This article appears in the February 2002 edition of the Catholic Medical Quarterly
Doctors on Death Row
'From Rage to Reconciliation': Perspectives against the death penalty
Two perspectives against the death penalty began a new series of 'Human Rights' lectures, co-ordinated by the Centre for the Study of Global Ethics (Birmingham University). The lecture was held on Tuesday 6th of November, the evening of another public execution in the US. In the introduction to the series it was contended that some people and states do not hold the 1948 declaration of human rights to be universal, but a Western agenda with little relevance to other cultures and societies. The lecture series is intended as a 'valuable beginning' according to centre director Prof. Donna Dickinson who says that 'the first requirement is to understand the key issues.'
The first speaker was Mr Bud Welch, a representative of Murder Victims' Families for Reconciliation in the US. He grew up on a farm in Oklahoma, and his only daughter was one of the many victims of the Oklahoma bomb planted by Timothy McVeigh which went off on April 19th 1995. Initially Mr Welch talked with fondness for his daughter, about her achievements and promise, to 'put a face on one of the victims'. He described his own anger, and initial desire to see the perpetrators executed without delay, or even a trial. He described how the defendants were taken to court with armed guards and wearing bullet-proof jackets, because people were quite prepared to shoot them. After months of misery and soul-searching he came to the conclusion that the execution was an act of vengeance and rage, just as the bomb itself had been. Around the time of the execution he had seen an interview on television with Tim McVeigh's Father, Bill McVeigh. He describes Bill McVeigh as 'stooped with grief' with a pain that showed in his eyes when he turned to face the camera. He resolved to meet Bill McVeigh, and described the sharing of grief and emotion when he met Bill and Timothy's sister Jennifer at their home. He has remained in contact with the McVeighs and describes the execution as not justice, but a 'Staged political event'.
Mr Welch frankly admits that, 'When they took Timothy McVeigh from his cage and killed him, it did not do for me what they said it would. Many others have told me this since.' 6 months after Oklahoma 15% of victims' families were against the death sentence, but by the following June this was 50%.
The second speaker was Professor Vivian Nathanson, a familiar face to BMA members. Prof. Nathanson began writing to prisoners on death row out of academic interest, and had assumed that an opposition to the death penalty was common ground amongst doctors around the world. However when visiting her brother in Texas she was advised that most doctors at the university were in full support of capital punishment. She gave an excellent breakdown of the points at which a doctor might be involved in capital punishment: the pre-trial assessment of fitness to be tried, the evidence of psychiatrists in responsibility, treatment on death row, the execution itself, and death certification.
"Which don't hold ethical problems?" she asked. In India, where execution is generally by hanging, doctors are called to pronounce a prisoner dead. The problem arose when the authorities, seeking to reduce the time someone was left hanging, called doctors to check on the person hanging. On finding the prisoner alive a doctor might sanction 'executing someone for just a little longer'. Organised medicine in the country at the time strongly opposed this. Interestingly the UK is one state where doctors confirm the cause of death as opposed to the fact of death, but the UK has no death penalty.
So where else are medics involved in the death penalty process? Psychiatrists are generally involved in the pre-trial assessment: assessing mental state, fitness to plead, as well as fitness to be tried. By taking part a psychiatrist may play a role in condemning someone to death, but by not taking part, someone who is ill may lose a chance to live. Regardless, many states execute both minors and the mentally incapable. Where a person has been found guilty of a capital crime, psychiatrists are called in the US to make an assessment of 'future dangerousness'. Prof. Nathanson was keen to point out that all of us are dangerous given the right circumstances and that future dangerousness has very little -if any- scientific validity. Both the World Psychiatric Association and the American Psychiatric Association have declared such involvement unscientific and unethical, yet statutes in many US States require it and regard such testimony as truth.
Medical expertise is required to assess and maintain mental and physical fitness for execution. A prisoner on death row is expected to understand death, and that it is the result of a judgement by a court. So should a psychiatrist treat a schizophrenic on death row in the knowledge that it will render them fit to die? Or should the patient suffer and remain alive? There is a similar dilemma over physical illness and injury. In 1999 US death row inmate David Long tried to commit suicide. He was taken to hospital, resuscitated and air-lifted back to hospital with intensive care support, so that he could be killed before he died. By contrast the Taliban graciously do not expect doctors to resuscitate the prisoners that have survived one of their various forms of execution.
In several states, notably in the US, death by lethal injection is being marketed as 'humane'. The ideal method proponents advocate involves administration of and anaesthetic agent without the various forms of support that keep any patient alive under general anaesthetic. This has set a worrying precedent where other countries regard the US as the 'gold standard' of 'humane' execution. China traditionally executed prisoners by a bullet in the head or throat, before harvesting their organs for transplant purposes. The Chinese authorities are taking up lethal injection on the grounds that, 'If America kills this way then China too will be humane.'
Who actually prescribes the anaesthetic agents for this purpose, and who is qualified or trained to administer them? In Texas, the death row staff were trained by a dentist and a vet, according to a Texan physician, even through doctors in Texas are generally in support of the death penalty. They don't prescribe because state law in the US requires doctors to conform to the American Medical Association code of ethics. The drugs are usually provided directly from pharmaceutical companies. The AMA prohibit doctors from taking any part in executions save confirming that death has occurred. New Mexico recently had their fist execution in decades, using drugs prescribed by a doctor, whose identity had been protected by the authorities. Prof. Nathanson suggested that this doctor should be referred to the State Licensing Board with a view to revoking his or her license.
The BMA recently made a ban on involvement in execution policy. However, any call for a world-wide ban on medicalised state execution will be too late to benefit hundreds, including may who were wrongfully convicted or sentenced. In the US 27 states say that a doctor 'must be' present at an execution. 4 say a doctor 'shall be' present. 5 say a doctor 'may be' present and 7 say a doctor may be 'invited to attend.'
"By medicalising this kind of death the US is not being humane' I believe there is no justice associated with it," says Prof. Nathanson, urging doctors around the world to stand true to their ethical code. Although the expression of emotion after a trauma could be arguably seen as therapeutic, the expression of hatred and revenge is part of a cycle, which needs to be broken.
Andrew Papanikitas BSc DPMSA, of Guy's and St Thomas', is medical student representative on the CMQ editorial commitee