There is nothing ethical about a death penalty execution itself as legalized by society. To cause death to occur, by law, in an individual who has not even requested to die and at the very same time (in the United States as an example) to deny the opportunity to die by an individual who desires death (suicide or euthanasia) is an irrational societal construction of the laws. When this is then combined with society demanding physicians participate and then physicians or nurses acting contrary to their very own professional code of ethics makes their behavior both of society and those professionals unethical. It is undebatable that the professional's personal beliefs due guide their actions but if that belief leads to unethical behavior, the result becomes even less ethical and more shameful if the professionals (as written in the NEJM article) fail to expose their beliefs and actions to the public and simply decide to remain anonymous. The anonymity, for whatever reason, simply compounds the unethical acts. ..Maurice.

Although I am in nearly total agreement with Maurice, I would like to add some points from my own perspective. I am against the death penalty in all cases, but can at least conceive of a rationale in one (which I'll discuss later).

First, the United States is a nation whose rule of law derives from the consent of the governed. In other words, our governmental authority is (or should be) an extension of individual rights. No person has a right to kill another in this country except in self defense, or in defense of others. Neither one of these conditions apply to a prisoner strapped to a table.

Secondly, those who argue for a death penalty because of the financial burden of keeping someone locked up for life should read the facts. After all mandatory appeals have been exhausted in capital cases, it costs more to execute people than it does to house them for life.

Thirdly, we are perceived a barbaric by the remainder of Western societies, in which we are the ONLY nation that retains the death penalty. Most countries will not even agree to extradite a murderer to the US unless the death penalty is taken off the table.

Fourth, there has never been a ANY proven deterrent effect from the death penalty. Nobody stands at the scene of a robbery and says to themselves, "I won't pull the trigger because they might execute me." In fact, the incidence of homicide is lower in most countries without a death penalty.

Fifth, we have had to release hundreds of prisoners from death row when we discovered through new techniques (e.g. DNA testing) that they were innocent of the crimes for which they were scheduled for execution. Any human system of justice will make mistakes. If we incarcerate someone and find out we were wrong, we can at least give them back part of their lives. If we kill them, do we bury the pardon with them? Additionally, there will be even newer techniques to add to DNA testing, like functional MRIs that are being shown to be reliable lie detectors. A supreme Court Justice once remarked that the death penalty cannot ever be fairly administered as long as there is even a possibility of an innocent person being executed.

Finally, all theories of criminal justice rest on one of two concepts; Retribution vs. Rehabilitation. Can we, as a modern, democratic and supposedly rational society base our criminal justice system solely upon the vengeance advocated in various religious texts that originated in early Bronze Age Societies? I think not! While we continue to ignore the rest of the world in not using the Metric system, to do so with regard to the death penalty would be both the height of arrogance, and a stain on our justice system as great as slavery was on our democracy.

Therefore, I hold that any participation by physicians in a death penalty, including "healing" a patient so they are "well enough" to be executed is inherently unethical and manifestly immoral. Moreover, state medical boards should create specific sanctions for any physician found to have taken part in such an activity, that should include the suspension and/or loss of license. Additionally, I would add that none of what I have stated above has any relationship to physician assisted suicide which is performed on otherwise terminal patients, at their own request, and only after we have made as certain as possible that it was a truly volitional request whose consequences were completely understood.

If a life is to be taken, the only one we have any right to take is our own.

Maurice,
I remember the maxim I was taught early in my education: if possible, cure, if a cure is not possible, palliate and if that isn't possible, at least comfort. It is into this last category that PAS falls, and falls AT THE REQUEST of a cogent patient. On the other hand, I believe it is a very personal decision for each physician to make. Since we are dealing with a cogent patient's request to provide the "comfort" of death, the individual physician must decide whether it is morally acceptable for them, personally, to do so. If not, they have a right, or even an obligation to refuse, but the patient has an equal right to seek other medical care.

Kim,
That was exactly my point. As for working for the prison system being a mandate for a physician to participate in executions, that isn't true. It was established long ago that a government agency cannot force people to do anything that is against their conscience. That was the concept behind Conscientious Objectors when there was a draft. The job of a physician working for the prison system is to care for the inmates' medical needs, not to participate in their execution,

On the other hand, the line begins to blur when they are asked to improve the health or mental state of a prisoner so that an execution can be legally carried out. That, I suspect would pose both moral and employment conundrums. I don't think I could do it, but it could well be grounds for the Department of Corrections to at least attempt to terminate their employment. I believe a court would require the DOC to allow them to keep their job without participating in such care, but it could be a fight; and an interesting case to be involved in.

