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The death penalty

UK (J Welsh PhD)
(email: jwelsh@amnesty.org)

James Welsh
James Welsh is medical coordinator at Amnesty International, 1 Easton Street, London WC1X 0DW, UK.

lthough the death penalty is as old as recorded

history, the central role of doctors in this
punishment only became evident after 1789.
In the spirit of postrevolution democracy and egalit,
French doctors Antoine Louis and Joseph-Ignace
Guillotin developed a device to behead the
condemnedthe louisette or the guillotine, used in
France between 1792 and 1977 before capital
punishment was abolished in 1981.
For nearly two centuries the medical role in
executions was driven either by a desire to lessen the
suffering of the condemned (and thus of the
witnesses) or by a more mundane willingness to play
the part insisted on by the stateto assist in
bureaucratic aspects of transforming a prisoner to a
corpse and to certify the death.
The most recent medical intervention to deliver a
so-called humane execution was in the mid-1970s
when a professor of anaesthesiology in Oklahoma
responded to a request from the state for a cheap and
effective chemical form of execution. Oklahomas
electric chair needed replacing, which was likely to
be expensive. The result was a mix of fast-acting
anaesthetic, a muscle-paralysing agent, and a cardiotoxin. The first man to be executed by this method
was Charlie Brookes in 1982 in Texas. He expired
under the combined effect of sodium thiopental,
pancuronium bromide, and potassium chloride. Two
doctors were present and were heard to advise the
executioner during the procedure.
In the two decades since Brookes death, the USA
has progressively changed methods, all but ending
executions by hanging, shooting, electric chair, and
gas chamber in favour of lethal injection. Since the
introduction of this method, more than 80% of
executions have been by lethal injection (and in the
past 4 years, it has been close to 100%).
Although the method has been described by
supporters as humane and scientific, not all such
executions have been free of pain or trouble, as

advocates of lethal injection might suggest. Sometimes, prolonged probing with needles takes place
before a suitable vein is found. On July 18, 1996, it
took 69 minutes for Tommie J Smith to be
pronounced dead. For 16 minutes, the execution
team could not find an adequate vein, and a doctor
was called. Smith was given a local anaesthetic and the
physician twice attempted to insert the tube in his
neck. When that failed, an angiocatheter was inserted
in his foot. Only then were witnesses permitted to
view the process. The lethal drugs were finally injected
49 minutes after the first attempt at administration.
Sometimes the line disconnects. 2 minutes after
drugs were administered to Raymond Landry in
Texas, 1988, the syringe came out of his vein, spraying
chemicals toward witnesses. The curtain between
witnesses and the inmate was closed, and not
reopened for 14 minutes while the execution team
reinserted the catheter. It was 40 minutes between
strapping down and pronouncement of death. During
the execution of John Wayne Gacy in Illinois in 1994,
the needle became blocked. The procedure took
18 minutes. In Guatemalas first lethal-injection
execution, there were also problems caused by
nervous paramedics taking a long time to insert the
catheter.
Over the past 21 years there seems to have been a
transfer of responsibility for the execution from
doctors to paramedics, although doctors can still be
called on to assist and in many US states they are still
required to be present during the execution.
Several other countries have either adopted lethal
injection for executions, or have indicated that they
will do so. Taiwan, although the first country after the
USA to adopt the method, is not known to have ever
completed a lethal-injection execution; condemned
prisoners are still shot in the head. The two countries
that did followGuatemala and Philippineshave
each done a small number of lethal-injection
executions before effectively imposing moratoria on

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further executions. China authorised lethal-injection

executions in 1997. While issues of ethics raised their
heads very early in the US debate on lethal injection,
there seems to have been little such discussion in
China. Physicians have been intimately involved in
developing the techniquethere are reports of
prisoners being injected by doctors using different
chemical mixesand in carrying it out. In China,
physicians play the part of executioner.
There are allegations that executed prisoners in
China are used as a source of organs. Although the
government denies such claims, investigations by
journalistsincluding some posing as kidney buyers
have led to the conclusion that cadaveric organs can be
bought in accordance with a timetable. Such a
scheduled supply would not be possible without
knowing the time and date of death of the donor.
Some Asian countries have shown an interest
in lethal-injection execution. The Thai parliament
decided in February, 2003, to introduce this method,
and the law was implemented on Oct 19, 2003. The
head of the prison where executions take place was
quoted by Associated Press in February, 2003 as
saying that when the new law is in place [the prisons
two executioners] will stop shooting guns and will
train to help doctors with injections. In mid-2003,
three quarters of death row prisoners in Thailand were
there for drugs-related offences. A doctor is required
by law to be present at executions, which before Oct
19, 2003 were by machine gun.
In India, authors of the Law Commission paper of
April, 2003, expressed the view that lethal injection
was the most humane form of execution. Currently,
physicians examine the body of the hanged inmate to
check for signs of life (or rather, their absence) after
the body has been hanging for 30 minutes. This
certification role would probably remain for physicians
in lethal-injection executions, with trained paramedics
doing the killing.
The ethics of medical participation in executions
has been widely discussed and condemned by
professional bodies. Nevertheless, surveys of doctors
in the USA showed widespread ignorance of these
ethical positions and a willingness to participate in
procedures that breached AMA standards, such as
prescibing lethal drugs or starting on injection.
There are other problems posed by executions. In
the mid-1990s, two prisoners in the USA attempted
suicide just hours before they were due to be executed.
Each man was taken to a nearby hospital intensive
care unit and, after resuscitation (in one case against
the protests of the treating doctors), was sent back to

Execution chamber

prison and executed. The doctors roleimposed

against their willwas to render the men healthy
enough to kill. This unpleasant role arose only because
the doctors followed accepted professional practice
after a suicide attempt.
The evolution of global policy on the death penalty
suggests that, over time, fewer doctors will be faced
with moral choices about executions. The number of
countries with capital punishment has been shrinking.
The whole of Europe, almost all of Latin America, and
Australasia have ended the practice of executing
prisoners. Several countries retain the death penalty
but either dont use it or apply it unenthusiastically.
In 2002, more than 80% of the worlds executions
were done in China, Iran, and the USA. The other
28 countries that executed prisoners in 2002
accounted for some 280 known executions. The death
penalty remains an ethical challenge for doctors;
professional associations should join human rights
organisations in calling for its abolition.
Further reading
Amnesty International Death Penalty page.
http://web.amnesty.org/pages/deathpenalty-index-eng
British Medical Association. The Medical Profession and Human
Rights. London: Zed, 2002.
American Medical Association. Physician participation in capital
punishment.
http://www.ama-assn.org/ama/pub/category/8302.html

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