Friday, January 11, 2008

Physicians and Their Role in Executions

The New England Journal of Medicine has published a provocative editorial on capital punishment and the physician's role in carrying it out.

Read my thoughts on this important editorial here.
The New England Journal of Medicine has published a provocative editorial on capital punishment and the physician's role in carrying it out. In truth, the position taken, that no physician should agree to facilitate an execution is old and has been endorsed by many medical societies. However, in over 1,000 words, the closest thing to an argument in support of this are these words: "A profession dedicated to healing the sick has no place in the process of execution."

Yet even this statement is offered without proof or justification and is merely a recapitulation of the authors' opinion. Cannot the exact opposite position also be offered, that in a nation that condones the death penalty through its laws and courts (and incidentally in public opinion), medical science should be brought to bear to insure that all executions are administered with compassion and decency?

If that is the case, who better to supervise an execution than a physician; preferably one expert in pain management, anesthesiology, or critical care medicine? After all, the article cites several instances of botched executions that almost certainly increased the pain and suffering of the criminal.

The position that this editorial takes, that the medical community's canon of ethics forbids it from participating in executions may well be heartfelt. Yet consider revealing words such as these:
Injected drugs, now used in all but 1 of the 37 states in which capital punishment is legal, have been part of the increasing medicalization of executions and the enlistment of medical personnel to lend them apparent moral legitimacy" (my emphasis).
I can't help but think that something else is going on here. Could it be that these authors are simply opposed to capital punishment and that by promoting a policy forbidding physicians from facilitating it, they in effect render it an impossibility?

If that is truly their agenda then that should have been their thesis and they should be forthright about it. Pardon me for finding it intellectually dishonest however, to hide behind some vague, poorly established interpretation of the Hippocratic Oath (which they also cited). The Oath was never understood to forbid the palliating of pain and suffering when death was imminent due to disease. Why should it be any different here?

By the way, unless you know me well, don't presume to know where I stand on the death penalty. This post is more about being upfront than about capital punishment.

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Blogger james gaulte said...

Without taking a position one way or other regarding physician's role in executions, I propose a somewhat abstract question? You correctly point out that the authors' views are presented without proof.My question is what sort of proof could be offered and/or what sort of proof would you accept as convincing? What sort of proof is offered in general to support an ethical position ?What proof was offered by the ABIM foundation and the ACP to assert that part of physician's ethical obligation is support social justice? Would proof refer back to a more fundamental ethical concept such as do-no-harm or the greatest good for the greatest number?

January 11, 2008 9:30 AM  
Blogger The Medicine Man said...

Dear James,

Your question is an excellent one and of course makes the valid point that whether or not physicians should be involved in executions is a personal decision. But to simply state that they should not as though it were some sort of generally accepted categorical imperative as these authors have done is nonsense.

If you're going to make such a statement, you should at least attempt to show some historical basis for it, of which they offer none. At least I attempted to refute it by arguing (effectively or not) that the Hippocratic Oath has never historically been thought to imply that palliating the death of a terminal patient was morally wrong even if to do so might hasten that patient's death.

Obviously with regards to moral issues, no proof is possible that will definitively end the discussion!


January 11, 2008 4:07 PM  
Blogger Michael Rack, MD said...

"I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy."
since all major medical organizations endorse abortion, I think any arguement/position against physician participation in executions based on the hippocratic oath should be disregarded.

January 11, 2008 9:12 PM  

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