New Voices - Medical Professionals

DOCTOR'S VIEW: "In the Execution Chamber, Medicine is Misplaced"

Dr. Philip B. Woodhall, M.D., who practiced emergency medicine in North Carolina for many years, recently wrote about the proposed role of doctors in carrying out lethal injections.  He stated that medicine and executions do not mix.  "[D]octors are given extraordinary rights and privileges," he wrote, and "these powers are dedicated to the preservation of human life, not to the service of death."  Woodhall urged North Carolina's Department of Corrections to abandon efforts to include doctors in any aspect of executions. He further commented:

When I think about executions in North Carolina, I think about advice I gave my teenage daughters: Nothing good happens after midnight. Our state executes prisoners at 2 a.m. on Fridays; we choose the same hour as folks who have something to hide. What remains in plain view is the frightful implication of converting execution to a medical procedure.

Since 1980 the American Medical Association has had policies in place to discourage doctors from participating in executions. Since 1992 the Code of Medical Ethics, Article 2.06, has specifically forbidden any participation in executions, with the exception of prescribing sedation beforehand and later signing the death certificate. The N.C. Medical Board has formalized a national professional standard that is 15 years old.
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On April 11, a Department of Corrections official called Aspect Medical Systems in Massachusetts to rush-purchase a special brainwave monitor. The written purchase order request from North Carolina stated, "This equipment is used to monitor vital signs and sedation scales of patients recovering from surgery." The machine is a technical but imperfect aid to assure that a sedated person is unconscious. Armed with this new monitor, the state received court permission to execute [Willie] Brown on April 21, 2006.

Aspect, appalled at this nonmedical use of its equipment, now requires purchasers to sign a statement declaring that the equipment will not be used as part of a lethal injection execution. As reported in the New England Journal of Medicine, the Department of Correction refused to comment on this incident.

Such behavior by our government buoys the moral and practical arguments against the death penalty. Whether an individual physician supports or decries execution, the Medical Board is right to use its power to prevent all physicians from participating.

Doctors are granted extraordinary rights and privileges, such as surgery -- which might otherwise be considered assault -- or the prescribing of potentially lethal and addictive medicines. These powers are dedicated to the preservation of human life, not to the service of death.
. . .

There is a good way to prevent this nightmare from recurring. Wake up. The whole world is watching.

(North Carolina News & Observer, March 13, 2007).

American Medical Association, EMT Association Say Participation in Executions Violates Medical Ethics

Both the American Medical Association (AMA) and the National Association of Emergency Medical Technicians (NAEMT) recently issued public statements reminding members of their ethical obligation not to participate in legally authorized executions. As courts and legislatures throughout the country continue to struggle with questions related to lethal injection procedures, AMA president William G. Plested III noted that AMA policy clearly prohibits medical professionals from participating in executions because it "erodes public confidence in the medical profession." The NAEMT issued a position paper stating that member participation in executions is forbidden because it "is inconsistent with the ethical precepts and goals of the EMS profession."

In his statement for the AMA, Plested noted:

The American Medical Association is troubled by continuous refusal of many state courts and legislatures to acknowledge the ethical obligations of physicians, which strictly prohibit physician involvement in a legally authorized execution. The AMA's policy is clear and unambiguous — requiring physicians to participate in executions violates their oath to protect lives and erodes public confidence in the medical profession.

A physician is a member of a profession dedicated to preserving life when there is hope of doing so. The use of a physician's clinical skill and judgment for purposes other than promoting an individual's health and welfare undermines a basic ethical foundation of medicine — first, do no harm.

The guidelines in the AMA Code of Medical Ethics address physician participation in executions involving lethal injection. The ethical opinion explicitly prohibits selecting injection sites for executions by lethal injection, starting intravenous lines, prescribing, administering, or supervising the use of lethal drugs, monitoring vital signs, on site or remotely, and declaring death.

As the voice of American medicine, the AMA urges all physicians to remain dedicated to our ethical obligations that prohibit involvement in capital punishment.

