Participation in Death Penalty: Where Should Line Be Drawn?

Ambivalence about the proper role of physicians in capital punishment cases was reflected in a November 2001 survey published in the Annals of Internal Medicine that questioned 100 practicing physicians. It found 41 percent would perform at least one action in capital punishment sentences disallowed by the AMA. Another 25 percent would perform five or more disallowed actions.

Those results reinforced an earlier survey published in the October 2000 Annals of Internal Medicine that found 80 percent thought at least one of the actions related to execution disallowed by the AMA was acceptable. Fifty-three percent indicated that five or more prohibited actions were acceptable, and 34 percent approved of all eight disallowed actions.

APA's position since 1980 has been against physician participation in carrying out capital punishment sentences. The APA position was based on the same arguments opponents of physician involvement continue to offer: that physician involvement with torture and killings in Nazi Germany, the Soviet Union, and other locations has shown that such involvement can smear the entire profession, according to APA's 1980 position paper opposing psychiatrist involvement with the death penalty.

The results of the surveys and the continued physician participation in executions, Halpern said, show that more physician education is needed to highlight the problems that arise when physicians become involved in state executions.

The AMA has no plans for a national educational effort of physicians on its death-penalty policies, but a publicity campaign describing its guidelines relating to medical conduct in general is under consideration, according to the spokesperson.

The issue of physician involvement in the death penalty was highlighted in March by a federal court mandate that an anesthesiologist participate in a scheduled California execution. The judge's order came after allegations that lethal-injection executions in California may have caused unnecessary suffering through poor sedation and inaccurate drug delivery. Two physicians, whose names were not released, volunteered to participate but balked when they realized the state required them to monitor the inmate actively, rather than passively monitor that proper steps were taken, according to Peter Warren, a spokesperson for the California Medical Association (CMA).

The CMA has since sponsored state legislation to bar the state from using physicians in executions. The CMA does not officially oppose the death penalty and allows physicians to sign the death certificates of executed prisoners but bars physicians from declaring an executed prisoner dead.

The response from hundreds of CMA members has been overwhelmingly in support of its efforts to bar physician involvement with the death penalty, Warren said.

“This is not a conservative/liberal issue. This is a physician issue,” Warren said about the CMA's efforts. “It is not our concern whether or not this ends capital punishment in the state.”

The CMA's guidelines against advising or observing executions also bar physicians from training prison staff to act in their stead during lethal injection, as some have suggested as a compromise.

The CMA has no position on punishing physicians who violate its guidelines on capital punishment, though there has been discussion recently over whether such a rule is needed, Warren said.

The physician advocates who criticized the TMA were also critical of the North Carolina Medical Society (NCMS) for not taking action against a physician who monitored the inmate's heartbeat as part of a recent execution. The NCMS has endorsed the AMA position on physician participation in executions since 1983.

“The society would frown on physician participation” in an execution, said Mike Edwards, an NCMS spokesperson. The physician would be“ acting against the stand of the medical society.”

Although the NCMS has no enforcement mechanism for physician members who operate counter to its guidelines, Edwards said, at least one member recently raised the possibility of reviewing that guideline.

Physician members of the AMA who violate its guidelines may be brought for a hearing before its Council on Ethical and Judicial Affairs. Priscilla Ray, M.D., a psychiatrist and chair of the AMA ethics council, said the council does not investigate whether physicians are actively involved in executions, counter to AMA guidelines. She said the council was recently made aware of a Georgia physician who publicly revealed an active role in executions. She would not confirm or deny that the council was investigating the physician's role.

The Georgia legislature recently moved to protect such physicians' medical licenses through legislation to protect any doctor who participates in carrying out a death sentence from being sanctioned by the state medical board.

The AMA position on the death penalty is posted at<www.ama-assn.org/ama/pub/category/8419.html>.▪