February 25, 2006

Assisting in Executions: No. Period.

Everyone is talking about the case of Michael Morales and the effect of physician refusal to participate in his execution. The best piece on it is a wire story piece from AP, in which David Magnus puts the dilemma best:
``The state has an obligation for the execution to be painless'' and humane, he said. ``On the other hand, it's a violation of pretty core ethical principles to have physicians euthanize patients against their will.''

Doctors played an unusually prominent role in the Morales case because his lawyers argued that California's traditional three-drug lethal injection was cruel and unusual punishment. The initial sedative, they contended, might not make him unconscious before the other two drugs are administered.

Concerned by the suggestions, U.S. District Judge Jeremy Fogel gave the state two options: Hire anesthesiologists to make sure Morales was unconscious, or execute him using the initial drug alone. The first option collapsed late Monday night when the anesthesiologists backed out, citing ethical concerns.

The second broke down Tuesday evening when the state said it could not find a licensed medical professional to give the lethal injection. Previously, prison employees have inserted the intravenous lines, and then the drugs were added by a machine.

Even before the execution was postponed Tuesday evening, the California Medical Association announced it is sponsoring a bill that would prohibit physician involvement in future executions here. On Friday, the state of Georgia went the other way, approving a bill to protect physicians who help administer capital punishment.

It already is a violation of the American Medical Association Code of Ethics for a doctor to participate in an execution, said Dr. Priscilla Ray, a Houston psychiatrist who is chair of the AMA's Council on Ethical and Judicial Affairs.

And while the council has not investigated a doctor in Georgia who announced that he had a contract with the state to monitor executions, ``the AMA president can appoint an investigator to look into that and bring it to us,'' she said. The chain of events surrounding the postponement of Morales' execution is just another blip in the long history of doctors and executions, one bioethicist said. During the French Revolution, it was a doctor who proposed the guillotine as a humane method of death for that time, said Dr. Stephen Miles, who teaches at the Center for Bioethics at the University of Minnesota.

``Rich people were being painlessly and swiftly beheaded after slipping money to the executioner to sharpen the blade,'' he said. ``Poor people were being drawn and quartered on the wheel and burned.''

That's when Dr. Joseph-Ignace Guillotin said ``everybody should be executed by decapitation,'' Miles said. ``Another French doctor actually invented the French guillotine.''

Doctors surfaced at the heart of the execution debate in the United States, he said, ``when docs weighed in about new technology called electricity. A committee of doctors developed the technology for the electric chair.''

The next major development with doctors happened during World War II, ``when people were totally disgusted with what Nazi medicine had done,'' he said. ``Then you had the Geneva Convention and the anti-torture movement, which essentially tried to get doctors out of the business of state punishments.''

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