Unwilling executioners?BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3461 (Published 06 June 2011) Cite this as: BMJ 2011;342:d3461
All rapid responses
I agree that doctors should never act as executioners. However,
Professor Spiers proposes that the American correctional system recruits
thoroughly trained non-doctor experts in the administration of lethal
injections to condemned prisoners. Vascular access is essentially the
skill required: but how are these "execution technologists" going to
acquire their expertise? Perhaps these folk will be apprenticed to
anaesthesiologists in the ER or better the intensive care units where
patients may be oblivious to the fact that venous cannulation is being
practised on them by an apprentice executioner learning their trade.
It is inconceivable that all US states
will ever abandon judicial killing. However, it is conceivable - but highly
unlikely - that the American Medical Association (AMA) might be empowered
by the profession to end the gentle, medicalized lethal injection method
of dispatching the condemned. Perhaps the states could then adopt the
progressive, humane, cost effective Chinese method of dispatch, which
minimises the near endless suffering on death row: an almost immediate
bullet in the back of the head with the cost of bullets charged to the
family of the executed prisoner.
Competing interests: No competing interests
The article "Unwilling executioners?" by Sophie Arie makes
interesting reading. She states that China executes the highest number of
people, which is true. But it is worth considering that on a per capita
basis, Iran with its small population executes far more people than China
with its huge population.
Two questions are involved: (a) is capital punishment a justifiable
procedure ? and (b) if capital punishment is justifiable, should physicians
have any involvement in it ?
I believe that capital punishment is not justifiable first because
its use brutalises the whole of society, and secondly because mistakes can
be made and there is no possibility of correcting them once the person is
dead. A proper penalty for murder is imprisonment for life with no parole.
Sentences for 20 years, with the potential for release after 15 years, are
ludicrous. After all, the victim remains dead for ever, and a second
murder by a released murderer is by no means unknown. In the case of
imprisonment, a mistake can at least in part be corrected by release and
substantial financial compensation.
In many nations and states execution is still considered to be
justified, and in some of these places doctors play a variety of roles in
executions, as Ms. Arie explains. This is definitely wrong: we did not go
to medical school to learn how to kill people and medical ethics has
always prohibited killing. The argument that doctors can, by reason of
their expertise, save convicts from needless suffering, is a powerful one,
but there is an answer to it: the empowerment of execution technologists
who are thoroughly trained and genuinely expert at their trade. In that
circumstance doctors will no longer be in an extremely difficult position:
they can completely dissociate themselves from the execution process with
no moral qualms.
Competing interests: No competing interests
The evidence suggests that there are many doctors in the English
speaking world who have decided where they stand on capital punishment and
are supportive of the notion of killing people and also in physician-
participation in the killing act.  However, I wonder what might be the
proportion of vehement 'pro-life', anti-abortionists in the English
speaking world, who might also vehemently hold 'pro-death' penalty views.
One such was high profile religionist, George W Bush, who was known
to strongly oppose abortion, but was more than happy to give the thumbs
down to 152 condemned people, during his six year tenure as Governor of
Another such high profile individual was former Presbyterian
minister, Paul Hill, who declined to appeal the death sentence handed down
by the good people of the State of Florida, for the murder of a doctor who
performed legal abortions in that state. The Florida Governor of the time,
Jeb Bush, Republican, staunch Catholic and brother to the POTUS, George W
Bush, "could have commuted the death sentence to life imprisonment, but
said he would not be "bullied" into stopping the execution".  After a
mere 9 years on death row - it can take over 30 years to achieve a legally
authorised killing in the US - Paul Hill was executed in September 2003 by
lethal injection - which one can probably assume was fully physician-
 Physicians' Willingness To Participate in the Process of Lethal
Injection for Capital Punishment. NJ Farber, BM Aboff, J Weiner, EB Davis,
EG Boyer, PA Ubel. Annals of Internal Medicine. Volume 135,pages 884-888.
 US anti-abortionist executed: the first man to face the death
penalty in the United States for killing a doctor who performed abortions
has been executed. BBC News, Thursday, 4 September, 2003.
Competing interests: no religious convictions, but feel some certainty about the notion that killing people is wrong
Anton Joseph's fascinating account inadvertantly highlights one of
the major deficiencies in Arie's article: namely, why we should oppose the
death penalty at all. Arie, and most others who have written on the
topic in the BMJ, seem to start from the premise that capital punishment
is completely wrong and then explore the role that doctors have in it.
Why this assumption? There are good arguments against capital punishment
(such as the risk of miscarriage of justice Joseph describes) and I
confess I don't know if I could bring myself to ever participate in it;
but the death penalty is used and supported by many around the world, and
the 'pro-capital punishment' arguments are simply never acknowledged.
Contrast this with recent controversies over abortion and assisted
suicide/euthanasia; difficult moral and ethical scenarios where,
generally, after much debate, the popular consensus seems to *support* the
ending of life.
I neither vocally support nor oppose capital punishment. I'm
honestly undecided. But I recognise there are arguments both ways and
popular opinion is very divided on the matter; surely we must deal with
this fact before simply shaking our heads in a bemused fashion at doctors
who are involved in it?
Competing interests: No competing interests
I was surprised that to date there were no rapid responses to this
It occured to me that I might be one of the very few doctors in this
country who had a personal experience in participating in the death
penalty as a lecturer in Forensic medicine and also serving as a judicial
medical officer in Sri Lanka.
I had no choice in the matter but since the method of execution was
hanging my role was to be present to ensure the length of the drop was
appropriate to the weight of the individual (although in practice the
hangman ensured this) to declare death at the end and carry out a
postmortem as a statutory requirement to determine the cause of death! As
the judicial medical officer I was one of a few who were required to be
present or permitted to be present at the time of execution.
I shall not delve into the traumatic experiences but my reason for
entering this discussion was my experience over one individual who I had
every reason to believe was innocent. This perhaps is entirely feasible in
the context of the levels of corrupton prevalent within the police force.
Those in the death row had strict restriction on visitors and some
never had any. The assistant superintendent of the prison, a very kind
hearted man and my teacher in school before he took up the prison job
asked me to spend time talking to these individuals, as he put it, to make
them feel that they were not just animals held in cages. Many of them were
disowned and this description was not far from how some of them
felt.Talking to them was an enlighteening experience but what struck me
most was that every single individual in the death row admitted murder bar
one. Admission was accompanied by expression of repentance or in some
instances a promise to repeat if there ever was another opportunity.
This one indidvidual protested his innocence with hood over his head
as walked to his death. He continued as the noose was placed round his
neck and was in the middle of the sentence expressing his innocnece even
as the trap door opened and he went down.
The micarriage of justice subsequently came to be known. A dead man
does not return to receive justice.
The prison superintendent told me that of all those who were hanged
in that prison during his term of office, this man was the only one who
had maintained his innocence to the very end.
As I held the rope to feel if the transmission of the carotid
impulses had stopped I knew that he would have been protesting his
innocence to the very last beat of his heart.
Although this may not sound to many as the most powerful case that
has been made for abolishing capital punishment, I felt that I was in a
position to convey my relatively unique personal experience and contribute
It is incompreehnsible how any civilised society could practice any
form of capital punishmnet considered benign or barbaric and worse still
if there was ever the possibility of even one innocent life being taken in
Competing interests: Will be relevant from my submission