Physicians, Executions and the Lethal Injection

In order to become a physician we all embarked on a long and strenuous educational path through which we acquired scientific expertise and medical skills that enable us to make life and death decisions. Then, upon demonstrating this expertise and skill in some measurable way, we had to apply for licensure. Through this process we each asked permission from society to make a career of using our knowledge.
Society licenses doctors because of an implicit expectation that we will use our knowledge for the good of society—to treat illnesses, help those who are suffering, and above all else, as we stated when we took the Hippocratic Oath, to “do no harm.”
A very troubling part of the work of a number of U.S. physicians is involvement in executions. The U.S. is one of the only industrialized nations that practices capital punishment. In the U.S. physicians are routinely involved–we have been present throughout the history of executions in this country. We have used our medical expertise to advise executioners about manners such as how much electricity to deliver to electrocute an inmate, or how far to drop a man suspended by a hangman’s noose given his height and weight. Physicians have also been present to pronounce inmates dead. A detailed historical report about the physician’s role in executions in the U.S. can be found here .
In 1977 the lethal injection was created. This method of execution delivers medications to condemned inmates in lethal doses through intravenous lines, and it was invented by a doctor. Prior to its first use the procedure drew the attention of the AMA, American College of Physicians, and the Institute of Medicine; each organization spoke out against this medicalized form of capital punishment. The AMA even passed a resolution against physician participation in the death penalty, however states responded by passing laws protecting the anonymity of doctors who assisted with executions crippling the organization’s ability to enforce any type of professional or ethical regulations. The first lethal injection was administered in 1982 by two physicians.
Today 35 states in the U.S., as well as the military and U.S. government, allow capital punishment, and all use lethal injection as the primary method of execution. Recently the British authorities put an end to the export of sodium thiopental to U.S. for executions, and Italian authorities mandated that the U.S. company Hospira not manufacture any of the drug unless a promise could be made that it not be used to kill inmates.
This move will not likely stop the lethal injection, and to me the news begs a question – why does the U.S. need to be told by European countries that using medical resources to kill inmates is unacceptable? What will it take for us to step up as a profession against the lethal injection?
Whatever our individual stances on the death penalty are, we should come together as physicians and recognize that killing for the purposes of punishment is not within our professional duties. Involvement in state-ordered killings harms the integrity of our profession, and risks erosion of the trust that society placed in us when they granted us the privilege of being physicians.