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Should Physicians Participate in the Death Penalty?

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Punishment by death is reserved for those whose crimes are considered to be in the worst category. The US Supreme Court recently ruled that using an established drug protocol to kill a criminal is not cruel or unusual. However, this has come into conflict with physicians who are opposed to the death penalty and consider it unethical to be involved in the killing of anther individual. This conflicts with the "healing" intentions of the profession and is extremely uncomfortable given the unusual use of medication for the promotion of health and well-being. However, a recent article in the American Journal of Bioethics (Keane 2008) argues that physicians delaying the death penalty may be participating in an unethical process themselves. Here is the thinking behind this idea:

According to the author, delaying or indefinitely postponing the death penalty can hurt the relatives of the accused criminals. The author argues: "...by using established principles in psychiatry and the science of the brain, it is shown that victims' relatives can suffer brain damage when justice is not done. Conversely, adequate justice can reverse some of those changes in the brain...." The author concludes that physician opposition to capital punishment may be contributing to significant harm.

This argument is persuasive and certainly introduces a whole other set of variables that need to be taken into consideration when weighing the risk and benefits of administering a punishment, but there are several unanswered questions that also deserve consideration. Below is a consideration of some of these questions:

(1) Should physicians be forced to be "licensed to kill"? Personally, I would find this role undesirable and completely outside the scope of my own comfort, but when in fact, there is sufficient evidence to prove that needles are better than guns in killing people, perhaps physicians should be given a choice in this matter. Why does having the knowledge about how to do something imply that a person should be comfortable and willing to do this? It raises the question of whether there should be a specific training program for people willing to kill so that physicians as a group are not forced to participate in this.

(2) Has anyone done a study on the brains of physicians who are being asked to kill the criminals? While I fully respect and understand the suffering involved in the relatives who have to wait for such a horrific outcome to someone they love, I wondered what the effects of this killing would be on the subsequent practices of physicians. Given my column last week on priming, I can see how if you did a few of these, that this might actually affect the way you practiced medicine consciously and unconsciously. I mean -- think about it. If you had the strong experience of giving someone a drug so that they died, and you were opposed to this, would this not in fact be really traumatic and significantly affect your practice as a physician? Every time you handled a needle afterwards, how could you not think of this?

(3) What would the effect of killing against your own will be on your patients in the future? If you were treating patients in the future, presumably your own brain would become anxious in remembering the killing you did even though you were unwilling to do this. This anxiety would most likely also affect patients whom you were treating with needle-related procedures. Is this fair to all your future patients? Who would like to be treated by a physician who had this kind of anxiety?

(4) Why should the focus on method of killing assume that killing is ethical in the first place? Whatever killing is -- cost effective, just punishment, best punishment -- it simply cannot be said that this is incontrovertible. The death penalty has a particularly pessimistic scientific premise: that neuroplasticity is not possible in criminals or that it is not worth it. The ability of the brain to change has been demonstrated under various circumstances, and while I am open to the reality that not all brains can change, we are not at the stage that we can predict which brains can change and which brains cannot. I understand societal punishment for crimes, but what is the point of this punishment if it is not "learning" and changing"? Dying removes this opportunity. Also, even if you make the argument that the crime is heinous and the most horrible crime on earth, is death really the most punitive and just way of handling this? Is ending the misery of the criminal a punishment?

(5) Are needles a way to prevent guilt? Clearly, guns are a more dramatic and scary way to die. If you offer someone a "better" way to die, are you really caring for the criminal or your own sense of guilt? Is it ethical for us to cater to our own sense of guilt when administering punishments about someone else's crime?

I submit that delaying the death penalty is an indication that our own brains are in conflict about killing people in the first place. To remove this doubt is premature and inaccurately closing off many arguments about the death penalty that could help us grow as a humane and just society.

Reference
Keane, M. (2008). "The ethical "elephant" in the death penalty "room"." Am J Bioeth 8(10): 45-50.

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