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.


Chiara Eisner, The death cham­ber doctor’s dilem­ma: A physi­cian in South Carolina breaks his silence, The State, May 4, 2022; Joel Zivot, Executions often put physi­cians in unfair dilem­ma, CNN, January 18, 2017; Joel Zivot, The absence of cru­el­ty is not the pres­ence of human­ness: physi­cians and the death penal­ty in the United States, Philosophy, Ethics, and Humanities in Medicine (2012).

Photo: South Carolina death row in the Broad River Correctional Institution.