Breach of Trust: Physician Participation in Executions in the United States

Introduction

When Charles Walker was executed by lethal injection in Illinois on September 12, 1990, three physicians assisted. Their medical skills were used to establish the intravenous portal through which the lethal preparation would pass, to witness and monitor the execution procedure and, in the end, to pronounce death. This occurred despite the appeals from many medical organizations to then Governor James Thompson urging that the state not use physicians to implement the execution. A few months following the execution, the Illinois legislature passed a bill providing for the anonymity of all persons participating in Illinois executions. Again, despite protest from the medical profession, Illinois' new governor, James Edgar, signed the bill into law.

The Walker execution and the action of the Illinois legislature brought the issue of physician participation in executions to the attention of many medical professionals and groups. These events brought into sharp focus the discrepancy between medical ethics and state laws on this subject. The ongoing controversy prompted a number of organizations to join together to examine the extent of physician involvement in executions and to provide policy recommendations to medical organizations, state governments and departments of corrections.

Four organizations participated in this project: the American College of Physicians (ACP), Physicians for Human Rights (PHR), Human Rights Watch (HRW) and the National Coalition to Abolish the Death Penalty (NCADP). As the working group began its project, members agreed on the nature and focus of its work. Each organization has different viewpoints on the death penalty itself, and all members agreed that this report would not take a position supporting or opposing capital punishment. Instead, the project would focus on medical involvement in executions, and the need to explore and define the ethical boundaries of such conduct.1 We also decided to narrow the scope of the project to physician involvement only, although we would point out when other health professionals participated in executions. Finally, we agreed to focus on executionprocedures, rather than on related issues, such as physicians' role in sentencing or conducting autopsies. Early in the project, the group realized the need for accurate data upon which to base policy recommendations. The extent of physician participation in executions, especially since the death penalty was reinstated by the U.S. Supreme Court in 1976, was not well documented. Therefore, we undertook research to systematically compile the necessary information, asking the following questions:

What are the requirements in state statutes and regulations regarding physician participation in executions?

What is the actual practice, prevalence and nature of physician participation in the execution process?

Are provisions made for medical staff to refuse involvement without reprisal? Are there procedures for raising and investigating ethical violations?

What are the policies of state and national medical societies regarding the ethical standards of physician involvement in executions, and what disciplinary procedures are in place in cases of violations of those standards? We reviewed all state laws (which are in the public record); we requested regulations (which are not always a matter of public record) from each state's department of corrections. All state medical associations were surveyed for their policies regarding physician participation in executions. Finally, interviews with witnesses and physicians were conducted to obtain case reports of actual participation in executions.

The results of this research form the basis of the following report. We begin in Chapter 2 with a short introduction to the history of physician participation in executions. We follow that in Chapter 3 with a review of medical organizations' responses to the issue . A summary of the results of our research appears in Chapter 4 (with a state-by-state description of laws, regulations and professional policies in the Appendix). Chapter 5 sets out the ethical framework for the prohibition against physician participation in the death penalty, and points out areas of consensus and controversy. Finally, our policy recommendations appear in Chapter 6.

This report documents that physicians continue to be involved in executions, in violation of ethical and professional codes of conduct. This involvement is often mandated by state law and specified in departmental regulations about execution procedures. Even when state laws are vague aboutrequiring physician participation, our research indicates that in practice, physicians are often directly involved in the execution process. As more states attempt to create the appearance of humane, sterile or painless executions, lawmakers and corrections officials may look to physicians to apply their medical skills for this purpose. But execution is not a medical procedure, and is not within the scope of medical practice. Physicians are committed to humanity and the relief of suffering; they are entrusted by society to work for the benefit of their patients and the public. This trust is shattered when medical skills are used to facilitate state executions.

Our recommendations are designed to ensure that current U.S. laws do not require physicians to violate professional ethics. Society must decide whether, how and when to impose capital punishment--without involving physicians in the execution process.

1 The American College of Physicians and Physicians for Human Rights have not taken a position on capital punishment, but oppose physician involvement on ethical and human rights grounds; Human Rights Watch and the National Coalition to Abolish the Death Penalty are opposed to capital punishment in all circumstances.