<<previous  |  index  |  next>>

IV. Physician Participation in Executions and Medical Ethics

States present lethal injections as a quasi-medical way of executing the condemned. New Jersey law goes so far as to refer to the lethal chemicals as “execution medications.”¹⁷⁴ But executions are not medical procedures, and professional ethics prohibit doctors from participating in them. Indeed, it was the growing practice of lethal injection executions that prompted the medical community to clarify and solidify its position that physician participation in executions violates the ethical precepts of the profession.

The prohibition against physician participation in executions is rooted in the medical ethics of a profession committed to the principles of non-malfeasance (the avoidance of causing harm) and beneficence (the affirmative provision of good).¹⁷⁵ The American Medical Association’s “Code of Ethics” states: “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.”¹⁷⁶ The AMA defines the prohibited participation to include monitoring vital signs, attending or observing as a physician, rendering technical advice regarding executions, selecting injection sites, starting intravenous lines; prescribing, preparing, administering or supervising the injection of drugs; inspecting or testing lethal injection devices; and consulting with or supervising lethal injection personnel. Under the AMA Code, the only permissible participation by a physician in an execution would be to provide a sedative to a prisoner upon his request prior to his execution and to certify the prisoner’s death after another person has pronounced it.¹⁷⁷ The code of ethics for the Society of Correctional Physicians states: “The correctional health professional shall not be involved in any aspect of execution of the death penalty.”¹⁷⁸ The American Nurses Association has adopted a similar provision, stating: “When the health care professionalserves in an execution under circumstances that mimic care, thehealing purposes of health services and technology become distorted.”¹⁷⁹

Despite medical ethics, twenty-eight states require a physician to determine or pronounce death during an execution.¹⁸⁰ Nine states require the presence of a physician without indicating the purpose of the physician’s presence.¹⁸¹ “One can only surmise that medical expertise is desired by those states to ensure that the execution runs smoothly, i.e., to respond in case something goes awry, or to pronounce death.”¹⁸² Some state rules call specifically for a more direct role for physicians. For example, in Oregon, departmental procedures specify that the physician “will be responsible for observing the execution process and examining the condemned after the lethal substance(s) has been administered to ensure that death is induced.”¹⁸³ California regulations require physicians to fit the heart monitor to the condemned inmate and to monitor the inmate’s heart. In Oklahoma, the original protocol devised by Chapman required a physician to inspect the catheter and monitoring equipment and to make certain the fluid would flow into the inmate’s vein. That provision is not present, however, in the current Oklahoma protocol.¹⁸⁴

Physicians have, in fact, participated directly in the execution process itself. In 1990, three physicians administered the first lethal injection execution in Illinois.¹⁸⁵ For a number of years, anesthesiologists injected the drugs in Arizona’s lethal injection executions, although that function is no longer undertaken by a doctor.¹⁸⁶ During Texas’s first lethal injection execution, Dr. Ralph Gray, the state prison medical director, was present, along with Dr. Bascom Bentley, a physician in private practice, to pronounce the prisoner’s death. They watched as execution team members struggled to find intravenous access.¹⁸⁷ Eventually, the team convinced Gray to examine the prisoner and point out the best injection site.¹⁸⁸ Gray had also watched the warden mix the chemical agents. When the warden tried to push them through the syringe, he saw that because the warden had accidentally mixed all the chemical agents together, they had “precipitated into a clot of white sludge.”¹⁸⁹ When Gray went to pronounce the prisoner dead, he found the prisoner was still alive.  Gray and Bentley suggested allowing more time for the drugs to circulate.¹⁹⁰

More recently, a physician, who requested that his name and state remain anonymous, described three lethal injection executions where the execution technicians were having a hard time finding a vein to establish an intravenous line, because the prisoners were obese or had a past history of intravenous drug use, or both.¹⁹¹ Although present to monitor the EKG machine and pronounce death, the physician was called upon to help establish an intravenous line after the technicians had tried to do so for thirty minutes without success.¹⁹² During another execution in which the technicians could not find a vein, the physician also could not, and, in the end, he needed to place a central line—a complex and highly technical procedure which involves inserting the catheter in one of the deep large veins in the groin, chest, or neck.¹⁹³

As the above examples suggest, executions can and do go awry, and it is not clear what would happen sometimes if physicians were not present. As one doctor who has certified the deaths of executed inmates noted, “If the doctors and nurses are removed, I don’t think [lethal injection] could be competently or predictably done.”¹⁹⁴

Although there are exceptions, there is strong resistance in the medical profession to directly contributing to the “success” of an execution. Even doctors who work for correctional agencies have refused to participate in executions, sometimes at considerable professional cost.¹⁹⁵ In Colorado, for example, the medical staff at the Department of Corrections refused “to have anything to do with the executions,” which is why the state uses EMTs to insert the catheter and inject the drugs.¹⁹⁶

Human Rights Watch recognizes that the ethical prohibition on physician participation in executions limits the way states can conduct lethal injection executions. This is a dilemma of the states’ making—by their refusal to abolish capital punishment—and it is a dilemma states must resolve if they continue to use lethal injection executions. For example, alternative methods of lethal injection have been suggested that would negate the need for anesthesiologists to monitor levels of unconsciousness. Some states are considering legislation to prevent physician liability for participating in executions in breach of medical ethics, in the hopes this will facilitate their participation in executions.¹⁹⁷ It is up to state legislators and corrections agencies to determine how to proceed, but they must do so respecting the human rights injunction to use the execution methods that will cause the least possible pain and suffering.