MDs who observe executions challenged

Two recent complaints to medical boards dismissed

Recent challenges to the medical licenses of physicians who participate in state-ordered executions have been dismissed, but the physicians and ethicists who claim that participation violates the American Medical Association (AMA) code of ethics vow to keep up the complaints.

Two highly publicized recent cases have brought attention to the fact that states that impose capital punishment require the participation of — or at least observation by — licensed physicians when executions are carried out, and there are those in the medical community who want doctors to stay out of executions.

Opponents say physician participation violates physician ethics on two fronts — the AMA ethics code and the Hippocratic oath.

The AMA code states that "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 code goes on to spell out what the AMA considers to be "participation": actions that would directly cause the death of the condemned (administering the lethal injection, for example); an action that would assist, supervise, or contribute to the ability of someone else to carry out the execution (placing a catheter, or merely being present, if a physician’s presence permits the execution to be carried out); or an action that would automatically cause an execution to be carried out.

The AMA code states that a physician’s mere presence, unless it is in a nonprofessional capacity or at the voluntary request of the condemned person, constitutes a violation of the code. The AMA code does not support or denounce capital punishment itself, but merely addresses physician participation.

Some critics add that participation in executions violates the classic version of the Hippocratic oath, which includes the lines, "I will give no deadly medicine to anyone if asked." That wording has been removed from most modern versions of the oath. Most medical schools, but not all, require graduates to recite some form of the oath, also called the "good doctor" oath.

Regardless, physician’s licenses, which are granted by the states they practice in, do not hinge on either the Hippocratic oath or the AMA ethics code; however, some state medical boards require physicians to adhere to the AMA code, and in states that make that requirement and also require physician attendance at executions, there is tension, legal and medical experts say.

Challenges dismissed

Late last year, a small group of physicians and ethicists lodged a complaint with the Georgia state medical board against a physician, Hothur Sanjeeva Rao, MD, who had assisted with executions by attending (Georgia requires the presence of two physicians at executions to verify death) and, in one case, by assisting in placing a catheter after numerous lay attempts by prison staff had failed.

The medical board dismissed the complaint in December, and the Georgia Department of Corrections has initiated legislation that would stop future challenges to doctors’ licenses if they participate in executions as required by state law.

Ernie Fletcher, MD, a Kentucky physician, was at the center of another challenge over participation in executions — this one, initiated by some of the same death penalty opponents who lodged the complaint against Rao, arose because Fletcher is the governor of Kentucky and signed a death warrant in November for a convicted double murderer. Kentucky’s Board of Medical Licensure ruled in January that it found no merit to the complaint and that Fletcher was acting as governor, not as a doctor, when he ordered the execution.

The AMA and state medical associations can, upon finding that a physician has violated an association code, revoke the physician’s membership in the organization. But neither the AMA nor state medical associations can revoke licenses. Corrections officials say that the primary effect they have seen from the complaints is that physicians who once were willing to observe executions, as required in those states, are opting out now to avoid possible challenges.

The group challenging physician presence or participation in executions has indicated it will continue to seek out physicians who participate in executions and lodge complaints against them. Corrections officials liken the complaints to those lodged against physicians who perform abortions in states where abortion is legal — the complaints are still lodged and cause physicians discomfort and inconvenience, but abortions are legal, and doctors who perform them legally are not in danger of losing their licenses.