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July 1, 2013

"Physician Participation in Executions, the Morality of Capital Punishment, and the Practical Implications of Their Relationship"

The title of this post is the title of this new paper on SSRN authored by Paul Litton. Here is the abstract:

Evidence that some executed prisoners suffered excruciating pain has reinvigorated the ethical debate about physician participation in lethal injections.  In widely publicized litigation, death row inmates argue that the participation of anesthesiologists in their execution is constitutionally required to minimize the risk of unnecessary suffering. For many years, commentators supported the ethical ban on physician participation reflected in codes of professional medical organizations.  However, a recent wave of scholarship concurs with inmate advocates, urging the law to require or at least permit physician participation.

Both the anti- and pro-physician-participation literature share a common premise: the ethics of physician participation should be analyzed independently from the moral status of capital punishment.  This considerable literature implausibly divorces the ethics of physician participation from the moral status of the death penalty.  Any ethical position on physician involvement requires some judgment about the moral status of the death penalty and the importance of physician involvement.  The article examines anti- and pro-participation arguments to show that each one either is unpersuasive without discussion of the death penalty’s moral status or implicitly assumes a view on the social worth of the death penalty.

The article then articulates the practical implications of its arguments for both lawmakers and professional medical organizations.

July 1, 2013 at 01:23 PM | Permalink

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Doctors are like the general public. Most support the death penalty. Yet, left wing rent seeking organized medicine organizations, including state owned licensing boards have promised to crush any doctor remotely participating in the design or actual execution of a death penalty. The Federation of Medical Licensing Boards mandates doctor obedience to the ethics rulings and guidelines of the left wing extremist AMA, an organization with 18% membership among doctors, not representing the best interests of the profession, and filthy, left wing, disgusting collaborators with President Obama's all out assault on medical care.

So only doctors who have given up their licenses may participate in the death penalty. If an anesthesiologist participates in any remote way, the Board certificate will be revoked by the left wing pro-criminal American Board of Anesthesiologists, jeopardizing all hospital jobs for the member.

I have addressed lawyer rent seeking, here. It is actually smaller than doctor rent seeking, and far less physically dangerous to the public. If people thought the ABA was a fatuous, idiotic, left wing propaganda outlet, check out the Ethics rulings of the AMA.

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion206.page?

It is the height of irony that most of the language of Roe v Wade was copied word for word from a 1970 AMA resolution. These a-holes want to protect the mass murderer, the serial killer, but have no problem eradication viable babies in the third trimester of pregnancy.

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion201.page?

I believe, the death penalty is not an act of medicine, any more than a commando raid on a terrorist camp is. It is not healing. It is killing. If a doctor goes along to help our warriors, and fires a weapon, that is none of the Board's business. The death penalty is beyond the scope or jurisdiction of the licensing board, the Board certifying the specialist. If any such body utters a single word about the death penalty, all government sanctioning, all tax exemptions, all government contracts, all government financial support, and all governmental privileges, such as any quasi-governmental powers should be stripped. All members should then be prosecutor for tax fraud, since they are being political and not educational in their utterances.

I support a federal temporary restraining order against the Board of Anesthesiology to prevent its retaliation against any certificate holder. Such an injunction is justified by the above reasoning.

Posted by: Supremacy Claus | Jul 2, 2013 12:33:05 AM

By: Supremacy Claus | 02 Jul 2013 Tuesday 00:33:05 EDT

I believe, the death penalty is not an act of medicine, any more than a commando raid on a terrorist camp is. It is not healing. It is killing. If a doctor goes along to help our warriors, and fires a weapon, that is none of the Board's business.

Makes sense to me .

Quoth the Docile , “Deadly, EVERMORE”

☺ With appropriate apologies to the estate of Mr. Poe.

Posted by: Just Plain Jim | Jul 2, 2013 6:58:33 AM

This topic has been a big issue in North Carolina in the past couple years. As part of its recent repeal of the Racial Justice Act, the North Carolina legislature has also attempted to head off claims re: physician participation, specifically providing, inter alia, that "(a) Any assistance rendered with an execution under this Article by any licensed health care professional, including, but not limited to, physicians, nurses, and pharmacists, shall not be cause for any disciplinary or corrective measures by any board, commission, or other authority created by the State or governed by State law which oversees or regulates the practice of health care professionals, including, but not limited to, the North Carolina Medical Board, the North Carolina Board of Nursing, and the North Carolina Board of Pharmacy." See http://www.ncleg.net/gascripts/BillLookUp/BillLookUp.pl?Session=2013&BillID=s306; see also N.C. Dep't of Corr. v. N.C. Med. Bd., 363 N.C. 189, 675 S.E.2d 641 (2009). Senate Bill 306 also provides that assistance with executions does not constitute the practice of medicine, surgery, pharmacy, or nursing.

