The Hippocratic Paradox: The Role of the Medical Profession in Capital Punishment in the United States

Article excerpt

INTRODUCTION

Although the outcome may be death, the act of the physician may be solely to provide comfort. In this case, a physician is not acting as a tool of the government; he is acting as a physician whose goals temporarily align with the goals of the government. (1)

The medical profession has been involved in capital punishment for hundreds of years. For the majority of history, this involvement has been limited to the design of execution techniques, with the primary goal of eliminating the risk of unnecessary suffering. (2) This effort on the part of physicians to make executions more humane influenced the development of the guillotine, the electric chair, the gas chamber, and lethal injection. Lethal injection, however, is unique in that it was not only designed by a physician, it was also designed to imitate a medical procedure: the intravenous induction of general anesthesia. Thus lethal injection, unlike other execution methods, not only simulates medical practice, but also uses materials and expertise that are ordinarily used for healing. This has required medical professionals (3) to become active participants in executions.

The introduction of lethal injection in the United States marked the beginning of a rapid rise in the execution rate that has only recently begun to decline. At the same time, executions by other modern methods have fallen to nearly zero. (4) Thus, lethal injection has become synonymous with capital punishment in the United States, forcing the medical profession to become an integral part of the machinery of death. Part I of this Article provides a brief background of physician involvement in capital punishment prior to the development of lethal injection and discusses the pathophysiology of various execution methods. Part II demonstrates how the introduction of lethal injection fundamentally changed capital punishment in the United States by adding a veneer of medical respectability to judicial executions. Part III concludes that the direct result of this "medicalized" execution technique has been to draw medical professionals into the death chamber in violation of national and international ethical guidelines. Part IV describes how medicalized executions create an ethical conflict--the "Hippocratic paradox." (5) This paradox exists because it is immoral for medical professionals to increase the risk of another human being suffering torture by not participating, but also immoral for medical professionals to perform executions, because such participation risks irreparable harm to the medical profession and to the community as a whole.

I. BACKGROUND: THE PHYSIOLOGY OF KILLING AND THE SEARCH FOR "HUMANE" CAPITAL PUNISHMENT

"The device strikes like lightning; the head flies, blood spouts, the man has ceased to live."

--Dr. Louis Guillotin, describing a humane execution (6)

The origin of physician involvement in legally sanctioned killing is unknown. The first, and still the most famous, physician to be associated with a specific killing technique was Dr. Louis Guillotin. (7) Torture-executions were common in Guillotin's time, including execution methods that caused multiple skeletal fractures ("breaking on the wheel"), massive full thickness burns ("burning at the stake"), and asphyxiation by spinal cord transection (hanging). (8) By comparison, beheading with a sword must have seemed quite humane. In fact, in Guillotin's day, this form of punishment was reserved for "convicted aristocrats, and occasionally for royalty." (9) Decapitation by sword, however, was exceedingly operator-dependent, and required both a strong, accurate executioner and a sharp blade for success. (10) Guillotin, in his role as a reformer of capital punishment, (11) sought to end torture-executions and suggested that the same killing technique be used regardless of the social class of the condemned. He endorsed, but did not design, the execution machinery that now so famously bears his name. …

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