Date:
Location:
Speaker: Atul Gawande, M.D., Assistant Professor, Department of Health Policy & Management, School of Public Health
Summary by Thomas Cochrane, M.D., Faculty Fellow 2005-2006, Instructor in Neurology at Brigham and Women's Hospital and Harvard Medical School
Dr. Gawande's lecture about physician participation in state-ordered execution came at a strangely propitious moment. One week before this talk, physician participation in execution became national news, when two California anesthesiologists refused to participate in the execution of Michael Morales. Although the doctors had initially agreed to participate as observers and were apparently willing to certify (but not declare) death, after a US Court of Appeals ordered that the doctors must administer further sedating medications should it become necessary, they recused themselves from the process.
Coincidentally, Dr. Gawande is nearing completion of a project started a year ago, whereby he sought out and interviewed physicians and nurses who participate in the enactment of capital punishment. He began by reviewing the recent history of capital punishment in the US. Various methods of execution, including death by firing squad, hanging, and the electric chair were employed by the states. All of these were challenged based on the 8th Amendment right against cruel and unusual punishment (at least in part because of some gruesome mishaps in botched executions). This led to the current state of affairs, in which lethal injection is the only method that is broadly accepted by the courts. Unfortunately, lethal injection also has a history of botched procedures; Dr. Gawande reviewed these, and made it clear that he felt it unlikely that lethal injection could be reliably performed properly without the supervision of a medical professional such as a doctor or nurse.
Dr. Gawande managed to interview four physicians and one nurse who have participated in executions. Their fascinating accounts describe varying motives, varying degrees of ethical reflection, and widely varying support for the death penalty itself. The first, "Doctor A," described himself as “not a zealot” in favor of the death penalty. Although he initially agreed to participate only to assist with cardiac monitoring and the pronouncement of death, he gradually found himself participating in more direct fashion. When his identity became public, he eventually quit participating. “Doctor B”, a family physician, is somewhat more reflective; he attends executions, but refuses to assist in any way. “Doctor C”, a full-time prison physician, in part felt obligated to participate, because “the jurors in [his state] ordered the death”. The one nurse interviewed by Dr. Gawande is also a prison employee, who included among his reasons for participation the desire to ensure that the executions were performed properly. “Doctor D”, an ER physician, is an opponent of the death penalty, but has participated in 6 executions so far. He explains his participation by likening the state-imposed death penalty to an inevitably fatal disease, and views his participation as an extension of his duty to alleviate suffering at the end of life. Interestingly, Doctor D has agreed to allow his name to be used publicly when Dr. Gawande publishes his written account.
Dr. Gawande courageously described his personal position. He believes that capital punishment is morally justified, if it can be performed without suffering on the part of the condemned. He conceded that, with physician involvement, executions could be performed without such suffering, and he thought it unlikely that it could be done by non-physicians without occasional tragic mistakes. Interestingly, however, he opposes physician involvement in capital punishment, and favors a law prohibiting physician participation. He does not accept Dr. D’s patient analogy, since the patient has no choice but to be a party to the doctor-patient relationship. He opposes having physicians’ skills co-opted by the government for the purposes of punishment, and believes that this ‘subverts medical purposes’. He believes that physician participation in execution puts at risk the public’s trust in physicians. Furthermore, he criticized physician-participants for their unwillingess to shed their anonymity (all but Dr. D), taking this as a sign that there was a sense in which their participation could not be ethically defended.
Without physician participation, he conceded that lethal injections would continue to be done improperly, and was willing to accept that the eventual outcome of this might be that capital punishment could no longer be performed.