Dr. Marc Stern, the former assistant secretary of healthcare for the Washington Department of Corrections, recently commented on physician participation in executions in the wake of the botched lethal injections in Oklahoma and Arizona. Dr. Stern resigned rather than cooperate with his state’s execution plan. He explained his views, “Although its foundation is in medical science, lethal injection is not a medical procedure: it has no therapeutic value, and it is not taught in medical school. A ‘successful’ lethal injection would require the training and expertise of a medical professional. Finding and accessing a vein – especially in someone who is older, obese or has abused drugs – can be challenging. Choosing a proper medication dose for a patient, monitoring medication administration and its effects, and making necessary course corrections need the expertise of a professional. But legitimate medical procedures are subject to scientific study, open discussion among peers, training, supervisory oversight and improvements in technique. Lethal injection will never benefit from these safeguards for one critically important reason: it violates medical ethics.” He acknowledged that some medical professionals are willing to anonymously participate in the process. “However,” Stern wrote, “we will continue to risk botched executions because they are conducted in a scientific vacuum.”

Read the op-ed below.

I was told to approve a lethal injection, but it violates my basic medical ethics

Marc Stern

I peered through the small window of an otherwise solid steel door of the isolation wing of the prison, and saw a small man on his knees in front of his steel framed bed. He had committed many murders and was sentenced to life without the possibility of parole. Perhaps he was praying. Perhaps he was looking for a pencil. But that’s when it struck me: There might be a punishment worse than execution.

Other than a maximum of one hour per day when he could be escorted to a recreational cage outdoors, he would spend the next 10, 20, perhaps 30 years of his life in this very room – eight feet by 10 feet. He would have little contact with other human beings aside from officers and medical professionals. Forging a new friendship or hugging a loved one, if possible at all, would be rare, supervised and not likely spontaneous. His life would be restricted to the same 80 square feet – forever.

It was 2005. I was making rounds as the assistant secretary for healthcare of the Washington State Department of Corrections. The death penalty and executions simply were not on my radar. My responsibility was only to ensure that incarcerated citizens were receiving safe, constitutionally adequate and humane healthcare.

But the death penalty eventually inched its way onto my screen as a medical professional – dead center, just as it did once again for so many people around the world Tuesday night in Missouri, and especially after the recent executions gone wrong in Oklahoma and Arizona.

In 2008, prison officials asked healthcare professionals under my supervision to procure the drugs for the lethal injection of a different citizen at Washington’s Walla Walla state prison, Darold Ray Stenson, despite assurances that department healthcare staff would not assist in any way in the execution. I learned about the drug procurement only a week before the scheduled execution.

It became clear to me: healthcare professionals cannot ethically participate in executions. Procurement of the drugs was a direct violation of ethics by the personnel involved. But it was also a violation of medical ethics by me, indirectly, as their supervisor. This kind of violation could be cured if lethal-injection drugs were returned to the pharmacy stores and obtained through a different source.

But prison authorities refused. The only cure remaining was to recuse myself. My resignation took effect three days prior to the scheduled execution, even though Stenson’s execution received a stay and he got a new trial. He waits in Walla Walla to this day, as Governor Jay Inslee’smoratorium on executions remains intact.

Ethicists, prison reformers and activists have long argued against capital punishment in the 32 states that still mete out the death penalty. And in many religious and moral frameworks, it is wrong. Of the world’s 196 countries, the US is among only about 67 that impose the death penalty, sharing that distinction with other like-minded nations such as China, Cuba, North Korea and Iran.

The lethal injection was originally a three-drug cocktail invented by a physician in 1977. Although its foundation is in medical science, lethal injection is not a medical procedure: it has no therapeutic value, and it is not taught in medical school. A “successful” lethal injection would require the training and expertise of a medical professional. Finding and accessing a vein – especially in someone who is older, obese or has abused drugs – can be challenging. Choosing a proper medication dose for a patient, monitoring medication administration and its effects, and making necessary course corrections need the expertise of a professional.

But legitimate medical procedures are subject to scientific study, open discussion among peers, training, supervisory oversight and improvements in technique. Lethal injection will never benefit from these safeguards for one critically important reason: it violates medical ethics.

Physicians, nurses and other medical professionals are bound to do things in their patients’ best interests, to do no harm, to be guided in all this by the wishes of their patients, all of which are incompatible with participation in executions. These precepts are captured in the Hippocratic oath and ethics guidelines from top medical organizations.

So could states just use medical professionals who are willing to anonymously sneak through the back door of the prison? They could, and they do. However, we will continue to risk botched executions because they are conducted in a scientific vacuum. And it is fair to say that these professionals operate devoid of any ethical compass. What, then, prevents them from cutting other critical corners during a procedure that kills someone?

Americans like things to be neat, clean and error-free … basically, nice. When we wrench the last breath out of a fellow citizen, we want to do it politely. So death by hanging, firing squad, electrocution and the gas chamber have fallen out of favor because they can be gruesome and don’t always go so smoothly.

We cannot ignore the very practical barrier that there is no method of execution that meets our “needs” as a society – a method that is “nice”, “reliable” and that does not require medical professionals to act unethically. And we can’t get there from here.

(M. Stern, “I was told to approve a lethal injection, but it violates my basic medical ethics,” The Guardian, August 6, 2014). Executions in Washington are on hold due to moratorium imposed by the governor. See Lethal Injection and New Voices.