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In the United States, medical professionals are not allowed to participate in executions of prisoners. Are they allowed to give palliative care to the prisoners during the process, if the care given serves only to reduce the prisoner's suffering and does not in any way hasten their death?

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    When you say "allowed" or "not allowed", do you mean allowed by the prison authorities carrying out the execution, or allowed by medical ethics? The latter is probably not on topic here. Commented Jan 28 at 5:26
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    But as far as ethics, I assume the issue would not about providing palliative care per se. Rather, that they could instead be providing potentially lifesaving care (CPR etc), and yet are withholding it and providing palliative care instead. That's the part that's unethical. Commented Jan 28 at 5:29
  • @NateEldredge luckily, the cases of Buckwell and Baze do offer a clear position of the board of the AMA...
    – Trish
    Commented Jan 28 at 9:47
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    The question is somewhat unclear, and Trish's answer demonstrates that. "Can" (the wording in the title) can trivially be answered with "yes". The answer to "are they allowed to?" depends on a clarification: Allowed by whom? Apparently, the professional association has a clear stance: Ethically, they are forbidden. Alas, that is pretty much off-topic here (it belongs rather in philosophy SE). The proper answer then depends on "in which jurisdiction?", because it's apparently state law in the U.S. Commented Jan 28 at 15:42
  • Why would you ask, please? How is it not clear that ethically or legally, any medic can always give purely palliative care to any patient? Commented Jan 29 at 21:26

2 Answers 2

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The position of Physicians is clear: They shall not take any active part during and in an execution.

In the case of Bucklew v. Precythe, 587 U.S. ___ (2019), the offered or possible methods of death penalty were the problem that lead to a SCOTUS case. Among the parties that sent an amicus brief - a professional opinion - to the court was the American Medical Association supporting neither party. The medical professionals word it quite strongly:

Starting with its origins at the time of Hippocrates, the medical profession has staunchly opposed physician assistance in state-mandated executions. This prohibition is based on more than happenstance or arbitrary tradition. Physician participation in capital punishment undermines the trust patients must accord their physicians in order for physicians to practice effectively. Furthermore, physician participation in executions falsely suggests to society that capital punishment can be carried out humanely, with the endorsement of the medical profession. Physicians should not further such a charade. Accordingly, Dr. Zivot is correct—testimony used to determine which method of execution would reduce physical suffering would constitute physician participation in capital punishment and would be unethical.

In addition, notwithstanding that technical medical issues may well underlie this Court’s ultimate decision, the AMA declines to comment on those issues or to advocate for either party as to which method of death may be constitutionally preferred. The reasons for this “no position” stance are the same as those which underlay Dr. Zivot’s prohibition: the AMA, being an organization of physicians, cannot ethically support or facilitate either method of capital punishment.

Doctors may not even discuss which method is less painful, they may not assist at all in any method, and medical professionals are, under the oath of Hippocrates, banned from doing so. The Oath of Hippocrates lead to the AMA ethical standards, which contain at 9.7.3 Capital Punishment:

Debate over capital punishment has occurred for centuries and remains a volatile social, political, and legal issue. An individual’s opinion on capital punishment is the personal moral decision of the individual. However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.

This does not just mean they can not administer it, they are not at all allowed to participate. In no capacity at all. Not advisory, not reducing pain and suffering, not by administering the drug. And SCOTUS acknowledged multiple times, that doctors can't do so:

In fact, this Court [SCOTUS] has itself acknowledged the ethical prohibition on physician participation (and participation by other health care professionals) in capital punishment. Baze v. Rees, 553 U.S. 35 (2008) (plurality), Baze, 553 U.S. at 63 (Alito, J., concurring), and 553 U.S. at 107 (Breyer, J., concurring).

Alito in Baze v Rees writes:

Guidelines issued by the American Medical Association (AMA) state that “[a]n individual’s opinion on capital punishment is the personal moral decision of the individual,” but that “[a] physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.” AMA, Code of Medical Ethics, Policy E–2.06 Capital Punishment (2000), online at http://www.ama-assn.org/ama1/pub/upload/mm/369/e206capitalpunish.pdf (all Internet materials as visited Apr. 14, 2008, and available in Clerk of Court’s case file) [link to modern version]. The guidelines explain:

[However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.][context added]

Physician participation in an execution includes, but is not limited to, the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution.” Ibid.

The head of ethics at the AMA has reportedly opined that “[e]ven helping to design a more humane protocol would disregard the AMA code.” Harris, Will Medics’ Qualms Kill the Death Penalty? 441 Nature 8–9 (May 4, 2006).

The American Nurses Association (ANA) takes the position that participation in an execution “is a breach of the ethical traditions of nursing, and the Code for Nurses.” ANA, Position Statement: Nurses’ Participation in Capital Punishment (1994), online at http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPosition/StatementsEthicsandHumanRights.aspx [link to modern version]. This means, the ANA explains, that a nurse must not “take part in assessment, supervision or monitoring of the procedure or the prisoner; procuring, prescribing or preparing medications or solutions; inserting the intravenous catheter; injecting the lethal solution; and attending or witnessing the execution as a nurse.” Ibid.

And beyond the ethical ban for them to take any part but for either preserving life or observing death is often written into law too. Like in Kentucky, as the very case of Baze v Rees denotes in Roberts' opinion:

Kentucky has put in place several important safeguards to ensure that an adequate dose of sodium thiopental is delivered to the condemned prisoner. The most significant of these is the written protocol’s requirement that members of the IV team must have at least one year of professional experience as a certified medical assistant, phlebotomist, EMT, paramedic, or military corpsman. App. 984. Kentucky currently uses a phlebotomist and an EMT, personnel who have daily experience establishing IV catheters for inmates in Kentucky’s prison population. Id., at 273–274; Tr. of Oral Arg. 27–28.

