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February 23, 2007

More on executions methods and the role of doctors

Jeff Mead and Larysa Simms are taking over Wednesday's class to discuss "The Role of Physicians." Here is the text and readings they sent for everyone's pre-class consideration:


Before you enrolled in this death penalty class, your mind likely jumped to a single inference when you heard mention of an interface between the legal and medical professions: malpractice suits. However, after class on Wednesday, February 28, you should also gain insight into another important interface between the two professions: the death penalty (executions). In fact, the topic is enjoying the spotlight as the focal point of several current events. In preparation for our discussion on Wednesday, please read the brief articles linked below that will orient you to the issues underlying these current events associated with the medical profession's role in the death penalty. These articles will give you a taste of what we will explore further through class discussion, including the moral, philosophical, medical, political, legal and practical implications of the role of physicians in the death penalty.

Please also answer the following questions in the Comment Section of the blog before class on Wednesday:

  1. Why do you think this issue regarding the role of physicians in the death penalty has erupted at this particular time as opposed to any other time?
  2. Why has the American Medical Association (AMA) seen fit to act as the moral compass for its members? What are the implications of this AMA decree?
  3. What political machinations do you think are at play?
  4. Given our recently expanded understanding of the assorted methods of execution, what role, if any, do you think physicians should play in the death penalty?

Required readings:

February 23, 2007 in Student-assigned readings | Permalink


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Here are my quick reaction to these interesting questions:

1. I think lawyers/judges want to believe (perhaps inaccurately) that having doctors involved in executions will help ensure they are more humane.

2. I think the AMA (perhaps wisely) wants to make it easy for its members to refuse to be drawn into these issues/debate. However, I am concerned the AMA has done so in a way that makes it hard for doctors who would like to participate in these debates.

3. There are, I suspect, lots of different types of politics in play, though I think everyone believe they are being faithful to their professional roles.

4. I do not think doctors should be a required part of the execution process, but I do think doctors who wish to be involved should not have to risk losing their license for this choice.

Posted by: Doug B. | Feb 25, 2007 7:09:26 AM

I will probably address the first three questions later, but I wanted to comment on question 4 with the lawyer/doctor analogue that popped into my head as we've been talking about the role of physicians in death penalty implementation. The ideal of the doctor - in some regard or another - is to extend life, to avoid death. So asking doctors to aid the process of death is in a way the exact opposite of what they are trained, or simply desire to do. The public expects this to be so. Indeed, euthanasia is still a widely unpopular practice (if memory serves).

Similarly, I see the ideal of the lawyer as extending justice, and avoiding injustice. As a soon to be lawyer, if I were asked to participate in a process that that sought to ensure injustice - even if it were government-sanctioned injustice, and even if my participation was limited to finding the most "painless" way to exact injustice - there is no way I could do it, and I might very well be disappointed in my colleagues who chose to participate.

Maybe the analogy isn't perfect, but it provided context for me to think about the role of doctors in the death penalty protocol debate.

Posted by: Brett T. | Feb 26, 2007 10:25:57 AM

1. I think the issue regarding doctors' participation in executions is more prominent now because of lethal injection is the execution method of choice. The whole feel of an execution has become medical, so perhaps there is more emphasis on medical professionals being involved in the actual execution.

2. I think it is appropriate for the AMA to set boundaries regarding doctors' ability to kill. No matter what you believe about the death penalty, or assisted suicide, doctors exist to heal. The AMA is not requiring doctors to be opposed to the death penalty, but professional involvement is something different. It reflects directly on the profession as a whole, and for patients' trust in medical professionals.

3. I may be wrong, but my impression from class and looking at the news that our society has become more determined that executions be "painless." I think that to reassure those folks, they need to see doctors involved to make sure that happens.

4. I don't think doctors should be involved at all in the execution process. I think it is appropriate for a doctor to perform an autopsy to determine the affect of the method of execution on the deceased.

