Doctors shouldn't advise states on making executions more acceptable, ethicist argues

Boston University ethicist George J. Annas takes his New England Journal of Medicine readers through a thicket of ethical issues entangling lethal-injection executions, constitutional law, and physician participation.

The Supreme Court has often considered whether the death penalty carried out in any form fits the Eighth Amendment definition of cruel and unusual punishment, but lately its task has been to weigh the thorny issue of whether the cocktail of drugs used to induce death also inflicts inordinate suffering. Annas asks whether doctors can be involved in ensuring that lethal injection is "more humane."

The case Annas describes involves one drug that Kentucky has banned from use in euthanizing pets because of the risk of suffering – something Justice John Paul Stevens calls “unseemly – to say the least.” Justice Clarence Thomas suggests it’s the intention to cause pain that makes execution run afoul of the constitution. Thomas’s opinion lists burning at the stake, gibbeting (helpfully defined as combining hanging and decomposition), emboweling alive, and more examples as beyond the pale.

But as fascinating a glimpse into the judicial minds as each opinion may be, Annas concludes the Supreme Court didn’t – and can’t -- solve the ethical problem of whether physicians should intervene.

No, Annas says, doctors should not "tinker with the machinery of death," quoting Justice Harry Blackmun.

"Physicians should not lend their medical expertise to the state to make executions more palatable to the public, even by advising on drug protocols, doses, and routes of administration," Annas writes. "Even physicians who support the death penalty should stay out of its execution, because the problem that the state seeks to solve by using physicians is one of the state's own making by its refusal to abolish capital punishment and its insistence on execution by lethal injection."