[...]

A physician is present to assist in any effort to revive the prisoner in the event of a last-minute stay of execution. Id., at 764. By statute, however, the physician is prohibited from participating in the “conduct of an execution,” except to certify the cause of death. Ky. Rev. Stat. Ann. §431.220(3). An electrocardiogram (EKG) verifies the death of the prisoner. App. 764.

Are they really banned from reducing suffering?!

There is only a tiny sliver of what a physician may do: among the exceptions of the total ban on participation is this:

The following actions do not constitute physician participation in execution: [...]

(s) Relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution.

Do note the time provision: they are only allowed to administer medicine to calm the condemned person before the execution procedure starts, and only if the person is specifically asking for them. That does not give any gap for palliative care, or to put them under anaesthetics.

The AMA, State Medical Board and Participation of Physicians

The AMA ethics rules are more than "icing" for some states, but are not law in others, so states fall into pretty much one of three categories:

In some states, the AMA rules are not written into law by the legislator but incorporated by the state bar. In those states, a law demanding or allowing the participation of a physician trumps the medical board's rules.

In other states, the AMA rules are incorporated into black letter law and thus the medical bars have the power and task to revoke a physician's license for taking part in an execution.

And yet again, some legislators have removed the ethical problem by banning physicians' ability to legally take part in the execution in the first place.

For group A, take , where Cal Pen Code §3604.3 specifically allows a physician to conduct an execution and overrides the ethics code, by barring the Medical Board from disciplining.

(a) A physician may attend an execution for the purpose of pronouncing death and may provide advice to the department for the purpose of developing an execution protocol to minimize the risk of pain to the inmate.

(c) No licensing board, department, commission, or accreditation agency that oversees or regulates the practice of health care or certifies or licenses health care professionals may deny or revoke a license or certification, censure, reprimand, suspend, or take any other disciplinary action against any licensed health care professional for any action authorized by this section.

As part of Group B, has O.R.C. 4731.22.. This law not just allows, but demands the state medical board to sanction doctors for specifically violating the AMA ethics rules. Those including the capital punishment rule, thus forcing Ohio doctors to not take part or be punished by the board.

(18) Subject to section 4731.226 [4731.22.6] of the Revised Code, violation of any provision of a code of ethics of the American medical association, the American osteopathic association, the American podiatric medical association, or any other national professional organizations that the board specifies by rule. The state medical board shall obtain and keep on file current copies of the codes of ethics of the various national professional organizations. The individual whose certificate is being suspended or revoked shall not be found to have violated any provision of a code of ethics of an organization not appropriate to the individual's profession.

And group C is like . Here, doctors are barred from participating in the first place under Ky. Rev. Stat. § 431.220:

“(3) No physician shall be involved in the conduct of an execution except to certify cause of death provided that the condemned is declared dead by another person.” Ky. Rev. Stat. § 431.220

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    – Dale M
    Commented Jan 29 at 10:13
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Yes, in many states.

There, they are legally allowed to and are protected from disciplinary consequences.

There is a 2014 New York Times article by Ty Alper, a clinical professor of law at the U.C. Berkeley School of Law, about the topic. He says (emphasis by me):

That said, the popular conception that doctors “cannot” participate in executions is simply untrue. They can, and they do. (A doctor was on hand during the botched execution of Clayton Lockett in Oklahoma, but his role in the events remains unclear.) Numerous doctors have participated in hundreds of executions over the past three decades. My research has determined that none has ever been disciplined by a state medical board for participation in an execution, and laws preclude such discipline in most states. Moreover, the ethical guidelines of the American Medical Association are just that – guidelines. The harshest punishment the association could dole out is revocation of A.M.A. membership, which is not much of an enforcement mechanism given that only about 20 percent of doctors are members of the association.

This was 10 years ago, but it is unlikely that all states have changed their law in the meantime.

It is also noteworthy that the state law in many states takes an actively unethical stance, as the highlighted passage demonstrates. Logically, this "professional amnesty" is entirely in line with and directly follows from the ethical failure of capital punishment as such.

In a 2009 article in the North Caolina Law review about the topic, Alper addressed the repercussions of the AMA guidelines. He said (again, emphasis by me):

No doctor has ever been disciplined [by AMA or a medical board] for participating in an execution in this country, and every court that has considered the matter has concluded that state medical boards cannot impose discipline, particularly where, as in most states, the governing death penalty statute appears to contemplate some form of physician participation. Moreover, the ethical guidelines of other medical professionals (such as nurses and EMTs) are nearly identical to the AMA's guidelines, and these guidelines have not stopped those medical professionals from participating in executions.

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  • My contention with the quotes is, that they are true but worded in a way that is overgeneralizing and makes them wrong in details. Yes, no doctor has been successfully disciplined, but there were proceedings against some of them. Some state medical boards can not impose discipline, because special laws ban them, but the Ohio and Kentucky boards could impose discipline for their laws do allow it. the ethical guidelines of the American Medical Association are just that – guidelines in many but not all states, because in Ohio, the AMA rules are law.
    – Trish
    Commented Jan 29 at 16:16
  • While the idea and gist of the things Prf. Alper says are true, and in generality are accurate, he is speaking too broadly. While I don't doubt he is well informed and knows what he talks about, those statements are meant to speak to the emotional side and less about the factual details - which is quite relevant due to variety of capital punishment laws between different states.
    – Trish
    Commented Jan 29 at 16:20

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