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Wednesday, February 22, 2006

More on Physician Participation in Executions

Following up on Betsy's post earlier today about the Michael Morales near-execution, here is a link to the AMA's Opinion 2.06 on "Capital Punishment" (if the link to the specific policy doesn't work, you can navigate to it by starting here).  The opinion broadly prohibits "participation" in an execution and then provides examples of conduct that would run afoul of the prohibition and conduct that would not.

(a) Definition of physician participation in an execution: "actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner."

(b) Examples of (a): "prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution."  With respect to lethal injections, the prohibition extends to "selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel."

(c) Actions that do not fall within (a): "(1) testifying as to medical history and diagnoses or mental state as they relate to competence to stand trial, testifying as to relevant medical evidence during trial, testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case, or testifying as to medical diagnoses as they relate to the legal assessment of competence for execution; (2) certifying death, provided that the condemned has been declared dead by another person; (3) witnessing an execution in a totally nonprofessional capacity; (4) witnessing an execution at the specific voluntary request of the condemned person, provided that the physician observes the execution in a nonprofessional capacity; and (5) relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution."

See also the AMA's Report A-1-92 (1992).

Jonathan Groner published "Lethal Injection: The Medical Charade" in Ethics & Medicine in 2004, in which he reviewed the hearing transcripts in State of Georgia v. Michael Wayne Nance.  Groner concludes that

physicians performed seven of the eleven activities that are forbidden by the AMA's ethical code . . . , and the nurses performed five of the eleven prohibited actions . . . . In two cases, the testimony about the role of the physicians was particularly noteworthy. In the execution of Ronald Spivey (executed January 24, 2002), a physician (the testimony does not make clear which specific doctor was present) ordered a second dose of intravenous potassium chloride after the first round of drugs failed to result in cessation of cardiac electrical activity. In the execution of Jose Martinez High (November 6, 2001), the nurses were unable to find veins for intravenous lines despite multiple attempts. Therefore, Dr. Rao, a board certified critical care physician, performed a right subclavian vein catheterization in order to carry out the execution.

Groner offered a more detailed discussion of the subject in the Nov. 2, 2002, issue of BMJ.  The American Public Health Association's policy statement on this subject also confirms the participationby physicians and other health care professionals. 

One of the best articles on this subject agrees: "Despite objections by many professional organizations the participation of physicians and nurses in capital punishment continues and is likely to become more common in the years ahead." See Truog RD & Brennan TA, Participation of Physicians in Capital Punishment. NEJM 1993;329:1346-1350 (paid subscription required).  Among other things, the authors disagree with the AMA's distinction between pronouncing death (not allowed) and certifying death (allowed).

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