(AMA Press Release, "AMA: Physician Participation in Lethal Injection Violates Medical Ethics," July 17, 2006)


The NAEMT position statement stated:

The National Association of Emergency Medical Technicians (NAEMT) is strongly opposed to participation in capital punishment by an EMT, Paramedic or other emergency medical professional. Participation in executions is viewed as contrary to the fundamental goals and ethical obligations of emergency medical services.
. . .
Historically, the role of EMTs and paramedics has been to promote, preserve and protect human life. NAEMT’s EMT Oath is based on the basic principles of saving life, respect for human life and the non-infliction of harm to all recipients of emergency medical service care. The EMT Oath is a guide for the EMT and paramedic code of conduct and stipulates that the EMT or paramedic “follow that regimen which, according to my ability and judgment, I consider for the benefit of patients and abstain from whatever is deleterious and mischievous.” The obligations to rescue, save and preserve life are part of the essential trust relationship that the EMT and paramedic have with all people in a community and should not be breached even when legally sanctioned.

Participation in capital punishment is inconsistent with the ethical precepts and goals of the EMS profession.

NAEMT strongly opposes to all forms of participation, by whatever means, whether under civil or military legal authority.

EMTs and Paramedics should refrain from participation in capital punishment and not take part in assessment, supervision or monitoring of the procedure or the prisoner; procuring, prescribing or preparing medications or solutions; inserting the intravenous catheter; injecting the lethal solution; and/or attending or witnessing the execution as an EMT or Paramedic.

The fact that capital punishment is currently supported in many segments of society does not override the obligation of EMTs and Paramedics to uphold the ethical mandates of the profession.

NAEMT recognizes that endorsement of the death penalty remains a personal decision and that individual EMTs and paramedics may have views that are different from the official position of the profession. Regardless of the personal opinion of the EMT or paramedic on the appropriateness of capital punishment, it is a breach of the foundational precepts of emergency medical services, and a violation of the EMT Oath, to participate in taking life of any person.

(NAEMT Position Statement on EMT and Paramedic Participation in Capital Punishment, June 9, 2006)

Anesthesiologists Advised to Avoid Lethal Injections

Dr. Orin Guidry, president of the 40,000-member American Society of Anesthesiologists (ASA), issued a public statement strongly urging members to "steer clear" of any participation in executions by lethal injection. In a four-page "Message from the President," Guidry noted that anesthesiologists have been "reluctantly thrust into the middle" of the legal controversy over lethal injections. In recent months, the procedures being used around the United States have been challenged because they may result in unnecessary and excruciating pain in violation of the ban on cruel and unusual punishment.

Guidry's announcement came after U.S. District Judge Fernando Gaitan Jr. ordered a halt to executions in Missouri until the state makes major changes in its lethal injection procedures. In that ruling, Gaitan said that a board-certified anesthesiologist needs to certify that an inmate has achieved sufficient anesthetic depth so as to not feel undue pain when the remaining drugs from the lethal injection cocktail are injected. Gaitan's order stated that an anesthesiologist would be "responsible for the mixing of all drugs which are used in the lethal injection process" and would either administer the drugs himself or "directly observe those individuals who do so."

In response to Gaitan's ruling, Guidry reminded members that the ASA has adopted the American Medical Association's position that doctors should not participate in executions. Guidry wrote, "Clearly, an anesthesiologist complying with the Missouri ruling - and despite the court's position on ethical obligations - would be violating the AMA position which ASA has adopted. It is my belief that the court cannot modify physicians' ethical principles to meet its needs."

(Los Angeles Times, July 2, 2006). Read the full text of Dr. Guidry's "Message from the President."

Deepak Chopra Writes About the Death Penalty

Dr. Deepak Chopra recently wrote that continuing use of the death penalty in the U.S. is irrational because it does not deter crime, risks innocent lives, and isolates the U.S. among the majority of First World nations that have chosen to abandon capital punishment:

The U.S. has isolated itself among First World countries by allowing the death penalty -- 123 countries have abolished it completely, or in practice never use it, a few permitting it under extreme circumstances.

Of the 50 countries that newly abolished the death penalty since 1985, only 4 have reinstated it. Why aren't more people chilled by the fact that in 2004, 97% of executions took place in China, Iran, Viet Nam, and the U.S.?

