Before the advent of lethal injection as a method of execution, the question of physician participation in capital punishment was not regarded by medical societies as a matter of concern since physicians did not function as hangmen, gun shooters, electric switch pullers, or releasers of poison gas.
Their role, if any, was considered necessary to relieve suffering in the event that the execution process went awry. When lethal injection was introduced as an ostensibly more humane method of execution, medical societies became alarmed at the likelihood that physicians would be directly involved and adopted policy statements opposing physician participation.
The American Medical Association, for example, held that a physician should not be a participant in a legally authorized execution. The American Psychiatric Association likewise stated that it strongly opposed any participation by psychiatrists in capital punishment.
However, the ethical prohibition against physician participation continued to be ignored by physicians throughout the country. It soon became recognized that lethal injection, though it might seem more palatable than other methods, is not reliably humane. Lethal injection might appear peaceful because pancuronium, which paralyzes, is included. But despite the use of pancuronium, those injected still may suffer.
For example, if the sedative is ineffective, those injected may experience "the sensation of suffocation, the pain of cardiac arrest and other effects of potassium injection, and the sensation of paralysis," as noted in a recent editorial. "Paralysis precludes the visions of wild death struggles, hanging bodies with protruding tongues, and steam emanating from the head of the person in the electric chair" (Ann. Intern. Med. 135[l0]:922-24, 2001).
Even a slight error in dosage or administration, however, can leave a prisoner conscious but paralyzed while dying, a witness to his own suffocation in a cruel, protracted death.
As more states in the 1980s adopted lethal injection as the preferred method of execution, the AMA adopted a resolution introduced by the American College of Physicians to declare that several actions …