Doctors shouldn't kill people


By: Robert Wilbur

Almost every state that kills by lethal injection requires that a physician either assist or actually carry out the execution. Notwithstanding the medical credo “Do no harm,” every state with capital punishment has physicians who will take their place beside the death gurney in some capacity, if only to ensure that the condemned person is dead. It was, in fact, an Oklahoma physician—medical examiner A. Jay Chapman, MD—who brewed today’s three-drug cocktail of sodium thiopental (an anesthetic), potassium chloride (to stop the heart), and pancuronium bromide (to paralyze the breathing muscles).

Thiopental is almost never used any more in medicine; just about it’s only remaining use is for killing human beings.

Even veterinarians have moved on to newer, better drugs for putting animals to sleep, because sodium thiopental does not reliably anesthetize man or beast, so that the condemned person might be awake when the pancuronium bromide kicks in—which causes excruciating pain. But there is no way for the condemned to express his pain, because his vocal cords are also paralyzed. 

In some states, physicians train “aides” (convicts who work in the prison hospital) to carry out the executions themselves, snaking catheters into the veins of the condemned, measuring out the drugs and consummating the execution. But a growing concern in correction circles has increased the demand for physicians, especially anesthesiologists, for a medical specialist who devotes his career to putting people to sleep (although not permanently) because that person ought to be able to deliver a more refined execution. 

After a lull to ponder whether capital punishment is “cruel and unusual punishment,” the Burger court in 1976 gave the green light for states to resume killing. The American Medical Association (AMA), increasingly troubled by the presence of physicians in the death house, forbade its members from participating in executions and threatened them with expulsion. 

But AMA membership is not required in any state to practice medicine, so the physician could still take part in executions and go about his business. If pursued aggressively, however, the AMA’s policy might well deter physicians by holding them up to public obloquy—would you go to a physician who had spent the previous night killing someone?

The North Carolina Medical Board, which has the power to regulate the conduct of physicians, took a tougher approach than the AMA, attempting to strip physician/executioners of their licenses to practice medicine. The North Carolina Supreme Court overturned the board’s policy of getting physicians off death row, and—for good measure—the legislature passed a law affirming the court’s decision. 

There the situation languished until the U.S. Supreme Court upheld the constitutionality of lethal injections. The American Board of Anesthesiology reacted with surprising alacrity: its leadership voted to revoke the board certification of any anesthesiologist who participates in an execution. If enforced, this spells the end of a lucrative and comfortable career in the surgical suite, for almost no hospital today would grant privileges to an uncertified anesthesiologist.

So far, chatter on the Internet suggests that the ABA’s policy is scaring anesthesiologists off death row, but there are sure to be court fights, legislative wrangles, and covert defiance. What is more, anesthesiologists will simply be replaced by other physicians and by paramedics (whose professional organization also proscribes participation in executions). 

If states are determined to kill, physicians can’t stop them. But physicians can make capital punishment more difficult to implement by giving lawyers another shot in the courts on the basis that unprofessional executions are indeed cruel and unusual punishment. Physicians are respected members of the community, and their words and actions can help to change minds.

Right now, the various organizations fighting to abolish the death penalty should be prepared to line up behind the AMA and any other medical organization that adopts an effective policy against executions. This development within the medical associations provides an opportunity to broaden the ranks of voices against the death penalty.