First, do no harm

Opinion

What if they gave a war and no one came? What if they (the same they, it seems) gave an execution and no doctor showed up? Maybe they would have to call off both.

Hippocrates gave the charge, “Primum non nocere – First, do no harm,” to his medical students almost 2,500 years ago. To this day, budding physicians start out on their medical careers holding up their right hand, swearing allegiance to the legendary Hippocratic oath.

There are codicils that, if not said verbatim, are certainly accepted by implication. One is the promise that they will uphold life and work to preserve it, to the best of their abilities. Controversies raged in recent years over the philosophy and actions of Dr. Jack Kevorkian, who became a standard-bearer for the practice of doctor-assisted suicide and is now serving prison time for this practice. Yet, the issue of physician involvement in the carrying out of the death penalty has never been tested in the courts.

State laws and regulations continue to mandate that medical professionals be directly involved in executions. Of the 36 states that now have death penalty statutes on their books, 23 require a physician in attendance at the execution to either “determine” or “pronounce” death.

The degree of doctor participation varies, from securing the prisoner on the gurney, locating the injection site for the tranquillizer and the fatal concoction, mixing the lethal potion in the desired strength, preparing the vein for the placement of the intravenous apparatus, to finally making the pronouncement of death. Physicians have also been hired to document the prisoner’s morphology or advise on the strength and tension of the noose in hangings, and sometimes are called on to decide if a further “jolt” is needed in an electrocution.

In 1992, the American Medical Association, the self-appointed watchdog over the ethical practices of American doctors, passed a resolution banning physicians from participating in any way in an execution of any sort, including offering advice and vicarious consultations as to method and dosing. In 10 death penalty states, state medical societies have written policies that ban doctors’ participation; others simply defer to the AMA guidelines.

No doubt prison officials are aware of the discomfort that has been simmering among practitioners. The doctors who participate in executions remain anonymous, certainly in part because of their own personal uneasiness with their role. Some have likened the whole process to the practice of the Nazi regime in Germany, which had its physicians administer anesthesia and perform mutilation surgeries on inmates for its grotesque “master race” purity schemes. Those many who refused were dealt with as harshly as might be expected.

Physicians are trained to be healers. Partaking in any form of a death procedure cannot be construed as anything other than destructive of life. Taking an ostensibly healthy person and assisting in his or her demise can only be a violation of the Hippocratic oath in essence and intent.

It is not clear what would happen to the death penalty were American physicians to abide strictly by the words of their oath and the dicta of their representatives. Perhaps legislatures would devise alternatives that would replace doctors with trained non-medical personnel. But that would be problematic, since many states require that only a licensed medical doctor can pronounce death.

The U.S. is the only developed nation with a state-authorized death penalty either on the books or in practice. In those countries that have not specifically outlawed the practice as excessive and barbaric, the death penalty has not been used in so many years it is assumed some sort of ban exists.

The death penalty, so controversial because of its religious, legal, moral and social issues, might not be able to withstand a united effort by our medical community against its practice.

It would certainly be worth a try.

Don Sloan is a retired physician and assistant editor of Political Affairs. He can be reached at donsloan@whereitis.com