Medical board decision suspends executions in NC

Doctors' role in capital punishment

North Carolina's governor, state agencies, and courts were forced to examine the state's capital punishment laws following the release of a position paper from the North Carolina Medical Board (NCMB) in January that effectively prevents physicians from actively participating in executions.

As of the first week in February, three executions already had been halted in the three weeks since the medical board ruled that "physician participation in capital punishment is a departure from the ethics of the medical profession," and the Department of Correction stopped scheduling executions until state leadership changes execution procedure. The process was recently modified to limit the role of physicians because of ethical concerns; however, a judge ruled that any such modification must be approved by a board headed by the governor and lieutenant governor. Others in state government say that even with that panel's approval, any change to the state's law governing executions would have to be approved by the legislature.

Attendance OK, participation not

According to the NCMB, physician participation in execution is defined generally as actions that would fall into one or more of the following categories:

  • an action that would directly cause the death of the condemned;
  • one that would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned;
  • an action that could automatically cause an execution to be carried out on a condemned prisoner.

The NCMB defines physician participation in an execution as including, but not limited to:

  • prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure;
  • monitoring vital signs on site or remotely (including monitoring electrocardiograms);
  • attending or observing an execution as a physician; and
  • rendering of technical advice regarding execution.

When the the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution:

  • selecting injection sites;
  • starting intravenous lines as a port for a lethal injection device;
  • prescribing, preparing, administering, or supervising injection drugs or their doses or types;
  • inspecting, testing, or maintaining lethal injection devices; and
  • consulting with or supervising lethal injection personnel.

The NCMB decision conflicts with a state law requiring a doctor's presence at executions, so the state changed its procedure to require a doctor to be present, but not have an active role. The board states that it will not discipline physicians who are merely present at executions. Examples of non-participation include:

  • testifying as to medical history and diagnoses or mental state as they relate to competence to stand trial, testifying as to relevant medical evidence during trial, testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case, or testifying as to medical diagnoses as they relate to the legal assessment of competence for execution;
  • certifying death, provided that the condemned has been declared dead by another person;
  • witnessing an execution in a totally nonprofessional capacity;
  • witnessing an execution at the specific voluntary request of the condemned person, provided that the physician observes the execution in a nonprofessional capacity; and
  • relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution.

The proposed change to the law would require a doctor's presence at executions, with a nurse and medical technician monitoring the condemned prisoner's vital signs. If a medical problem required the doctor to intervene, the execution would be halted and rescheduled so that the doctor could tend to the inmate without violating the NCMB rule.

NC, other states examining execution process

Defense attorneys in North Carolina have argued in various death penalty cases that only anesthesiologists or other specially trained medical professionals determine that an inmate is unconscious before being put to death. They argue that the state's new protocol could result in an inmate waking up during the execution and being aware but paralyzed while dying.

Florida and Tennessee recently issued moratoriums on executions. A Florida lethal injection execution in December 2006 took 34 minutes — twice as long as usual — after needles delivering the chemicals were inserted incorrectly into the flesh of his arms, rather than into veins. The physician who performed the autopsy refused to state publicly whether the inmate suffered a painful death.

Executions also are on hold in Missouri and California as those states examine their laws governing executions. Tennessee Governor Phil Bredesen said he supports capital punishment, but that his state's guidelines for carrying out executions contain flaws such as not specifying dosages for the lethal chemicals.

After physicians in Georgia were repeatedly sued by an anti-death penalty physicians' group seeking to have their licenses revoked for participating in lethal injection executions in that state, the Georgia legislature passed a bill protecting any doctor or medical professional who assists in an execution from having their state license challenged, suspended, or revoked.

The American Medical Association (AMA) steadfastly opposes physician participation in state-ordered executions, saying to do so violates medical ethics.

"The American Medical Association's policy is clear and unambiguous — requiring physicians to participate in executions violates their oath to protect lives and erodes public confidence in the medical profession," AMA President William G. Plested III, MD, said in a prepared statement.