An Ethical Duty: Physician Participation in Lethal Injection, Research Paper Example

Being a physician is a power. Unlike “common people”, healthcare professionals are privy to the laws of functioning of a human being. They are here when we are born, they are our hope and support when we are in pain, and, finally, it is they who fight for our lives in the face of death. In the presence of a physician, we are bound to feel that they know more about us than we will ever be able to know about them. That is why it is so important for us that this power should be ethical. We would go any length to ensure that physicians do not harm us. Of course, the best example of such social effort is the Hippocratic Oath which the physicians are to swear before they start practicing. A separate point in the Oath is by no means giving deadly drug to a person, whether on request or not. However, with the popularity of lethal injection as in punishment practice, healthcare professionals are being increasingly involved in the execution of capital punishment in the United States.

Today lethal injection is the most commonly used form of execution in America. Consequently, numerous states require the aid of doctors and nurses to kill. Physicians are increasingly under pressure to break their Hippocratic Oath by assisting in lethal injections, and at the same time, are challenged by a chain of blotched executions that have put the condemned at risk of suffering excessive pain. Still, involvement in aiding in a death by way of lethal injection is construed as immoral; defying the physician’s responsibility, thus, weakening trust. So, should the government be allowed to request physicians to go against their ethical standards in order to resolve problems raised by lawful challenges? No. By doing this, the government creates a contradiction of values: medical ethics vs. public duty imposed by state.

Although it still finds its opponents, the concept of death penalty is accepted and put into practice in the United States (to be more exact, in thirty-eight American states). And, with an almost record number of prosecuted population and overcrowded prisons, the practice is quite wide. The year 2004 saw 59 executions and Kenneth Lee Boyd executed on December 2, 2005, completed the first thousand of Americans who died in capital punishment. Despite the determination to kill the guilty, many find the process of execution quite unpleasant and would rather use the least disgraceful methods. Moreover, there is a notion of a “humane” death, i.e. the death which does not involve too much suffering. Still, doubts persist whether lethal injection is a really good way of executing death penalty and, of course, whether the participation of doctors is really necessary.

The preparation to capital punishment in the form of a lethal injection may take several days and vary in its elements from state to state. Among other elements, it includes the invitation of witnesses who are usually not allowed to leave the witness room near the execution chamber during the execution. No communication of the condemned with the witnesses is allowed. The witnesses must remain silent. The condemned has a heart monitor attached to him / her. The monitor will show when the heart stops and the person dies. During the execution, a prisoner is restrained on a bed and the execution team inserts two intravenous tubes in his / her veins. For fear of mechanical failure, the execution is mostly performed in person despite the existence of lethal-injection machine.  The execution team is usually concealed from the view of the condemned. The warden gives a signal, and the team starts injecting lethal doses of a combination of drugs in the tubes. With some states, the principle is that the executioners work simultaneously and inject different drugs, but only one of them actually injects the deadly one. No one of the team knows who injects the lethal dose.

The three drugs used in the lethal injection mixture were once deemed a normal induction of anesthesia.

It includes, first of all, an anesthetic – Sodium thiopental. This barbiturate should render the condemned unconscious. Although the dose administered is lethal in itself, the drug is combined with two others.

The second is usually Pancuronium bromide or its analogue. It relaxes the muscles and paralyzes breathing by stopping the diaphragm and lungs. The heart is paralyzed by Potassium chloride – the third component of the mixture. The three drug mixture used to carry out the execution is excessively higher than the dosage employed in an ordinary anesthetic induction.

The combination might sound quite threatening, but the problem is that it may not provide a sure, instant and painless death.  However, there have been many issues regarding whether or not the three drugs used in a lethal injection are strong enough, or the right mixture, to properly and painlessly carry out the death penalty. According to Gawande (2001), there is a record of a number of botched executions because of a failure to constitute the dosages properly.  It is a matter of common knowledge that one and the same substance may have absolutely different effects on different people. Many were caused to suffer terribly remaining fully conscious before they died. Legally, this goes against the Eighth Amendment prohibition (banning cruel punishment).

First of all, the role of a physician or other medical professional present at the execution involves stating the death of the condemned. However, unless the condemned has been previously treated by a particular doctor and a lethal injection must be supervised by him or her, the doctor does not have any obligation to participate and make sure the death has occurred and the prisoner has not suffered. Moreover, it does not mean that the doctor must help the prisoner. In his article Should physicians participate in capital punishment? A. Caplan (2007) expresses an idea that it sounds strange that there is a tendency to invite a physician to oversee several last minutes of a prisoner while it remains extremely difficult to elicit physician’s help during the person’s incarceration due to the generally poor level of prison-based medicine. Isn’t it too late to take care of a person who might have long been denied proper medical help? Polemic as it may seem, this question touches a very important issue: do we really care about a prisoner or do we only want the execution process to acquire certain prestige in the public eye? The presence of a physician at the execution does make the process look more professional, respectful, and morally legitimate, and those responsible for the execution surely appreciate this effect. In effect, it means that medicine, with its universal mission of helping people, agrees with the practice of capital punishment in general and lethal injections in particular and sends its agents to attend and assist.