Posted by: Kristin | Feb 26, 2007 12:23:23 PM

1. I think the issue has arisen because society is trying to move toward a painless/humane method of execution. Challenges to this method have come up perhaps in part because for the first time there is an obvious segment of society that has far more experience and knowledge than the executioners in dealing with these drugs/techniques (it's arguable that allowing medical personnel to assist could have made every method of execution previously employed more humane/less painful). Also -- where are the Depts of Corrections even getting these drugs if, as one of the postings mentions, doctors are proscribed from even prescribing? And what is the point (as with North Carolina) of having a doctor in a separate room "monitoring," when she is prohibited from intervening if she observes something going wrong??

2. The AMA has taken a hands off approach because society has taken the view that doctors are only supposed to heal/save -- and this goes way beyond the forum of capital punishment... (the vast majority of docs that I've worked with are uncomfortable talking to patients/families about death even when it has become inevitable).

3. I'm sure it behooves the AMA to stay away from capital punishment altogether, because if they assist in developing a method or being present at executions -- they appear to at least tacitly approve capital punishment.

4. If we are going to continue to use lethal injection, I think it's imperative that doctors/nurses play a role. A death row inmate could be taken to a hospital for IV insertion (or better yet, central line insertion) the day prior to execution. With some training, the executioners could be trusted to inject the drugs (even the guy in Missouri). If IV access could be assured -- the doses of each of the protocol drugs ensure that death would be quick.

Posted by: Kate G. | Feb 26, 2007 11:44:56 PM

This is a response to Kate's reply to question no. 4: The individual in Missouri is actually a PHYSICIAN! A dyslexic physician, yes, but I guess he did not figure his dyslexia would play much of a role in his OR environs. However, this same physician had more than 20 malpractice claims against him (outside of the correctional institution!) and had been denied staff privileges in 2 hospitals. His was one case in which the state could not even trust a physician to administer lethal injection. This horrifying aberration might highlight the lack of state screening in selecting physicians which is another disconcerting concept to ponder.

Posted by: Larysa | Feb 27, 2007 12:04:59 AM

I have a quick response to Brett's comment. It seems that comment avoids the issue of who gets to decide whether its the exact opposite of what the professionals are trained. To use his lawyer analogy, what if the ABA declared that no lawyer was allowed to participate in the criminal trial of OJ because the trial was clearly going to be an injustice (a vast majority of Americans believed that he did it and also that he wouldn't be convicted). Obviously lawyers would be upset because they were not given the right to choose whether they would participate in the supposed injustice or not. Many wouldn't participate, but some might believe that the trial would not be an injustice and would. Many of us might be very disappointed in our colleagues who did decide to participate in seeking an injustice, but we wouldn't expect the ABA to tell those participating they aren't allowed to. Now maybe the fact that the only quick example I could come up with is still a trial where the constitution guarantees counsel in order to make our system work illustrates that the lawyer context is wholly different from the doctor one, but that conclusion would destroy the analogy altogether, including Brett's example.

Posted by: Kurt | Feb 27, 2007 9:22:45 AM

Hello, I'm second year medical student from Tulane. Larysa's brother and my classmate, Eric, invited commentary from our class on this. I recommend Atul Gawande's When Law and Ethics Collide — Why Physicians Participate in Executions (http://content.nejm.org/cgi/content/full/354/12/1221) in the New England Journal of Medicine for the perspective of one influential doctor.

A couple of other situations I might suggest testing your assertions against:
-- A doctor's role in interrogation
-- A doctor's role in end-of-life care. Do you want the same doctor titrating your grandmother's morphine who just came back from an execution? At what point might your doctor's sense of empathy in end-of-life pain management be skewed?
--Iatrogenic complications. Are doctors more likely to detect more subtle errors in their own procedures? What if the doctor places a central line, nicks the aorta, proceeds with the injections, the patient still dies quietly, but autopsy reveals massive internal bleeding as an indistinguishably possible cause of death? Bleeding out is leads to fatigue, not panic. Does the family then sue? Would a layperson be equally liable?

Posted by: Niels Olson | Feb 27, 2007 4:57:15 PM

Thank you for your input, Niels! Your comments will definitely play into our class discussion on Wednesday. As for my classmates, you are more than welcome to look at the Gawande article for which Niels kindly provided the link. I have reviewed the article as part of my preparation for class, but having other students on the same page may enhance the discussion. Thank you!

