Physician participation in executions is a violation of medical ethics

November 19, 2001

CHICAGO --- Despite arguments that physician involvement in executions reduces prisoners' pain and suffering, lethal injection and other forms of capital punishment are no closer to being medical procedures than is killing with a knife or a gun, according to two Northwestern University researchers.

Physicians who claim that their involvement in executions helps reduce suffering actually facilitate the type of procedure they are ethically barred from participating in, say physician and medical ethicist Linda L. Emanuel, M.D., and legal scholar Leigh B. Bienen. Emanuel is Buehler Professor of Aging and director of the Buehler Center on Aging and of the Professionalism and Human Rights program at Northwestern University Medical School. Bienen is senior lecturer and a death penalty expert at the Northwestern University School of Law.

In an editorial in the November issue of the Annals of Internal Medicine, Emanuel and Bienen commented on an article in the same issue that examined why physicians are willing to participate in the process of lethal injection. The article found that a large minority of physicians are willing to participate in executions and do so out of a sense of citizen obligation, even though the law goes out of its way to avoid obligating physicians to participate in capital punishment.

However, "examination [of the information] reveals that medical involvement [in executions] mostly serves to advance pro-death penalty political purposes," Emanuel and Bienen said.

"Death penalty advocates sought medicalization and physician involvement for the purpose of improving public acceptability of executions," they said.

Emanuel and Bienen contend that lethal injection is not even reliably humane -- rather, it is less unpalatable to observers. Inclusion of a paralyzing chemical in the lethal injection "cocktail" makes the procedure seem peaceful, but it may only mask suffering since the person is totally paralyzed, they stated.

"Paralysis avoids the visions of wild death struggles, of hanging bodies with protruding tongues and of steam coming from the head of the person in the electric chair," they said.

They also found little solace in a research finding which indicated that, as involvement in execution becomes more direct, physicians experience diminishing readiness to participate.

"Neither does the diminishing willingness with proximity [person-to-person activity] offer much comfort when set against the reality that, since reenactment of the death penalty in 1977, physicians have been involved at every stage, whether preparation for, participation in, monitoring or attempting organ harvest for transplantation after execution," Emanuel and Bienen said. This involvement has occurred despite many professional injunctions that declare it unethical. For instance, the American Medical Association's House of Delegates passed a resolution in 1980 opposing physician participation in executions. The AMA subsequently expanded and reaffirmed that resolution in 1992 and 1997. The British Medical Association's stance that effective lethal injection would necessitate physician administration and thus was unacceptable enabled England to outlaw execution by lethal injection in the 1950s.

More recently, pressure from several professional medical societies helped to overturn a law that concealed the identity of physicians involved in executions.

Emanuel and Bienen emphasized that "traditional ethical positions opposing physician involvement are authentically derived and remain valid despite the minority view, and that physicians should take responsibility for reorienting these apparently confused minority views."

Northwestern University

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