I too oppose the death penalty. For those interested, see the article "Incarceration Nation" and the accompanying slide show which outlines the history of the death penalty and arguements against its use at http://phsj.org/the-criminal-justice-system/

martin
Martin Donohoe, MD, FACP
Adjunct Associate Professor, School of Community Health
Portland State University
Chief Science Advisor, Campaign for Safe Foods and
Member, Board of Advisors
Oregon Physicians for Social Responsibility
Senior Physician, Internal Medicine, Kaiser Sunnyside Medical Center
http://www.publichealthandsocialjustice.org
http://www.phsj.org
martindonohoe@phsj.org

I strongly recommend Naseem Rakha's The Crying Tree, which directly addresses in a moving and often surprising way the issue of how one might react if a member of one's own family is killed
martin
Martin Donohoe, MD, FACP
Adjunct Associate Professor, School of Community Health
Portland State University
Chief Science Advisor, Campaign for Safe Foods and
Member, Board of Advisors
Oregon Physicians for Social Responsibility
Senior Physician, Internal Medicine, Kaiser Sunnyside Medical Center
http://www.publichealthandsocialjustice.org
http://www.phsj.org
martindonohoe@phsj.org

I'm afraid I have nothing to add to the excellent responses that have been posted to this question. I do have a few general comments I would like to offer with your permission:

-First of all, why are doctors, who have an oath that should prevent them from participating in such an event, needed to instill the 'serum of vengeance' in the first place? Anyone can learn to insert an IV, push a button and check for the absence of life. Is it merely because someone thought it should be a law that a doctor be involved? I wonder if it was a doctor who suggested that.

- I too am perplexed as to why the accused prisoner must be mentally capable of sustaining maximum suffering. Is that to assure society that the prisoner is capable of atonement if they wish? Or is it to make sure we get the biggest bang for our buck in suffering for the crime?

- How often do we hear 'Eye for an eye...' as Maurice pointed out, when justifying the death penalty? Will we never understand that 'Eye for an eye...' was never about assuring vengeance, it was a plea to not inflict more harm than was suffered!?

- The imaginary money saved by executing a human being as opposed to 'housing' them for a lifetime will never reimburse society for the loss of humanity we have suffered by allowing it to go on. Not to mention the incredible mental and spiritual anguish that is suffered by all involved when the innocence of the executed is proven when it’s too late.

- I have heard about the desire of our society to maintain the death penalty but I wonder what that desire is based on? And I wonder who they asked?

- It is indeed a slippery slope when we allow laws to dictate our medical ethics. It is obvious that we physicians cannot hold ourselves above laws; yet laws cannot be used to ease our conscience when we ignore the oath that we use to professionally guide us, and provide us with moral clarity.

The issue of victim impact statements is a difficult one. I suspect their main purpose is to allow the victim or family to "vent," not to justify a sentence. That should be determined by the nature of the crime as well as the nature of the convicted criminal (e.g. age, background,education, etc.). Moreover, while I believe that victim impact statements have a place in our criminal justice system and should be considered by a judge and/or jury before sentence is passed, no such statement can ever justify state sanctioned killing (my opinion).

Let me throw one other scenario out to those writing here. Suppose the death penalty is totally eliminated and a murderer, serving a life sentence without parole kills someone while in prison (a guard, another prisoner . . .). Since he or she would already be serving the maximum sentence allowed by law, any further killings would essentially be "free." Should this be the single case in which a death penalty should be allowed? Would it deter such a criminal from further murders?

And..and.. and. (related to the original question of the title here ).would this exception as interestingly suggested by Eric and possibly supported by Martin be the only exception where a physician participating in the execution process of such a criminal would be considered professionally ethically acceptable? Or are there no exceptions for the relationship of trust between the doctor and the person to which the doctor attends? Hmmn? ..Maurice.

Eric, since I, personally, am against physician-assisted suicide, I would hope that the prison officials, themselves, obtain the lethal dose of the drug to offer that prisoner in solitary confinement. Surely, they can do that rather than involving a physician and a prescription writing exercise.. Obviously, there is no legal problem for these same officials obtaining the lethal barbiturate along with a drug to paralyze respiration and a cardiac lethal dose of potassium as the intravenous killing potion. If society finds it is legal to kill that prisoner, it is equally legal, I would think, to assist in his or her suicide and without a physician. ..Maurice.