Illinois sanctions doctors' role in executions

BMJ 1995; 311 doi: (Published 12 August 1995) Cite this as: BMJ 1995;311:407

The World Medical Association is urging the American state of Illinois to reverse a new law permitting doctors to take part in executions involving the injection of lethal substances. Dr Ian Field, secretary general of the association, which represents more than three million doctors worldwide, has written to the governor of Illinois, saying that such legislation would weaken the “moral authority of such a great country” in the eyes of the international medical community.

Dr Field's letter said: “Regardless of the decision of a state to impose capital punishment, or the method by which that capital punishment is carried out, no physician should be encouraged to act as an executioner. The method of execution employed by the state of Illinois does not necessitate the use of a physician and for any physician to act in this way is a breach both of the Hippocratic Oath and of its modern equivalent, the Declaration of Geneva.”

A doctor's only role in an execution would be to certify death, Dr Field said. “The association believes that physicians should not be directly involved in any aspect of capital punishment.”

The new law, which came into effect earlier this year, amends Illinois state's Medical Practice Act to permit doctors to give controlled substances “for other than a therapeutic purpose” in compliance with an execution ordered by the state and amends the state's code of criminal procedure to state that “assistance, participation in, or the performance of ancillary functions.. .including but not limited to the administration of the lethal substance or substances.shall not be construed to constitute the practice of medicine.”

The law states that defendants sentenced to death shall be executed by “an intravenous administration of a lethal quantity of an ultra-short-acting barbiturate in combination with a chemical paralytic agent and potassium chloride or other equally effective substances sufficient to cause death until death is pronounced by a licensed physician according to accepted standards of medical practice.”

It adds, “The identity of executioners or other persons who participate or perform ancillary functions in an execution…shall remain confidential, shall not be subject to disclosure, and shall not be admissible as evidence… in any action of any kind in any court or before any tribunal, board, agency or person.” To protect confidentiality, the law permits the Department of Corrections to pay such people in cash.

The ethical code of the American Medical Association states that doctors should not participate in legally authorised executions. It defines participation as the performance of actions that would directly cause the death of the condemned person; actions that would assist, supervise, or contribute to the ability of another person to directly cause the death of the condemned person; or actions that could automatically cause an execution to be carried out on a condemned prisoner.

The ethical code states: “Where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering or supervising injection drugs or their doses or types; inspecting, testing or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.”

The code allows doctors to certify death once the condemned person has been declared dead by someone else; and to relieve the acute suffering of a condemned person awaiting execution, including providing tranquillisers at the request of the condemned person to help to relieve anxiety in anticipation of the execution.

It is the American Medical Association's stated policy to oppose laws that “seek to enable or require physician participation in legal execution and/or which protect from disclosure the identity of physicians participating or performing direct or ancillary functions in an execution.”--SHARON KINGMAN, freelance journalist, London

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