Execution amounts to cruel and unusual punishment by the world's prevailing standards. A current case before the Supreme Court is testing that proposition here. Yet somehow the American public feels undisturbed by this issue. Few if any politicians dare to run on the wrong side. In this case "wrong" means humane and rational. Why do we kill criminals? The right wing surely can't hide behind morality, unless they want to warp Jesus into an eye-for-an-eye advocate.

No, the death penalty is almost entirely irrational. It has little if any deterrent effect. Tragic mistakes have been made in its application. The very fact that inmates must wait on death row for years, even decades, is cruel enough. How many times do they die in their own minds before the actual event?

The landscape of cruelty in America has become more and more disturbing recently.
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Under what possible moral scheme can a civilized country consider this anything but barbaric? Our prisons are called penitentiaries (from the root word 'penance') because over two hundred years ago it was felt that an enlightened society must move beyond Old Testament revenge for wrong-doing. Now we have slipped back across that moral boundary, and the saddest thing, in this boom time for building more prisons, locking away more non-violent criminals, and handing down maximum sentences, is that we have learned to condone cruelty almost as if it didn't exist. As if it was a good thing.

(Huffington Post, June 27, 2006). Deepak Chopra is the founder of the Chopra Center for Well Being in California and a leading expert in mind-body medicine.

Leading Forensic Scientist Calls For Halt to Executions Because of Faulty DNA Testing

An editorial by Dr. Cyril H. Wecht, past president of the American Academy of Forensic Sciences, notes that crime labs are overwhelmingly backlogged with work and that deficiencies of personnel, space and equipment in forensic science labs often lead to shoddy practices and erroneous test results, as recently exemplified by the problems uncovered at the Houston Police Department DNA lab (see below). Dr. Wecht notes:

There can be little doubt in the minds of trained, experienced forensic scientists that testing defects, backlog pressures, inadequately qualified personnel, and prosecutorial bias exist in many other DNA labs even though they have not yet been uncovered and publicly reported.
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Until these glaring deficiencies are identified, objectively reviewed, and carefully corrected, society cannot expect that justice will be served.
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State lawmakers should carefully scrutinize DNA labs that use inferior testing methods that lead to inaccurate results. An immediate freeze on executions is essential until scrupulous federal and state reviews of all DNA labs have been accomplished. This is the only just way to proceed. Close attention to this critical problem will not only lower the risk of executing innocent people, it will also facilitate the capture and conviction of the guilty. (Emphasis added).

(Knight Ridder Tribune - Tallahassee Democrat, June 15, 2003)

American Psychological Association Calls for Death Penalty Moratorium

The American Psychological Association (APA), the largest association of psychologists worldwide, recently called for a moratorium on executions. In passing the resolution, the APA cited the number of wrongly convicted inmates exonerated by DNA testing, inconsistencies in prosecutors' decisions to seek the death penalty, and the role that race plays in death penalty cases. The resolution also noted that two-thirds of all death penalty cases from 1973-1995 were reversed because of error. The APA called upon each jurisdiction in the U.S. to halt executions "until the jurisdiction implements policies and procedures that can be shown . . . to ameliorate the deficiencies" cited in the resolution.

(APA Resolution, 8/26/01)

Doctor Urges Discipline for Execution Involvement

Sidney Wolfe, M.D., Director of Public Citizen Health Research Group, recently wrote to John Romine, M.D., President of the New Mexico State Board of Medical Examiners urging the immediate suspension of Dr. Fred Pintz's license to practice medicine because of Pintz's involvement in the upcoming execution of Terry Clark. According to the letter, Pintz, the Chief Medical Officer of the State of New Mexico, violated ethical and legal principles governing the Board of Medical Examiners when he authorized the acquisition and provision of the drugs to be used by the New Mexico Department of Corrections in the execution of Clark. Clark is scheduled for execution on November 6th.

Read Dr. Wofle's letter. (Shortly after Dr. Wolfe's letter was received, the execution drugs were returned to the State Dept. of Health. However, Terry Clark's execution went forward on Nov. 6.)

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