Should Physicians Participate in the Death Penalty?

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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Comments

[CrzyRussell]

I think it should be up to the individual to decide.

It is the MD's right to chose.

[PlaceboStudman]

Personally I don't see how anyone can choose to go into a profession that might lead them to do something that they fundamentally oppose in the first place. I mean, why would a Catholic become an OBGYN, knowing full well that they will likely be performing abortions. Why would a Catholic become a paliative care (end of life) doctor, where end of life, death-with-dignity issues will arise? If someone has a fundamental moral obligation to the choices that others make, then they need to go into religion or politics and help change the society from a position of power, not as a public servant, such as a doctor. And, let's face it, at the moment, the church and politicians DO have the power, otherwise half of the social issues this country faces wouldn't even be up for debate, because logic and rational thought would win over mostly outdated, antiquated ideology

[DiogenesOfAlaska]

ex contradictione sequitur quodlibet

Don't they learn any latin in med school anymore?

(it's one of the few latin phrases I know, but I'm not a physician)

[NevaforLeadership]

Physicians participate in the death penalty? The death penalty should be banned immediately.

It is particularly troubling because prosecutors seem to have forgotten what justice is all about: a win-lose attitude instead of justice for all. All-too-many instances when prosecutors refuse to co-operate to free the obviously wrongly convicted and work to keep these innocent people behind bars for years and years sometimes. What am I saying? They shouldn't have been convicted in the first place.

I believe prosecutors should be held personally liable for wrongful convictions. That would reign them in and remind them what the the profession of law is all about.

[Strepsi]

re: "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." It should be in conflict with any moral PERSON, never mind doctor.

Capital Punishment is illegal here in Canada, as is extraditing a Canadian to any country that practices it: as a nation, we believe it to be immoral and uncivilized. Canada is not perfect, but this stance, along with the fact we give all our citizens equal civil rights, clearly point out that the U.S. is not as free, equal, or just as it tells the world it is.

[BobLablah]

I've always been fascinated by the idea that most people who support abortion seem to be against the death penalty. In my opinion if you support one it's hard to argue against the other.

[rlugbill]

I agree that it would be unethical for a doctor to participate in either abortion or the death penalty. I'm not saying abortion should be a crime- just that it is unethical for a doctor to perform an abortion. It is against the Hippocratic Oath.

Likewise, the death penalty does harm and physicians should not participate in it.

Yes, you can rationalize anything and people will, but to me, the question is whether what I am doing does harm or not. If harmful, it's wrong.

I know some people will consider the weighing of the good it does versus the harm it does. They will say something like, "what if killing this one person saved 10,00 others?" However, I do not think that good comes from evil. Doing something evil does not make for something good to come from it later, so I don't believe those hypothetical scenarios to be true.

So, I cannot see any good coming from abortion, war or the death penalty.

[been2there]

Abortion violates the Hippocratic Oath ONLY if the mother's wellbeing is ignored. When a doctor has to chose which patient takes precedence, the woman should come first.

[NevaforLeadership]

I am all for abortion and totally against the death penalty and have absolutely no qualms about that.

My main reason for being against the death penalty is the propensity for wrongful convictions, particularly with inept prosecutors.

A fetus of up to three months is just a bunch of cells -- not life. After three months, if it comes down to a mother's life or an unborn's life, the mother's life comes first.

[Pyrum]

I'm even more fascinated by people who are against abortion but support the death penalty! That's common, too.

[been2there]

The death penalty is, or at least should be, a bet that the judge and jury make on behalf of society. If the penalty is life without parole, the system is betting that the criminal will not escape and cause more mayhem; the criminal will not kill guards or other innocent bystanders while in prison, and that the criminal will not kill another criminal. If the odds of another death are so high that the system's choice is not life or death, but whose death, then execution is appropriate.
However, execution is forever. We really do need, as a society, to try as hard to exhonerate anyone suspected of a capital crime as hard as we try to convict them. Expediency should never over-ride justice.