Are U.S. doctors willing to be involved in executions of death row inmates?

Death row inmate executions by doctors

Poll on SERMO yields ethical debate among nations’ physicians

There was a lot of press coverage of an Arkansas state execution in April: the state’s use of an atypical execution drug which was nearing its expiration date, the intervention of the U.S Supreme Court, and Arkansas’ first inmate execution in 12 years. Many states have seen drug shortages for use in death penalty cases in recent years, as most pharmaceutical companies no longer are willing to sell their products for use in executions. In many states, a physician must assist with or be present during an execution, if not conduct the execution. With Big Pharma taking a firm stance against the death penalty, we asked more than 1,800 doctors from the US: Would you ever feel comfortable performing or assisting with an execution of a death row inmate?

74 percent said they would never feel comfortable in this role. What was even more interesting than the poll data alone was the conversation that accompanied the question:

Is it Right to medicalize the death penalty?

“Execution is outside most of our specialties. If you believe that there should be executions, it should be done the time honored way, hanging, firing squad, electrocution. All this stuff with gurneys, drugs with expiration dates, white paper or sheets on the execution table, is weird. In Arkansas, the expiration date is for medical purposes. Execution is completely off label use.” – Ophthalmology

“^^^ I agree with that, doctors shouldn’t make any attempt IMHO to ‘own’ executions by helping transform them into something that has all the appearance and logistics of a medical procedure. (Side note: Why don’t they get vets involved? Veterinarians are the experts in mammalian euthanasia, not us.)” – Psychiatry

“I don’t have a theoretical objection to legal execution, but physician participation muddies our role in society.” – Intensive Medicine

“Doctors have no business in the execution business…We’re not Joseph Mengele. Even if a dirtbag like Timothy McVeigh were lying on the gurney, I couldn’t and wouldn’t push through the midazolam or KCl.” – Family Medicine

Where do physicians draw the line on being involved in death?

“The next question after answering this one is, would you be comfortable in participating/performing euthanasia in a patient in a state which allows assisted suicide? How about performing an abortion? I don’t have a problem with assisting in a state execution. It is a legally sanctioned procedure, which is determined by applicable law. Given how some of these executions have gone, it is too bad really they haven’t taught whoever puts in the IV’s to put in a central line.” – Radiology

“I have to wonder if the people who said yes, would ever provide abortion services to a woman in need. Very different situations.” – Psychiatry 

“Only if there is a state sponsored abortion clinic down the hallway.” – Anesthesiology

“The Hippocratic oath admonished against abortion, yet many here favor it. And that line applies towards euthanasia and PAS.” – Psychiatry

Does participating in a state execution violate the Hippocratic Oath?

“Participation violates the Code of Medical Ethics and the ethical codes of most, if not all, specialty societies.” – Internal Medicine

“Whether I believe in Capital punishment or not, it is not what we spent so many years preparing for. We are here to save and preserve lives, and not to take them. While I tend to agree that there are evil people out there not worthy of breathing the same air as us, unlike these people being prepared to meet their maker, I would not be able to look into the eyes of the future dead, and not see a living breathing human being.” – OBGYN

A counter point was offered to the line of argument above: “Not all of us [are here to save and preserve lives]. Pain folks are here to minimize pain. Shrinks are here to hunt demons. Palliative care is here to comfortably usher in the hereafter. I’m here to provide comfort and hemodynamic stability… I’d rather nobody be executed, for lack of want. But if we, as a society, say it’s OK, let’s at least do it well. The ABA/ASA says I can’t do it without consequences, so I won’t volunteer.” – Anesthesiology

“What you see depends on where you stand. Many of us would have difficulty taking another human life, whether state sanctioned (death penalty, abortion, etc.), euthanasia (state permitted or not), or any other circumstance.” – Emergency Medicine

What about legality?

“As a citizen, I’m for the death penalty. As a doc, I’m conflicted.” – OBGYN                                                             

“I don’t object to capital punishment in theory. Certainly there are a lot of people who need to be killed for the safety of the rest of us. However, what stays my hand are the numerous cases of people who are convicted and then later DNA evidence proves they were innocent. Sometimes this happens after they have been executed. So how would you feel if you killed one of these people and later found out they were innocent? Our court system is anything but foolproof… The way capital punishment is done now it takes decades and costs far more than if they were just given life without any chance of parole. For those reasons, I’d get rid of it.” – Neurology

“I’m against capital punishment for all the reasons that anyone should be against a large and overbearing government. Do you trust government to manage the nation’s healthcare? Do you trust government to come up with exactly the right balance of regulations that constrain your (or anyone’s) business activity? Do you trust government to tax you fairly, and spend your tax dollars with maximal efficiency and minimal waste and corruption? If the answer to those questions is no, then why on earth would you entrust government with the power to kill citizens?”

What do the remaining 27 percent, who are comfortable assisting, think?

“I know that some people want to show compassion to people like this, but frankly, I don’t. I wouldn’t criticize those people for that decision (to not kill these people), but they also shouldn’t criticize me for my decision. I think taking someone’s life is a very difficult decision and hard to face the reality of carrying out that deed, but sometimes needs to be done. I’m glad that I am not put in that position and would not voluntarily put myself into the position of executioner except under unimaginably extreme circumstances.” – Family Medicine

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