Posted by: Larysa | Feb 27, 2007 5:18:03 PM

Q1. Why do you think this issue regarding the role of physicians in the death penalty has erupted at this particular time as opposed to any other time?

While I agree with Professor Berman that lawyers/judges believe that the use of doctors during executions will make them more humane - or at least make them appear so or that we are trying to make them more humane - I think this also is a by-product of some of the politics at issue in Q3 as evidenced in particular by the shift in representation with the last election. That didn't happen overnight - it was at least two years in the making. Generally speaking, more Democrats in Congress means the potential to advance policy issues on the subject.

Q2. Why has the American Medical Association (AMA) seen fit to act as the moral compass for its members? What are the implications of this AMA decree?

It's hard to read into another's motivations, particularly as a group. It's a controversial area and I think the AMA is trying to stand up for the rights of its members to exercise their collective conscience but it may come at the expense of individual members who view things in a different light than the majority.

Q3. What political machinations do you think are at play?

It's hard to say. I don't know how much is at play with respect to the AMA, but I'm sure that many are anxious to capitalize on (or denounce as I do in Q4) the AMA's position through the political/legal process.

Q4. Given our recently expanded understanding of the assorted methods of execution, what role, if any, do you think physicians should play in the death penalty?

If they want to be involved, or are at least willing to be, doctors should be involved in whatever capacity they feel comfortable with given their code of ethics. They should in no way be compelled, but they should not be chastised by the AMA or stripped of their license if they so choose to participate, either individually or collectively. It is one thing to "do no harm"; it is not a far leap from that principle to wish to make one's experience as painless as possible. If a doctor knows that the State is going to execute X irregardless of any doctor's participation (which it should in my opinion), it seems to me that some doctor will want to participate on some level to ensure that the X's death is as painless as possible. If not, oh well - the State at least tried to incorporate a medical perspective - and the State should continue to do its best to execute X in the most humane way possible absent medical opinion. This way, it's not on the doctor to do something he is uncomfortable with but at the same time this method eliminates a potential backdoor challenge to that which I believe is clearly constitutional and appropriate for the worst offenders.

Note: That Gawande article is very interesting and a good read. So, thank you to the poster.

Posted by: Ben D | Feb 27, 2007 6:30:14 PM

1) I agree with what others have said in regards to the painless/humane arguments. I just wanted to add to that- I think that the call for increased role of physicians is in part because public support worldwide for the death penalty has gradually decreased on the theory that it is inhumane. While the majority of Americans still support the death penalty, we don't want to be seen as barbaric and so we are trying to make the process as humane as

2)They want to maintain the integrity of the profession. I had assumed that most doctors would be opposed to assisting anyway, but I found this article
which says that 19% of doctors polled said they would give the final drugs.
I was very surprised at this because I personally suspect that this is a higher percentage than what a randomly selected group of people would say given the guilt one might feel.

3) As far as the AMA goes, again, upholding the integrity of the profession and also avoiding the appearance of supporting the death penalty.

4) I do not think they should play any role.

Posted by: Katherine L | Feb 27, 2007 7:18:56 PM

1. I think the attention on “botched” executions has brought focus to the methods that are being employed to execute. As such, with things like veins not being found and insufficient amounts of injected serums, there is greater emphasis being placed on the medical side of the execution.
2. The AMA is the moral compass for a profession, and thus, the profession’s members. Just as the ABA sets guidelines for lawyers’ ethical behavior and practices, the AMA sets standards to ensure the quality of our medical personnel and to protect the consumer from sub-par medical care. Ethical oversight is needed in the medical profession as to have control over the practice of medicine in all controversial areas of the field, such as researching cloning or protecting personal medical information of a patient. The AMA has long been the organization that holds this pedestal as the moral compass, and if medical professionals have an issue with this, they have the ability to reorganize or insist on change.
3. The ABA is exercising its political arm by implementing this policy and thus effectively verbalizing their opposition to the death penalty.
4. I believe that prisoners who are sentenced to death should have the presence of medical personnel at their death. It seems to be cruel to have uncertified, non-medical people injecting prisoners with drugs. As to ensure the “quality” of a prisoner’s death, medical personnel are needed to monitor the drugs, the vital signs, etc. and medical personnel are the only profession of people capable and trained of doing this properly. Depriving a prisoner of this level of care subjects the prisoner to an added level of anxiety during their most final moment. I think that the current AMA rule is depriving prisoners of medical attention at the time when they need it most. Furthermore, the AMA is refusing to partake in an action by the state that supposedly is sanctioned by the people of that state. Thus, the prisoner’s punishment, delivered by the state in the name of the people of that state, is not being adhered to because of this organization’s stance therefore depriving the people of the state of a humane deliverance of justice.

