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Participation of Health Professionals in Capital Punishment

Policy Date: 1/1/2001
Policy Number: 200125

THE AMERICAN PUBLIC HEALTH ASSOCIATION,
Resolves to publicly reaffirm its policy 8521, that health professionals not be required to participate in capital punishment.
Noting that there have been 710 executions, of which 545 have been done by lethal injection, between January 1, 1977 and April, 2001 in the 38 states which have capital punishment1; and
Noting that 85 executions have occurred in this year alone, and the first federally authorized execution in 38 years occurred in June 20012; and
Noting that the majority of executions in the United States require, by statute or warden’s procedures, health professional participation in the execution process3; and
Noting that the medicalization of the death penalty by lethal injection particularly employs the same medical knowledge, devices, and methods used by health professionals to comfort, to heal, and to preserve life3–5; and
Recognizing that the APHA has clear policy prohibiting the participation of health personnel in legally authorized executions6; and
Recognizing that the American College of Physicians–American Society of Internal Medicine, the American Medical Association, and the American Nurses Association have similar clear policies7–9; and
Recognizing that in March 1994, in response to concern about the increasing number of executions requiring health professional participation, the APHA in collaboration with the ACP-ASIM, the AMA, and the ANA publicly stated that ethical codes of health professions forbid participation in executions and, since these codes are integral parts of most state medical, nursing, mental health, and other health professional practice and licensing acts, health professional participation in executions violates state law10; and
Whereas this 1994 statement directed state professional licensing and discipline boards to treat participation in executions as grounds for active disciplinary proceedings, including license revocation; and
Whereas, this statement also called upon all health care professional societies to ensure that their members know and understand that participation in an execution is a serious violation of ethical standards, that professional societies should also impose disciplinary actions on those members who do participate in execution including expulsion from membership and reporting of these violations to the state licensing and discipline boards3–5,10; and
Whereas, the World Medical Association in its October 2000 meeting unequivocally restated its opposition to physician participation in executions: “RESOLVED, that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process”11; and
Noting a recent article indicates that, despite medical society policies, the majority of surveyed physicians approve of most disallowed actions involving capital punishment indicating that they believe that it is acceptable for physicians to kill by state order12; therefore
Resolves, that the APHA publicly reaffirm its March 1994 collaborative statement to all health professional societies and state licensing and discipline boards that health professional participation in executions or pre-execution procedures is a serious violation of ethical codes and should be grounds for active disciplinary proceedings including expulsion from society membership and license revocation.
References
1. National Coalition to Abolish the Death Penalty: Death Penalty Profile, November 2000.
2. Halperin, R: Communication from Amnesty International in Texas, November 2000.
3. American College of Physicians et al. Breach of trust: physician participation in execution in the United States, Philadelphia ACP, 1994.
4. Curran, WJ, Castles, W. The ethics of medical participation in capital punishment by intravenous drug injection. N Engl J Med. 1980:304:226-230.
5. Truog, RD, Brennan, TA: Participation of physicians in capital punishment. APHA Public Policy Statement, 1948 to Present, Cumulative. Current Volume.
6. APHA Resolution 8521: Participation of health professionals in capital punishment. APHA Public Policy Statement, 1948 to Present, Cumulative. Current Volume.
7. American Medical Association Council on Ethical and Judicial Affairs: Opinion 2.06: Capital punishment in Council on Ethical and Judicial Affairs 1992 Code of Medical Ethics: Annotated Current Opinions. Chicago: American Medical Association, 1992.
8. American College of Physicians: American College of Physicians Ethics Manual: Third Edition. Ann Int Med. 1992:117:947-60.
9. American Nurses Association. Position statement on the nurse’s participation in capital punishment. Kansas City, Missouri: American Nurses Association, 1983 rev. 1988.
10. APHA et al. Health care professional participation in capital punishment: statement from professional societies regarding disciplinary action. press release, March 23, 1994. Published in Nation’s Health, November 1994.
11. World Medical Association Resolution, October 7, 2000.
12. Farber, N, Daviss, EB, et al: Physicians’ attitudes about involvement in lethal injection for capital punishment. Arch Int Med 2000:160:2912-2916.