Posted by: J.D. | Jul 2, 2013 10:09:52 AM

JD: Thank you for the citation. The next step is for the NC AG to enjoin the Board of Anesthesiology. It is a quasi-governmental, but private organization. Revocation of a certificate would tremendously burden and deter anesthesiologists. The AG should offer to sue any hospital revoking privileges to a participant in the death penalty. They are the most expert at the subject, and would have no learning curve as to doses, timing, etc of lethal injections. The other group that should be enjoined would the veterinarians. They carry out euthenasias on animals with a wide range of sizes and weights.

Posted by: Supremacy Claus | Jul 2, 2013 11:01:05 AM

From JD: "Senate Bill 306 also provides that assistance with executions does not constitute the practice of medicine, surgery, pharmacy, or nursing."

A federal act should be considered, to establish that correct principle across the nation. Such a statute should also preclude the FDA from any regulatory activity on the death penalty, since we are not using safe and effective drugs, but poisons. The Department of Agriculture might regulate the handling of such substances as it does pesticides, herbicides, now. The EPA may chime in regarding disposals.

Posted by: Supremacy Claus | Jul 2, 2013 11:10:35 AM

| "This considerable literature implausibly divorces the ethics of physician participation from the moral status
of the death penalty." |

Perhaps. For some questions, matters on the periphery are better set aside for a time, to rightly focus on the main.
In other debates, uncomfortable or contradictory implications are falsely dichotomised as the authors suggest.

What one finds incredibly relevant, and unethical, is that anti-capital punishment groups including the Southern Center
for Human Rights (SCHR), have repeatedly imposed their ethics upon physicians, e.g.

2011: SCHR "filed a complaint to Georgia's medical board seeking to revoke the medical license" of a doctor to prevent him
from overseeing executions;

2009 (& afore}: the NC Medical Board "issued a statement threatening disciplinary action for any [meaningful] physician participation in an execution" with backing from the ACLU.

Simultaneously and remarkably, anti-DP groups take hold of cost and delay as support for their argument against the functionality of capital punishment!
To wit, to divorce the ethics of judicial obstructionism of a legally sanctioned state function, from the debate of the
death penalty is implausible .

Posted by: Adamakis | Jul 2, 2013 11:48:46 AM

Perhaps, out of laziness, or a need to avoid responsibility, medical licensing boards have adopted the view that doctors should obey the AMA Code of Medical Ethics.

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?

Because this document prohibits participation in the death penalty, the complaints of the ACLU were not frivolous. Indeed, docs have an affirmative duty to report unprofessional conduct of other doctors to licensing boards. The AMA is a professional society. It should stay out of general political controversies not involving the practice of medicine. It is located in Chicago, with all the baggage of that culture. It threw its support behind Obamacare, against the wishes of the majority of doctors, inside and outside the organization. While docs may be center right in politics, the staff of the AMA, the people that make all the policy decisions, are Ivy indoctrinated lawyers and non-doctors. Elected officials of the organization are doctors but are figureheads. It has quasi-governmental powers. For example, it can put a member on trial, with rules of procedure, legal representation, etc. If the member is expelled, that gets reported to the National Practitioner Data Bank, and must be explained to all current and future employers, hospital privileges committees, in a manner similar to the devastating civil consequences of a criminal conviction, often far more damaging and punitive than any criminal sanction.

Posted by: Supremacy Claus | Jul 2, 2013 12:38:07 PM

I read this article and as someone against the death penalty find it persuasive. It's a hard call really but I can understand the logic of allowing physicians to assist since the alternative is threatening those being executed by making it more liable for them to harmed by botched executions. Even if executions are immoral, it is a matter of reducing harm, particularly if the person asked for them. If the net result is the executed person is harmed, it is an ironic result. But, I can see the argument of principle. It's tricky. Good article.