Posted by: Caitlin C | Feb 27, 2007 7:51:05 PM

1) I think the issue regarding the role of physicians in the death penalty has intensified lately at least in part because of the problems with recent lethal injections in Florida. Judging by the survey in the last class, many people seem to think that lethal injection is preferable to other methods of execution, because it seems relatively painless and quick. The recent botched lethal injections have definitely called this assumption into question. A logical next step would be to attempt to get physicians involved in order to improve the system.

2) I think the AMA took a position in line with the do-no-harm oath that doctors pledge. The AMA is in a sense the moral compass of the medical profession and has every right to advise its members. Nevertheless, I don't think the moral opinion of the AMA should be binding on every doctor. Doctors should be able to choose whether or not they want to be involved in the process.

3) I think that by taking a stand against any doctor involvement in the death penalty process the AMA is essentially supporting the abolition of the death penalty. By insuring the process is not improved, the AMA may change the minds of people that would otherwise support the death penalty if the processes were administered by a doctor, such that it would be less painful and more humane.

4) I think physicians that choose to be involved in the process should help to develop procedures that insure the person is put under before administering any lethal drugs.

On another note, if the issue of a doctor's involvement is so contentious, states could invest in better training executioners on inserting iv needles and other medical issues. A medical course focusing on things pertinent to lethal injection is likely not too difficult. Each state could train several people in a crash nursing/doctor course, which although not perfect, could help solve this debate.

Posted by: Caitlin D | Feb 27, 2007 9:16:43 PM

1.) I submit to those who think that doctors should not be involved in the dying process that "death is not the enemy, suffering is" (author anonymous). Should you not like to take my word for this, I invite you to a tour of the medical ICU. If doctors' only imperative is to prevent death, then they shall turn a blind eye to countless cases of suffering in patients who are irrevocably dying and who need relief of suffering and pain. Such, I might add, is the plight of the death row inmate.

2.) Many physicians, like me, are not members of the AMA (but subscribe to their journal) precisely because of the hubris with which they have declared themselves the moral compass of the medical establishment, apparenlty by decree, as a substantial minority (or is it the majority?) of US physicians are not members, and nor is the establishment sanctioned by any other legitimate governing or elected body. They have taken other political positions (e.g., gun control) under the guise of "public health" and "medical ethics", which they use to thinly veil their political motivations.

3.) Were I responsible for an execution process, I can absolutely guarantee and assure that I could make the entire process as painless as a routine dental visit, almost without fail except under the most extenuating of circumstances. This is another example of Berman's frequently invoked pretenses of abolitionists - that where a workable solution to one of the "problems" they expose is proposed, it is attacked on other contrived grounds - here, the assertion that doctors should not be allowed to participate, even though it is a wonderful solution to the proposed problem, and one which promises to relieve the very suffering that they proclaim to detest.

4.) The medically popular "doctrine of double effect" could possibly (probably?) be invoked regarding the administration of an anaesthetic agent prior to an execution and thereafter the route of administration (i.e., a central venous catheter) could be used to deliver doses of lethal chemicals, thereby removing the physician from the actual "killing" (if you must) process.

