Doctors and executions
February 24, 2006
The
Christian Science Monitor
After two refuse to assist a lethal injection in California, debate
over end-of-life ethics grows.
By Brad Knickerbocker
In California this week, two anesthesiologists refused to monitor the
administering of a barbiturate designed to render unconscious convicted
killer Michael Morales before he was to be killed with two other drugs.
The execution was called off - or, at least, postponed. Death-penalty
opponents cheered. And the roiling debate over the ethics of medical
professionals' involvement in the officially sanctioned ending of human
life got a little hotter.
At issue: Should a healer help the executioner?
Beyond abortion (where the question of when life begins remains the
major debating point), this includes executions carried out by the
state and physician-assisted suicide now legal in Oregon and being
considered in other states.
Similarly, medical ethics are involved in growing questions about
military doctors taking part in the interrogation of prisoners and the
force-feeding of those on a hunger strike.
In the eyes of most professional medical organizations, physicians have
the ethical and professional obligation to do what they can to make
people well, not to help kill them. The American Medical Association
(AMA) code of ethics states, "A physician, as a member of a profession
dedicated to preserving life when there is hope of doing so, should not
be a participant in a legally authorized execution."
While most states now favor lethal drugs in capital punishment, courts
increasingly are taking a skeptical view of a procedure that critics
say violates the Constitution.
"The issue is whether the method the government has chosen to employ in
our case constitutes cruel and unusual punishment," says Steve Northup,
a Richmond, Va., attorney with a client on death row for gang murders.
"There's a lot of scientific opinion out there to the effect that it
causes a great deal of pain."
In the California case, a federal district judge ordered - for the
first time - that licensed medical personnel administer the sedative.
In recent weeks, stays of execution have been granted in four cases,
and the US Supreme Court has agreed to hear a Florida case involving
lethal injection.
The California Medical Association has proposed legislation that would
end the role of physicians in capital punishment. In at least a dozen
states, lawmakers are considering proposals that would allow doctors,
nurses, pharmacists, and other medical personnel to become, in effect,
conscientious objectors regarding certain medical treatments.
In Oregon, doctors' involvement in end-of-life treatment focuses on the
nation's only law allowing physician-assisted suicide. The state's 1997
"Death with Dignity Act" specifically prohibits "lethal injection,
mercy killing, or active euthanasia." But doctors may prescribe lethal
drugs for mentally competent adults who declare their intentions in
writing and are diagnosed as terminally ill.
"It's an inherent conflict of interest," says William Toffler,
professor of family medicine at Oregon Health & Science University
in Portland. "It's an inherent degradation of the role of physicians."
That's a concern among some medical personnel in the armed forces, who
worry about doctors in uniform handling of detainees at
Guantánamo Bay, Cuba.
"There is a slippery slope that needs to be addressed," says retired
Army Brig. Gen. Stephen Xenakis, a psychiatrist who once headed one of
the Army's regional medical commands.
Referring to the reportedly harsh treatment of detainees, General
Xenakis told a panel last August, "I don't see that compatible with
what we do as physicians.... There needs to be guidance from the
Defense Department that says that we will not do that, irrespective of
what the CIA and the special ops folks want to do."
In a report to the Army Inspector General last year, Maj. Gen. Lester
Martinez-Lopez, M.D., recommended that military physicians and
psychiatrists not aid interrogators, but that recommendation was
rejected by the Pentagon.
More recently, military doctors have been involved in the force-feeding
of detainees strapped to chairs. Military officials say the treatment
remains relatively humane. And they point out that they, in fact, are
preventing the possible loss of life of prisoners who are on a hunger
strike.
Critics disagree.
"If you look at the obligations of the health professions and doctors
in particular, UN standards, World Medical Association standards, AMA
standards, the responsibility of the physician in war or peace is to
improve peoples' health and not to inflict pain or harm," says Leonard
Rubenstein, director of Physicians for Human Rights.
It's important for professionals to abide by their ethical standards,
says Carl Coleman, a law professor specializing in health policy at
Seton Hall Law School. "Part of the nature of a profession is the idea
that it's at least to some extent self-regulating, that there are
ideals that may go beyond the minimum standards the law requires."