California law allows doctors to sit out prison executions

Most medical groups oppose doctor involvement in executions, but one survey shows that some doctors approve of such participation.

By Damon Adams, amednews staff. Sept. 10, 2001.

A new California law says that physicians do not have to attend state executions of prisoners.

Previously, state law required the prison warden to invite two physicians to an execution. The new law removes that requirement and protects physicians working for the state from disciplinary action for not attending.

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It's the latest action in the ongoing debate over physician involvement in executions. Some California doctors call it a victory for those who believe playing a role in executing a prisoner violates medical ethics.

"Physician participation in executions is unethical," said Michael J. Franzblau, MD, a clinical professor of dermatology at the University of California at San Francisco School of Medicine who pushed for the legislation, Senate Bill 129.

No more ambiguity

Under the previous law, California doctors could aid prison technicians with lethal injections, said Dr. Franzblau, who lectures on medical ethics. Physicians who refused to participate in executions risked their working status with the state Dept. of Corrections, according to the California Medical Assn., which supported the legislation.

But the California Dept. of Corrections said physicians could refuse to attend under the old law and not face discipline.

"This really does change nothing," state corrections spokesman Russ Heimerich said of the new law.

The California Medical Assn. disagrees. "We felt that the current law was ambiguous in that it really required physicians to attend executions, and thereby possibly risked administrative action against their license, not to mention their employment status, should they refuse," said Bob McElderry, associate director of government relations for the association. "They now shouldn't feel that they will face any disciplinary action should they not want to attend."

Most medical organizations oppose physician involvement in executions. For example, the American College of Physicians--American Society of Internal Medicine, the nation's largest medical specialty society, said participation is unethical except to certify a prisoner's death.

While organizations object, many individual doctors feel involvement is acceptable.

A survey published in the Archives of Internal Medicine, Oct. 23, 2000, found that 74% of doctors approved of physicians pronouncing an inmate dead and 43% approved of doctors injecting lethal drugs into condemned prisoners. The survey said 27 states require or permit doctors to be involved at an execution.

But "most states, when they enact these laws, tend not to check with physicians," said Edward Harrison, president of the National Commission on Correctional Health Care in Chicago.

Doctors have participated in the death penalty for hundreds of years.

During the French Revolution, Dr. Joseph Guillotin promoted a decapitation device for executions that he believed was less painful than other methods. In the United States, two doctors supervised the first execution by electric chair, according to the 1994 report "Breach of Trust: Physician Participation in Executions in the United States."

AMA provides guidelines

In 1980, the AMA passed a resolution against physician participation. Its Code of Medical Ethics, since revised, says doctors should not take part in an execution by administering drugs, starting intravenous lines or monitoring vital signs. But doctors would not violate the code by certifying death after the prisoner had been declared dead by another person or by voluntarily witnessing the execution in a nonprofessional capacity at the inmate's request.

Doctors have fought state requirements in places such as San Francisco and Illinois. Opponents of participation lost a battle in 1995, when Illinois rewrote a law to shield doctors involved in executions from discipline.

William Gibbons, MD, a pathologist in Aurora, Ill., said involvement in executions violates the profession's ethical standards and sends the wrong message to a doctor's patients.

"This is totally destructive of the doctor-patient relationship," Dr. Gibbons said. "How can you have a doctor-patient relationship if people know you are really working for the state on the side as part of the executioner's team?"

ADDITIONAL INFORMATION:

Weblink

California Senate Bill 129, death penalty executions (http://www.leginfo.ca.gov/pub/bill/sen/sb_0101-0150/sb_129_bill_20010717_chaptered.html)

Abstract, "Physicians' Attitudes About Involvement in Lethal Injection for Capital Punishment, Archives of Internal Medicine, Oct. 23, 2000 (vol. 160, issue 19) (http://archinte.ama-assn.org/issues/v160n19/abs/ioi00020.html)

"Breach of Trust: Physician Participation in Executions in the United States," a Human Rights Watch publication (http://www.hrw.org/reports/1994/usdp/)

California Medical Assn. (http://www.cmanet.org/)