Group wants ban on role of physician in executions

Anesthesiologists refuse to participate in execution

Spurred by the controversy that arose over a court order compelling physicians to participate in prisoner executions, the California Medical Association is sponsoring legislation seeking to eliminate any role of physicians in future executions.

The proposed legislation is in response to attempts to compel anesthesiologists to take an active role in the execution of San Quentin State Prison inmate Michael Morales in February 2006.

Stated simply, says California Medical Association Chief Executive Jack Lewin, MD, "Physicians should be treating people’s illnesses, not participating in their executions.

"Participating in an execution goes against longstanding principles of professional ethics and is a violation of the Hippocratic Oath: First, do no harm," he says.

According to a 2002 study of state statutes and execution protocols, published in the Ohio State Law Journal, seven states require active participation in executions, such as making sure intravenous lines are in place or making sure the prisoner is dead. Four states simply require physicians to be present at executions.

In the Morales case, a federal judge ruled that to ensure Morales did not suffer undue pain during his execution, San Quentin officials could choose to either administer fatal levels of sedatives exclusively, or have an anesthesiologist present so that Morales was unconscious from a sedative before he received the standard mix of paralytic agents and heart-stopping chemicals.

Although two anesthesiologists hired by the state had agreed to participate by verifying that appropriate protocol was followed, they backed out before the execution could take place when they reportedly learned their role would include ensuring that the execution was painless by monitoring the patient’s unconsciousness while the fatal dose of paralytics was administrated. The physicians decided that their participation would be "ethically unacceptable."

Corrections officials chose to let Morales’ execution order expire for that date rather than administer a fatal dose of sedatives; Morales’ execution is scheduled for a later date.

The American Medical Association (AMA) Council on Ethical and Judicial Affairs released a statement following the ruling by the federal judge requiring physician participation in executions by lethal injection, saying the judge "has disregarded physicians’ ethical obligations."

AMA ethics preclude participation

The AMA code of medical ethics addresses physician participation in executions involving lethal injection in ethical opinion 2.06, which states in part, "An individual’s opinion on capital punishment is the personal moral decision of the individual. A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution."

The AMA defines "participation" as either an action that would directly cause the death of the condemned; an action that would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; or an action that could automatically cause an execution to be carried out on a condemned prisoner.

That includes, according to the AMA, 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.

In the case in which the method of execution is lethal injection, the AMA says 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.

Proposed bill takes no stand on executions

The California bill that would address physician participation in court-ordered executions does not take any stand on capital punishment itself, only the participation or presence of physicians at executions. The bill would change state law to state that the department of corrections "shall not utilize a physician and surgeon to assist with or otherwise participate in the execution."

The American Society of Anesthesiologists recognizes the AMA’s ethical guidelines regarding physician participation in lethal injections, but does not take a position on capital punishment because it is not a medical practice, the society said in a statement released regarding the California case.


  • American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, IL 60068. Phone: (847) 825-5586. Statement on lethal injection available at
  • American Medical Association, code of ethics regarding capital punishment available on-line at
  • Jack Lewin, MD, chief executive, California Medical Association, 1201 J Street, Suite 200, Sacramento, CA 95814. Phone: (916) 444-5532.