Former South Carolina Death-Row Doctor: ​“I’m Supposed to be Saving People, Not Killing People”

After 37 years of silence, a South Carolina prison doc­tor who was in the exe­cu­tion cham­ber when eight pris­on­ers it was his duty to treat were put to death has for the first time pub­licly dis­cussed his conflicting roles. 

In an inter­view with Chiara Eisner of the Columbia news­pa­per, The State, short­ly after South Carolina Department of Corrections announced plans to car­ry out exe­cu­tions by fir­ing squad, Dr. Green Neal stepped for­ward to share his expe­ri­ences. ​“Death is death, no mat­ter whether it’s by dis­ease, by homi­cide, whether it’s state sanc­tioned or mur­der,” Neal said. ​“But it’s just, here I am, I’m sup­posed to be sav­ing peo­ple, not killing people.”

The arti­cle, pub­lished May 4, 2022 in South Carolina’s sec­ond-largest news­pa­per, high­lights Neal’s expe­ri­ences as a prison med­ical direc­tor charged with both being doc­tor to the peo­ple on the state’s death row as well as being in their exe­cu­tion cham­bers and sign­ing their death cer­tifi­cates. A doc­tor who par­tic­i­pates in exe­cu­tions vio­lates the eth­i­cal norms of the med­ical pro­fes­sion. The American Medical Association states that doc­tors can sign an offi­cial death cer­tifi­cate but do noth­ing more in an exe­cu­tion. The American College of Correctional Physicians pro­hibits prison doc­tors from par­tic­i­pat­ing in any stage of the exe­cu­tion process what­so­ev­er. Apart from being present, Neal’s sole role dur­ing an exe­cu­tion was sign­ing death warrants.

Neal, who oppos­es the death penal­ty, did not regard him­self as a mem­ber of the exe­cu­tion team. However, South Carolina’s exe­cu­tion pro­to­col express­ly required a doctor’s pres­ence and state law man­dat­ed that a doc­tor sign the execution certificate.

“I just didn’t think we should do it,” Neal said. ​“But, you know, I took their mon­ey as med­ical direc­tor. So if I took that mon­ey as med­ical direc­tor, then they expect­ed a job to be done. You do your job. And I didn’t see myself as killing any­body. All I was doing, the nat­ur­al thing that physi­cians do, I was pronouncing.”

“[P]art of your duty as an offi­cial for the state is to car­ry out the man­date to the court sys­tem,” he said. ​“So if you’re being paid for it, you need to do what you’ve been paid for. And that’s the way I rationalized it.”

Dr. Joel Zivot, an anes­the­si­ol­o­gist and pro­fes­sor at Emory University School of Medicine who has writ­ten exten­sive­ly on the ethics of physi­cian par­tic­i­pa­tion in exe­cu­tions, says that the pres­ence of doc­tors to assist in pro­ce­dures tak­ing a prisoner’s life is not the prac­tice of med­i­cine and doc­tors should not be involved at any stage of the exe­cu­tion process. By hav­ing doc­tors appear as part of the exe­cu­tion process, Zivot told The State, ​“You’re try­ing to san­i­tize killing some­one in the way that you can, and your claim is that by doing this, ​‘we are not act­ing with cruelty.’” 

Veteran cap­i­tal defense coun­sel David Bruck has rep­re­sent­ed numer­ous South Carolina death-row pris­on­ers, includ­ing Terry Roach, whose elec­tric-chair exe­cu­tion was one of the pro­ce­dures in which Neal par­tic­i­pat­ed. Bruck is crit­i­cal of those who ratio­nal­ize their involve­ment in the exe­cu­tion process. ​“Everybody thinks it’s not them,” he said. ​“Everybody has some delu­sion that they cling to to jus­ti­fy their par­tic­i­pa­tion. And if it wasn’t for that whole net­work of delu­sions, it would come to a screeching halt.”

In a 2012 com­men­tary in the jour­nal Philosophy, Ethics, and Humanities in Medicine, Zivot likened physi­cian par­tic­i­pa­tion in exe­cu­tion to the com­pro­mised roles doc­tors have been asked to per­form in mil­i­tary set­tings. ​“Physicians’ desire to reduce cru­el­ty in the set­ting of the death penal­ty may be com­pared to the actions of mil­i­tary physi­cians who use med­ical knowl­edge to enhance pris­on­er inter­ro­ga­tion, resolve hunger strikes and pre­scribe psy­chotrop­ic med­ica­tions to retain sol­diers in com­bat areas or accel­er­ate a return to active duty,” he wrote.

“The right­ness or wrong­ness of cap­i­tal pun­ish­ment remains an open ques­tion,” Zivot wrote in a 2017 com­men­tary for CNN. ​“Lethal injec­tion,” he wrote, ​“only imper­son­ates a med­ical act and … as present­ly prac­ticed, is an imper­son­ation of med­i­cine pop­u­lat­ed by real doc­tors who don’t acknowl­edge the deception.”

Neal’s involve­ment in exe­cu­tions was fur­ther com­pli­cat­ed by his back­ground. The son of a Baptist min­is­ter and the grad­u­ate of one of the few Black med­ical schools in the coun­try, Neal, now 76 years old, took a job in the South Carolina prison sys­tem with the aim of improv­ing the care avail­able to those who were incar­cer­at­ed. He nev­er told his father or his broth­er — a state rep­re­sen­ta­tive for 25 years — of his involve­ment in executions. 

His silence was also a prod­uct of South Carolina’s racial his­to­ry. A descen­dant of rel­a­tives who were enslaved, Neal was raised in deeply seg­re­gat­ed, rur­al South Carolina. After the exe­cu­tion of one white pris­on­er, a news arti­cle iden­ti­fied Neal as hav­ing par­tic­i­pat­ed in the exe­cu­tion. He received death threats, includ­ing an anony­mous phone call from a per­son who had fol­lowed him in a car and knew where he had dropped his chil­dren off to school. ​“If you lived here you had to con­form,” he told The State. ​“If you act­ed out you got squished, so I learned to con­trol my emo­tions way, way back.”

Neal repeat­ed a crit­i­cism oth­ers involved in South Carolina exe­cu­tions pre­vi­ous­ly told The State: ​“We nev­er had any coun­sel­ing, noth­ing. … We put it behind us and nev­er men­tioned it again.” But he was always aware of the incon­gruity of his par­tic­i­pa­tion in the execution process. 

“I fight for life. My job is not to kill; my job is to save,” he said.