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

Conclusions and Recommendations

In this report, we have examined physician participation in executions. We reviewed ethical standards of conduct and explained the importance of the ethical prohibition against physician involvement. Recent guidelines specify the activities that constitute unethical conduct by physicians in the execution process. In the course of our research, we found that physicians are involved in all methods of executions, especially ones performed by lethal injection, in violation of professional ethical guidelines. Physicians continue to consult on lethal dosages, examine veins, start intravenous lines, witness executions and pronounce death. The threat posed to the moral standing of physicians, and to the public trust that physicians hold, is great. It warrants immediate and decisive action to assure the public, and each patient, that physicians will not use their skills to cause immediate and irreparable harm.

We also discovered that state law and regulation are in direct conflict with established ethical standards regarding physician participation in executions. The majority of death penalty states define a role for physicians in the execution process, from witnessing in an official capacity to monitoring vital signs and pronouncing death. Although many states declare that execution methods are not medical acts, they seek to involve physicians to make the process more "humane"; this is contradictory and a distortion of the physician's role in society.

Our recommendations are geared to eliminate this conflict between medical ethics and the law, and to allow the medical profession to enforce its ethical guidelines.

Recommendations

The laws and regulations of all death penalty states should incorporate AMA guidelines on physician participation. In particular, laws mandating physician presence and pronouncement of death should be changed to specifically exclude physician participation.

Laws should not be enacted that facilitate violations of medical ethical standards (such as anonymity clauses). The medical

profession cannot regulate and police itself properly if laws protect violators from scrutiny and review.

All state medical societies should adopt the AMA guidelines on physician participation in executions. Medical societies should inform state medical boards of the seriousness of this violation of medical ethics, and urge that prompt action be taken against violators.

State medical boards, which are responsible for licensure and discipline, should define physician participation as unethical conduct, and take appropriate action against physicians who violate ethical standards.