Lethal injection was introduced in the United States in 1977 explicitly to sanitize executions, as older methods including hanging, electrocution, and chemical gassing were declared inhumane. This change in methodology led to the increased involvement of medical personnel in the process of execution. While the arts of taking and preserving life have been irrevocably intertwined almost since the earliest days of medicine, with even texts as ancient as the Illiad speaking to the physician’s dual role in preserving life and easing death, this involvement in execution represents a radical change in thought. Determining what role, if any physicians should play in executions, represents one of the most ethically challenging questions in medicine of the modern era. It is the contention of this post that physicians should not participate in executions as doing so represents not only a challenge to multiple guiding principles of medical ethics but more worryingly, allows scholars of jurisprudence to undermine the status and dignity of the medical profession.
Despite being viewed by many as a physician’s issue that must ultimately be settled from within the medical profession, a review of the literature reveals that support for physician participation in lethal injection emerges almost exclusively from the legal world. A group of eminent legal professionals known as the Death Penalty Committee of The Constitution Project has, for example, published a sweeping set of 39 recommendations in hopes of addressing many of the issues surrounding lethal injection as an execution method. Their recommendation unambiguously states: “Jurisdictions should ensure that qualified medical personnel are present at executions and responsible for all medically-related elements of executions”. Through these legal rulings, it appears the justice system is coopting the medical profession to legitimize lethal injection and allow it to meet an appropriate constitutional standard to not be considered, “cruel and unusual punishment.” What is legal is not always ethical however and the fact that justifications surrounding physician involvement in execution emerge almost exclusively from outside medicine is concerning.
Unilateral recommendations from the legal world urging physicians to take part in execution reveal a troubling perception on the part of the legal system that medicine and its ethics can be subordinated to serve the law. This poses a major threat to medicine’s autonomy given that a centerpiece of the definition of a “profession” is that it both defines and enforces its own ethical standards . Returning to statements by the Constitution Project, an explicit understanding that their “requirement may…conflict with various professional medical societies’ policies or codes of medical ethics” pervades the exercise. Despite this, they remain resolute that “so high are the risks of conducting executions without the involvement of medical professionals that the Committee maintains its recommendations for medical professionals to be present and responsible for all medically-related elements of executions despite this possibility”. There is seemingly no way to reconcile this recommendation with established principles of medical ethics, universally embraced by health professional societies. Consequently, the only interpretation is that the authors believe enough medical professionals will violate core ethical positions to enable the continued conduct of lethal injections. This not only expresses a cynical view of the ethical integrity of members of the medical profession but also demonstrates a profound disregard for professional integrity in general, by “using mandates from the law to encourage unprofessional behavior in medicine”.
In addition to undervaluing their ability to properly guide the behavior of their members, the legal profession also actively undercuts the influence of ethical standards such as those espoused by professional societies like the AMA by enervating their ability to take punitive measures such as revoking the membership of individuals who violate ethical standards. Courts in several states have addressed the question of whether state medical licensing boards may discipline physicians who participate in lawful executions, and in each case concluded that these boards do not have such authority. Other states have enacted “safe harbor” laws that protect such physicians who participate in executions from licensing challenges to preempt lawsuits by professional organizations. The legal profession’s motives are clear and understandable. Without the involvement of physicians and other medical professionals with special training in the use of anesthetic drugs and related agents, it is unlikely that lethal injection will ever meet a constitutional standard of decency. However, it is not the responsibility of medicine to meet this standard or ensure that executions take place. The use of an appropriate methodology to utilize for capital punishment are political and legal questions. In attempting to utilize the medical profession to serve its own interest’s, legal efforts to mandate physician assistance with execution undermine medicine’s professional status and autonomy and engender the medicalization of what is essentially a civil and legal procedure undertaken primarily to serve the goals of the state.
 “Prison Legal News.” Prison Legal News. Accessed December 03, 2016.
 Gregory D. Curfman, Stephen Morrissey, and Jeffrey M. Drazen. “Physicians and Execution.” New England Journal of Medicine 358, no. 20 (January 24, 2008): 2182-183. doi:10.1056/nejmc080384.
 Robert D. Truog, “Physicians, Medical Ethics, and Execution by Lethal Injection.” Law and Medicine | JAMA | The JAMA Network. June 18, 2014. Accessed December 03, 2016.
 “Irreversible Error: Recommended Reforms for Preventing and Correcting Errors in the Administration of Capital Punishment.” The Constitution Project. May 7, 2014. Accessed December 05, 2016.