The cost of such prestige born by a physician may be unreasonably high. I have already mentioned in the thesis statement that the practice goes contrary to the professional code of physicians voiced in the Hippocratic Oath and shared by the medical community all over the world. Apart from the traditional Oath, there is a document which protects physicians from being induced to take part in the interrogation or torture of prisoners. It is “Guidelines for Medical Doctors Concerning Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment in Relation to Detention and Imprisonment”, or the Declaration of Tokyo, adopted by the World Medical Assembly of the World Medical Association in 1975. According to the Declaration, a doctor must not provide premises, instruments, substances, or knowledge that will support the practice of torture or other forms of cruel and inhuman treatment of human beings or decrease the human’s resistance to such practice. Although the Declaration does not speak immediately about capital punishment, many understand it to be prohibitive of physician’s participation in any form of execution. Strictly speaking, however, capital punishment is not torture defined, according to Dworkin (2002),  as “the deliberate systematic or wanton infliction of physical or mental suffering”, and this is what the advocates of physician’s participation in lethal injections say.

But from the point of view of physician’s participation, assisting by killing is only a step further. After all, the aim of the Declaration was just to forbid physicians to deliberately cause people to suffer and to prevent anyone including the state from making them perform the actions which are totally inconsistent with their professional code, mission, and, presumably, morals. After all, the Declaration does not forbid torture or dub it morally unacceptable, which makes torture analogous to widely accepted capital punishment. But it does prevent physicians from having a finger in it.

Another official ban of physicians’ involvement in practices that violate medical ethics followed in 1980 with the American Medical Association issuing a resolution that prohibited them. The ban was affirmed and elaborated on in 1992 in the Code of Medical Ethics. According to Article 2.06 of the Code, “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”. The Article leaves, however, it up to the moral judgment of an individual physician whether to support capital punishment or not. An opinion is not, by any definition, a means of action.

What is also important, the Article identifies prescribing medications for execution, as well as supervising the process for a death statement, giving technical advice, or just being present as unacceptable.

The Society of Correctional Physicians issued an even more categorical ban: “The correctional health professional shall… not be involved in any aspect of execution of the death penalty” (Code of Ethics of Society of Correctional Physicians, 1992). A similar document was adopted in its turn by the American Nurses Association. It was only the American Pharmaceutical Association that allowed voluntary provision of lethal medications to pharmacists.

Psychologically, we must not overlook the ruinous effect of the practice of participation in capital punishment on the personality of a physician. A physician is a person who once decided to undertake one of the most humane professions in the world. If the state goes as far as inducing physicians to take part in capital punishment, it risks averting a number of potential physicians from taking up the profession and creating great psychological discomfort to existing professionals. It should be mentioned, however, that physicians and nurses, even if they work as prison employees, cannot be induced to participate in the execution. They can only do it voluntarily. And many physicians stand by their judgment to assist in carrying out the death penalty to help minimize harm to the condemned. They believe that being there will help the condemned in his or her sufferings and is in this respect an action of mercy. They feel it in their power to make the last minutes less painful.

However, this is where the concern of trust arises. Even if a physician sees it his or her duty or job to take part in the capital punishment, this view may not be shared by a great number of his or her patients. When a patient knows that outside his or her office the physician acts in assisting death, the patient is likely to feel disheartened to trust such physician with one’s health. Even in case the government decides to impose the practice globally, it will find its opponents who cannot be denied grounds in asserting that the practice is unscrupulous and one and the same person cannot be required to both heal and kill by profession.

References

Caplan, A. (2007, September). Should Physicians Participate in Capital Punishment?. Mayo Clinic Proceedings, 82(9), 1047-1048. Retrieved June 30, 2009, from Academic Search Complete database.

Dworkin, G. (2002, April). Patients and prisoners: the ethics of lethal injection. Analysis, 62(2), 181. Retrieved July 2, 2009, from Academic Search Complete database.

Farber, N., Aboff, B., Weiner, J., Davis, E., Boyer, E., & Ubel, P. (2001, November 20). Physicians’ Willingness To Participate in the Process of Lethal Injection for Capital Punishment. Annals of Internal Medicine, 135(10), 884-888. Retrieved July 3, 2009, from Academic Search Complete database.

Gawande, A. (2006, March 23). When Law and Ethics Collide — Why Physicians Participate in Executions. New England Journal of Medicine, 354(12), 1221-1229. Retrieved July 3, 2009, doi:10.1056/NEJMp068042.

Gawande, A., Denno, D., Truog, R., & Waisel, D. (2008, January 31). Physicians and Execution — Highlights from a Discussion of Lethal Injection. New England Journal of Medicine, pp. 448,451. Retrieved July 1, 2009, doi:10.1056/NEJMp0800378.