Physicians, Medical Ethics, and Execution by Lethal Injection

JAMA. 2014;311(23):2375-2376. doi:10.1001/jama.2014.6425

Robert D. Truog, MD; I. Glenn Cohen, JD; Mark A. Rockoff, MD

In an opinion dissenting from a Supreme Court decision to deny review in a death penalty case, Supreme Court Justice Harry Blackmun famously wrote, “From this day forward, I no longer shall tinker with the machinery of death.” In the wake of the recent botched execution by lethal injection in Oklahoma, however, a group of eminent legal professionals known as the Death Penalty Committee of The Constitution Project has published a sweeping set of 39 recommendations that not only tinker with, but hope to fix, the multitude of problems that affect this method of capital punishment. [Full text]

Should doctors take part in executions?


 Michael Cook

It is unethical for American physicians to participate in executions, according to a commentary in the Journal of the American Medical Association. Robert D. Truog, a bioethicist, I. Glenn Cohen, a law professor, and Mark A. Rockoff, a doctor, all of Harvard University, assert forcefully that “Regardless of whether execution is justified … it must never be perceived as a medical procedure.” That is almost universally acknowledged around the world, and by all medical associations.

The Harvard academics were responding to a study by the Death Penalty Committee of The Constitution Project, a group of eminent lawyers who oppose capital punishment. Recommendation 39 was that doctors should be involved in those executions which do happen in order to ensure that they are humane as possible – even if medical associations object. This is impossible, the three authors contend. Participation is a violation of the principles of medical ethics. Expecting that some doctors will participate is cynical and shows a “profound disregard” for the integrity of the medical profession. “Medical professionals cannot permit state law and regulation to subvert an ethical commitment that has uniform support across virtually the entire profession around the world.”

Of course, this begs the question of physician involvement in assisted suicide. But the authors appear to look upon this as an altogether different question. They imply that an execution is an “involuntary” taking of life, while assisted suicide is a voluntary taking of life. Dr Truog distinguished between the two in a 2011 article in the Hastings Center Report: “the critical ethical distinction between physician-assisted suicide and capital punishment, which is that the former is focused upon patient-centered goals, whereas the latter serves the goals of the state”. He thought that a doctor might participate as a citizen in a firing squad, but he could not administer a lethal injection as a doctor.

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