AMA ethical standards for Capital Punishment

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Here are the standards that the American Medical Association states as their ethical standards for Capital Punishment.

An individual's opinion on capital punishment is the personal moral decision of the individual. 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. Physician participation in execution is defined generally as actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner.

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.

In the case where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.

The following actions do not constitute physician participation in execution: (1) testifying as to medical history and diagnoses or mental state as they relate to competence to stand trial, testifying as to relevant medical evidence during trial, testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case, or testifying as to medical diagnoses as they relate to the legal assessment of competence for execution; (2) certifying death, provided that the condemned has been declared dead by another person; (3) witnessing an execution in a totally nonprofessional capacity; (4) witnessing an execution at the specific voluntary request of the condemned person, provided that the physician observes the execution in a nonprofessional capacity; and (5) 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.

Physicians should not determine legal competence to be executed. A physician's medical opinion should be merely one aspect of the information taken into account by a legal decision maker such as a judge or hearing officer. When a condemned prisoner has been declared incompetent to be executed, physicians should not treat the prisoner for the purpose of restoring competence unless a commutation order is

Issued before treatment begins. The task of re-evaluating the prisoner should be performed by an independent physician examiner. If the incompetent prisoner is undergoing extreme suffering as a result of psychosis or any other illness, medical intervention intended to mitigate the level of suffering is ethically permissible. No physician should be compelled to participate in the process of establishing a prisoner's competence or be involved with treatment of an incompetent, condemned prisoner if such activity is contrary to the physician's personal beliefs. Under those circumstances, physicians should be permitted to transfer care of the prisoner to another physician.

Organ donation by condemned prisoners is permissible only if (1) the decision to donate was made before the prisoner's conviction, (2) the donated tissue is harvested after the prisoner has been pronounced dead and the body removed from the death chamber, and (3) physicians do not provide advice on modifying the method of execution for any individual to facilitate donation. (I)

Issued July 1980. Updated June 1994 based on the report "Physician Participation in Capital Punishment," adopted December 1992, (JAMA. 1993; 270: 365-368); updated June 1996 based on the report "Physician Participation in Capital Punishment: Evaluations of Prisoner Competence to be Executed; Treatment to Restore Competence to be Executed," adopted in June 1995; Updated December 1999; and Updated June 2000 based on the report "Defining Physician Participation in State Executions," adopted June 1998.

Last updated: Aug 15, 2005

Source: www.ama-assn.org/ama/pub/category/8419.html

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PRESS RELEASE


from Citizens United for Alternatives to the Death Penalty (www.CUADP.org)
on behalf of Doctors Freedman, Groner and Halpern



For Immediate Release – June 4, 2006


Physician Ethicists Call on the American Medical Association to Launch a National Educational Campaign on the Ethical Guidelines for Physician Involvement in Executions.


Contact:
Jonathan I. Groner MD,
Associate Professor of Surgery,
The Ohio State University College of Medicine and Public Health
614-722-3919 office, 614-204-1824 cell,
<mailto:[e-mail]>[e-mail] (PRODUCERS - Reps Available for Talk Shows)


The following statement is attributable to these individuals:
* Alfred M. Freedman MD, 212-348-8661, Professor and Chairman Emeritus, Department of Psychiatry, New York Medical College, and past president of the American Psychiatric Association
* Jonathan I. Groner MD, 614-204-1824, Associate Professor of Surgery at the Ohio State University College of Medicine and Public Health
* Abraham L. Halpern MD, 914-698-2136, Professor emeritus of psychiatry, New York Medical College. and past president of the American Academy of Psychiatry and the Law
In advance of the upcoming American Medical Association House of Delegates meeting in Chicago, which begins on June 10, Dr.’s Freedman, Groner, and Halpern have issued the following statement:


“A total of six lethal injection executions are scheduled this month in Oklahoma, Texas, and Virginia, and a physician will be in the death chamber at each execution. In fact, in the last 3 years, 99% of executions were carried out by lethal injection, and it is likely that a physician was present at most, if not all, of these executions.


“For over a decade, the AMA’s ethics guidelines have forbidden physician participation in lethal injection. However, these guidelines have never been properly publicized, and only a small minority of physicians are even aware of their existence.


“Therefore, we call on the AMA house of delegates to support a resolution to launch a national educational campaign on the ethical guidelines for physician involvement in executions.


The proposed resolution:


SUBJECT: Ethics and Physician Participation in Legal Executions


Whereas, there is widespread participation by physicians in legally authorized executions, notwithstanding the Code of Medical Ethics, specifically, CEJA Opinion 2.06; and


Whereas, there is a lack of knowledge by physicians of the Code of Medical Ethics, in regard to physician participation in executions; and


Whereas, in many instances the unethical participation of physicians in executions is the result of lack of knowledge and awareness of ethical standards for physicians taking part in executions; therefore, be it


RESOLVED, that our American Medical Association launch a campaign of education, in collaboration with State and County Medical Societies, concerning actions allowed and disallowed by the Code of Medical Ethics in connection with physician involvement in executions.


Background information:


Like many other execution methods, lethal injection was designed with physician input. However, unlike other methods, lethal injection was intended to mimic a medical procedure: the intravenous induction of general anesthesia.


For over a decade, The AMA has published a well-articulated position against physician participation against capital punishment in its Code of Medical Ethics. However, this position has never been publicized. In fact, a 2001 study showed that only 3% of doctors surveyed were even aware of these guidelines.


The AMA guidelines forbid physicians from monitoring vital signs, meaning that a physician cannot pronounce death (since pronouncing death involves examining for the presence or absence of vital signs). The guidelines also forbid physicians from making recommendations on how an execution should be performed:


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.


With regard to lethal injection, the AMA guidelines state:


In the case where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.


Recently, litigation by death row inmates has sought to establish that lethal injection is cruel and unusual (and therefore unconstitutional) because it is a sophisticated medical procedure performed by individuals with no medical training. In response, prison officials have made physicians even more integral to the execution process. For example, the lethal injections in Missouri in the early 1990s were supervised by the head of prison maintenance. Now they are performed by a surgeon and a nurse. Several doctors have been involved in Georgia’s executions. In Connecticut, a “licensed and practicing physician” must assess the qualifications of those inserting the IVs and administering the drugs. And in two recent court cases -- in California and North Carolina – a judge demanded that anesthesiologists be present to monitor the execution and intervene if necessary. In the California case, the anesthesiologists refused and the execution did not occur. In North Carolina, the prison officials used a brain wave monitor on the inmate during the lethal injection. The judge permitted the substitution of the monitor for the anesthesiologist.


In addition, there have been calls in the press to make lethal injection "better" by bringing more medical expertise to the death chamber (see June 2, 2006 editorial in the Austin-American Statesman, which calls for prison officials to "seek expertise or advice from medical professionals" in order to improve the Texas execution protocol). This clearly constitutes “rendering technical advice” and is not ethical according to the AMA guidelines. Hence, we have the "Hippocratic paradox" where the only way to make lethal injection “better” is to force physicians to violate their ethical principles.


The proposed AMA resolution seeks to promote public dissemination of the AMA guidelines so that every physician will know his or her ethical obligations concerning legal executions. When doctors participate in executions, it disgraces the entire medical community. Even death penalty supporters are often dismayed (if not horrified) to learn that there are doctors who care for people during the day and kill them during the night.


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SENT BY:


Citizens United for Alternatives to the Death Penalty
www.CUADP.org
800-973-6548