Posted by: Joe | Jul 2, 2013 11:59:09 PM

/-/ http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?
Because this document prohibits participation in the death penalty, the complaints of the ACLU were not frivolous. Indeed, docs have an affirmative duty to report unprofessional conduct of other doctors to licensing boards.
/-/ : : Supremacy Claus

1. The larger state of medical ethics education is tenuous and arbitrary, perhaps in disarray, see for an instance: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?

2. These complaints may seem more than frivolous to you, but they are objectively obstructionist toward the law. So SC,
are you asserting that the ACLU and sympathetic groups such as the NC Medical Board & SCHR are hereby making genuine appeals to a higher moral plane or law?

3. Would this be the law of the 'end-justifies-the-means', since a physician's presence could only promote less suffering
at an execution, ergo the "complaint" is a tired and disingenuous, yet effective ploy to promote cost and delay
[the proverbial death by a thousand cuts]?

Might it be the law of Humanism, shamanism, or just uncritical progressivism,
e.g. Bill Clinton embracing then denouncing DOMA?


Posted by: Adamakis | Jul 3, 2013 10:11:28 AM

Adamakis: The left wing extremists in organized medicine and on boards have made it so that filing complaints is not frivolous.

I strongly support the death penalty. I strongly oppose pretextual, and seemingly infinite nit picking. I support assessing costs to the personal assets of any appellate lawyer who fails to put forward new evidence of innocence. The constitution endorses the death penalty, so all claims to be protecting the constitution by phony arguments of law are in bad faith.

That being said, the attorney generals of the states must protect doctors from licensing boards, from certifying boards, from hospital privileges review committees. Without this protection, opponents of the death penalty will use complaints to harass and deter participating doctors. These should be enjoined and punished to encourage doctors to participate. Otherwise you will have only weird docs participating, those without licenses, those not doing other clinical work.

Veterinarians are even more experienced than anesthesiologists, and should be protected with preventive litigation against boards, and other bodies.

Posted by: Supremacy Claus | Jul 3, 2013 7:26:21 PM

Student

It is clearly hard to decide if whether involvement by physicians in lethal injection is ethical or not. The ABA and AMA have set strict guidelines that outline the respective organizations views' towards lethal injection. Their view is that: as affiliated physicians, whose overarching goal is to preserve and ameliorate life, they should steer clear from involvement in execution. They disallow any actions that contribute directly to the death of the inmate or allow any alternative personnel to carry out the procedure. They have allowed physicians to participate in nonclinical ways where they merely are spectators in the process.
The ABA’s and AMA’s stance can be understood when we consider the Hippocratic oath. The Hippocratic oath states that the practicing physician will neither administer a lethal drug nor contribute to the death of a patient. When a physician participates in lethal injection, he/she is both administering a lethal drug, three different dosages to be exact, and directly causing the death of a patient. Granted the involvement of the physician can reduce the pain felt by the prisoner by minimizing the errors that could occur during the procedure.
It is also important to consider the bioethical values that were used by the ABA to draw their conclusion. These ethical values are justice, autonomy, beneficence, and non-maleficence. Autonomy refers to the patients right to decide his treatment regardless of the physician’s warnings. If the inmate about to face lethal injection requests physician involvement to ease pain, then that inmate should receive the treatment he desires. Justice refers to the adherence of the physician towards the wants of the patient, which supports the previous example of autonomy.
Beneficence and non-maleficence are defined as: actions taken by the physician should benefit the overall health and well being of the patient and the idea that physicians should take no action that can result in harm or death to the patient, respectively. Clearly, these values are broken when the physician participates in lethal injection. Yet, it is important to consider the Double Effect Doctrine that holds that actions that are taken for the benefit of the patient, even when the action results in the death of the patient, are justifiable. In short, as long as physician involvement reduces the pain of the inmate, their involvement can be seen as justifiable.
Clearly it is hard to without an uncertainty if it is ethical for physicians to be involved. The ABA and AMA have taken stands but these stands do not represent the views of all physicians within the organizations. These organizations have no power to enforce the standards that are clearly contradictory of the beliefs of individual physicians; individual physician that compose the AMA. A common ground is needed where the standards are altered.

Posted by: Nelson Corona | Dec 13, 2013 2:44:27 PM

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