ultimately glad that the law is (hopefully) applied dispassionately.
    In any case, a main reason I’m opposed to the death penalty is how it hardens people and makes them willing to be cruel.

  6. Gilad

     /  January 9, 2008

    In fact, I think this post raises an interesting “meta-question”. Can you have a moral obligation as a professional that you don’t have as a regular human being? [Anyone remember the quote about God being forced to do in his public capacity things he wouldn’t dream of doing in his private capacity?]. A doctor, a psychologist and a priest all have a moral obligation to keep the secrets of their patients (or members of their community), but this is just a simple extension of the general moral obligation not to expose secrets told to you in confidence. For some professions a particular moral imperative may be important enough for it to be “more important than usual” – we don’t want anyone to steal money, but if you do you shouldn’t be allowed to become an accountant.

    Thus, the moral obligations imposed on doctors are simply obligations of every human being, with some “additional focus” – all people are expected not to kill others needlessly, and to render assistance when possible to people in distress. Doctors are simply given more opportunities to save lives or hurt people than most others. As mentioned above, doctors are also told things in confidence as part of their profession, and are thus expected to keep peoples privacy. However, if you do think that the death penalty is moral (I don’t), I don’t see how you can object to doctors participating in an execution. Except in some religious beliefs (that I consider inconsistent), I can’t think of a moral action that is immoral only to a particular subset of the population based on profession.

  7. Very interesting and well-reasoned. I have one problem with it though:
    Physicians who participate in executions are acting in a professional, not personal, capacity. They can vote for death-penalty candidates, etc, but they cannot perform a medical service that kills someone against their will (assisted suicide is a whole can o’ crud I don’t wanna get into.)

    An interesting grey-zone issue to me would be if a physician is on a jury, could they morally support a death sentence?

  8. I am not a doctor, but my interpretation is that the only reason a doctor can do invasive things on a patient is because that patient has given the doctor permission to do so on the patient’s behalf. Who is the patient in a medicalized execution? Has the patient given informed consent? If the state can authorize an execution, can it authorize a lesser sanction? Torture? Experimentation? Involuntary organ donation? Euthanasia? Sterilization? Nuremburg established that there are some things that states cannot authorize. Those who perform those acts are guilty of crimes against humanity, even if they were only “following orders”. Those are “illegal orders” and cannot be carried out with legal authority. Execution of an innocent person is one such illegal order.

    As the final act, who ever performs an execution is (in my opinion) stating that the execution is a “legal order”, that is that every step in the legal chain has been carried out accurately and precisely according to law, and that no injustice will occur if the execution is carried out. People are responsible for the reasonably foreseeable consequences of their actions. If an innocent person is executed, all the people involved in that execution bear responsibility for it.

    Maybe the “legal” system can allocate “legal” responsibility, and a doctor who unknowingly executes an innocent person may not bear “legal” responsibility. That does not change the doctor’s moral responsibility. Does malpractice insurance cover it? If an innocent person is wrongly executed and his estate sues the doctor, is the doctor indemnified? How does executing an innocent person affect a doctor’s record and reputation? I would be curious what an insurance company would charge for a policy to protect a doctor from liability in case the doctor executed an innocent person.

    I don’t have enough confidence in the legal system to trust it with making life and death decisions. I have seen too many press reports of innocent people on death row.

  9. Wow. That was a really interesting analysis, vis-a-vis consent. Honestly, I thought you were going to bring NO into it somehow!

    We cannot do anything to a patient without their consent, and executing someone, well…

    I haven’t read that particular argument, but I’m stealing it now.

  10. I thought some more about responsibility for accuracy of tests that are relied upon. If a doctor relies on an erroneous test and commits malpractice, it is still his “fault” for not using sufficiently reliable methods. I think a doctor who relied upon the justice system and erroneously executed an innocent person is in exactly the same situation.

    If you want me to bring NO into it I could, but that would be more in the context of low NO inducing a psychotic or delusional state when the crime was first committed. That psychotic state might not meet the definition of insanity, I mention some of this in my blog on acute psychosis. I think that low NO is the mechanism for the cycle of violence, and it is the brutal treatment in prison which makes prisoners more violent. If you want to rehabilitate criminals, you have to coddle them. Of course that won’t satisfy the feelings of vengence that the (supposed) non-criminals want so much.

  11. jen_m

     /  January 9, 2008

    Gilad wrote, “Except in some religious beliefs (that I consider inconsistent), I can’t think of a moral action that is immoral only to a particular subset of the population based on profession.”

    Mostly a side-point, but soldiers come to mind immediately as a class of professionals whose principal job (disabling and/or killing other soldiers at the order of the state) is entirely illegal when performed without state auspices.

    I think the consent issue is interesting, but may be a red herring, because to explore consent implies the medication associated with execution is treatment. The very reason that physicians should not participate as physicians is that execution is neither treatment nor necessary research. That was the main point of the Nuremberg trials – that consent must be obtained for any intervention, and for any experimentation, as those are primary activities of medical care providers and researcher. Execution is neither, and requires a whole different approach.

    Another problem is that the physician’s role subsumes his identity – he is a doctor even when he’s unemployed, and has professional obligations morning, noon, and night, as long as he’s licensed to practice.

  12. Gilad

     /  January 14, 2008

    First and foremost, regarding soldiers – I did not discuss legality but rather morality. I do think serving in the military may be OK under certain circumstances (I actually spent 4 years in the military, and still perform reserve service), and it’s clear that soldiers are called upon to kill people who are only threatening them in a very round-about way. However, the responsibility of protecting one’s country or people with arms may not require you to be in the military – consider the American war of independence, and (you’ll probably agree with at least one of the following two) the Israeli war of independence, or armed operations by Palestinian liberation organizations. The fact that the law limits this action to a subset of the population does not mean the morality of the action is likewise limited (consider other licensed professions such as doctors and lawyers, and professions such as policemen).

  13. Dave

     /  September 21, 2011

    Jack Kevorkian’s book, Prescription:Medicide goes into great detail about various execution methods. I think he wrote much of it before he got involved in assisted suicide. He advocated using anesthetized death row inmates as subjects for surgical research. Doesn’t pass the whiff test for me, but his point was to glean some good out of a bad idea, and ultimately reduce suffering for the inmate.

  14. DLC

     /  September 22, 2011

    then let them take the person to be executed out and shoot him. No bullshit, no tying them down, no quick, clean bullet through the back of the head. It’s not humane. executing someone never is.
    Doing it that way at least might let it sink through to some cement-heads out there that No, executing a prisoner is not ever “humane”.
    But then, I find myself wondering, what about someone who’s on fire, clearly going to burn to death, and who has no chance at all of surviving ? Would it be moral (if such things exist as Morals) of me to shoot the man and so save him the pain and horror of burning alive ? What would the law do to me if I did ? If it isn’t right to kill the man who’s going to die of burns, is it still alright to turn some already dying cancer patient’s IV morphine up to the max ? These last two questions really aren’t easy. But then, these issues never are.

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