Lethal Injection as Death Penalty

There are many debates on the physician’s role in lethal injection. This paper is not going to be about the ethics of lethal injection itself, but rather it will focus on the ethics surrounding the involvement of the physician. My opinion is that the most ethical response from the physician is to be involved to help facilitate the most humane death possible with little to no pain and suffering. In no way am I agreeing with lethal injection or condoning its use. For the sake of this paper we are going to assume that the execution of prisoners by lethal injection will occur with or without the physician, because it will.

First let us examine what goes on surrounding lethal injection. In the past, the physician’s involvement in lethal injection has been minimal, if at all. The executioner is usually a volunteer prison officer who is not medically trained. According to a YouTube video showing a Texas lethal injection, the physician’s only involvement is inserting the IV’s, attaching the syringes, and then pronouncing the prisoner’s death. [So, there is some involvement, including the fairly direct involvement of inserting the IV (?).]. The director of corrections, who usually has no medical training, is ultimately the one responsible for which chemicals get used and when they get injected. According to the Death Penalty Information Center, the typical injection protocol includes three medications, midazolam, vecuronium bromide, and potassium chloride. Midazolam is a sedative that is used to anesthetize the prisoner, vecuronium bromide then paralyzes the prisoner, and potassium chloride stops the heart. If administered incorrectly, these medications can cause immense pain and suffering for the prisoner and even more for the family who is watching the death. [ok, so the question is really not just whether or not the physician should be involved (because they already are, at least in Texas), but specifically whether or not the physician should be the one to actually administer the drugs. You should state this explicitly, maybe early in this paragraph.]

Due to the lack of medical knowledge of those involved i.e., the prison officer who is controlling the drugs, there is an increased chance of the procedure going wrong. According to Statista.com, between 1890-2010, it was estimated that 7.1% of lethal injection executions resulted in a prolonged or painful death. One legitimate function of a doctor is to alleviate the suffering of a dying person and to ensure that the process of dying will be as painless and easy as possible [yes]. It is highly unlikely that a humane execution could be done without a physician’s involvement, and it is more likely that occasional tragic mistakes are possible without their involvement. With that being said, how can a physician stand by and watch non-medically trained people cause pain when they could easily minimize the pain involved? The simple answer is, they cannot. Nelson & Ashby believe that even though capital punishment is not in a physician’s typical practice, that does not mean they cannot still be involved as a compassionate figure (32).

If the physician’s goal in lethal injection is to maximize the comfort and minimize the pain of the prisoner, then there is no doubt that a Utilitarian would agree to their involvement. The goal of Utilitarianism is to maximize the good and minimize the pain for everyone involved: this includes the prisoner, witnesses, and prison staff. [you might briefly explain the psychological pain of a botched execution for the witnesses and staff.] There is no doubt that it would be unethical and immoral for the physician to sit by and watch the prisoner suffer in pain when there is something he could do to alleviate said pain.

In an article in the American Journal of Bioethics, Michael Keane examines the potential harm that could arise to the family of a murder victim when an execution is “delayed or indefinitely postponed” (45). Keane continues to explore the idea that the family of the murder victim can actually suffer a form of brain damage when “justice” is not done due to the significant mental stress they go through (45). According to Keane, “It is accepted that an ongoing negative psychological experience has a correlate in both the function and the microscopic and organizational structure of the brain” (47). This is a very different and unique viewpoint on the physician’s involvement in lethal injection. If we look at it this idea from a Utilitarian viewpoint, we would agree that the physician refusing to be involved would be unethical due to the known harm that is being done. [ok, this is interesting, although it seems to address more the pain of delayed execution, rather than the pain of a botched execution. Arguably, a vengeful family of the victim might think that a difficult execution was more just, and therefore find more psychological closure in it!]

A common disagreement with my opinion would be that it is a direct violation of the Hippocratic Oath. The Hippocratic Oath is an oath that physicians have taken for centuries after completing their medical education (Dworkin 182). If we take a look at the portion of the classic Hippocratic Oath that people commonly reference, it states the following; “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect” (The Hippocratic Oath). This means that physicians will not administer, prescribe, or recommend any medications that could be lethal. If we are just looking at this, we would with no doubt disagree with physicians assisting in lethal injections. However, it is important to remember that this oath was formed when executions involved non-medically necessary procedures such as beheadings and hangings. If we take a look at a more modern version of this oath, it states:

If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God (The Hippocratic Oath).

This modern version of the oath mentions the fact that physicians have the knowledge and ability to take a life but should not “play god”. I take this differently than some. [What do you mean by this? How do others take this part of the oath?] I believe this means that they have a patient in front of them and can choose to give them a medication that will save their life or withhold that medication knowing they will surely die. In the case of state execution, I do not consider administering lethal injection as “playing god”. To play god is to choose who lives and who dies, and in this case, the physician is not choosing who is dying. The state court has already made that decision; the physician is just there to help facilitate a proper procedure.

While it may be easier for some to say that a physician’s involvement in lethal injection is unethical, most people fail to separate that idea from their opinion on the death penalty itself. The death penalty is not something that is going to be easily eradicated. Currently, the most humane capital punishment would be lethal injection. Unlike other forms of capital punishment, this one requires medical knowledge to successfully complete without substantial pain or complications. This is why overall, I believe that it is completely ethical for a physician to be involved in the lethal injection procedure.

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