5.) That a physician is incompetent in medical practice (or dyslexic if you must) has absolutely no bearing whatever on his ability to carry out a simple procedure such as required by an execution. This is a distraction. In fact, it it an epiphenomenon of the topic of this whole thread - it is the marginalization of physicians who are willing to participate in executions that FORCES the "corrections" establishment to scrape from the bottom of the barrel for the remnant dregs of the medical establishment for such services in the prison environment. Were these activities not proscribed by medical boards and the AMA, more reputable physicians (like me?) would be available for participation....

6.) The medical student pointed out a very good NEJM article that ends with a nice summary that exposes the author's (go figure, liberal) bias. However, rare potentialities and counterfactuals such as "nicking the aorta" are an untenable distraction - we are talking about optimizing not perfecting the process (as the latter is rarely possible in medicine or elsewhere).

7.) One of the reasons that the process seems "medicalized" and why physicins have been thrust into the debate of late seems to derive from the evolution from violent/traumatic means of effecting death to biochemical or poison-derived means of effecting death. Traumatologists will tell you that trauma results from energy transfer, something that lay persons would generally classify as violence which disrupts bodily functions and processes. Lethal injection (and, less elegantly, gaseous asphyxiations), instead of disrupting such processes through energy transfer into the system, interrput them by interferring with effective energy use/scientific WITHIN THE SYSTEM. It is almost inevitable that this transition, which relies upon a more profound understanding of biochemistry and physiology, will appear to be medical/scientific. Moreover, the trend towards making the process "painless" (both psychologically and physically) seems to require administration of anesthetics and anxiolytics which will, of course, appear superficially medical.

Which begs the question - does the appearance that something is medical make it so? If the sadistic serial killer uses surgical instruments, has he "medicalized" his killing? And so what if he has?

Posted by: Scott A | Feb 27, 2007 11:57:34 PM

Click here:


And you will find this:

"Despite the public perception that the AMA represents all physicians, only one-third belong to the organization. Membership has declined from 300,000 in the mid-1990s to 260,000 in 2003"

Therefore, the notion of the AMA as a "moral compass" is seriously flawed and easily challenged.

Moreover, I have noted in several of the posts a visceral abhorrence to the notion that a physician, perhaps YOUR physician might be treating you after performing an unsavory act such as an execution. I would like to remind those persons that there are several other unsavory acts that, depending on one's background, disposition, and religious and psychological makeup would perhaps cause equally strong visceral reactions if you decided to dwell upon them as your physician was treating you; e.g., autopsy, organ harvestation, abortion, pelvic examinations, colonoscopies, amputations, brutal surgeries like pelvic exenteration, and the like.

For my own part, I would, rather than dwell on dramatic and viscerally exciting and repugnant aspects of a physician's behavior, I would rather have confidence that, as an overarching goal and dictum, my physician has the wherewithal to perform duties which may be distasteful to him and others for the greater good of his patients and society. Such wherewithal and moral fortitude may give him pause when he considers that his and his profession's FAILURE to act in the execution process is causing unnecessary, wanton, and gratuitious suffering.

We would not quickly excuse a physician for failure to act who, because rotting flesh disgusts him, refuses to act to to save the limb of a person in need. That this process resulted from "nature" as opposed to "human/societal intervention" [as an execution] creates an artificial distinction: humans are part of nature and their acts and those willed by society are as natural as anything else that occurs in nature. That they appear more mutable is an illusion, as a doctors refusal to be involved does as little to change the course of events as would his refusal to treat the infected leg - protest as he might, nature will run its course, as it has proven it will in the realm of capital punishment.

Should the physician feel a moral obligation to oppose capital punishment, there ARE ways that he can to that (through the political process) that DO NOT require him to turn a blind eye to the potential suffering of death row inmates who are being administered poisons by unqualified persons.

Therefore, I propose that in general physicians are hiding behind the Hippocratic oath and other anachronistic dictums as a pretext for their own repugnance and visceral abhorrence of capital punishment, and their lack of wherewithal regarding the possibility of their participation.

Posted by: Scott A | Feb 28, 2007 10:46:11 AM

I'm sorry but I can't help myself, as there appears to be an omission bias here:

Suppose that it it YOU who is going to be executed tomorrow. It will take place. It cannot be stopped. Who would you rather have perform the execution - some lackey at the dept of corrections, or a competent physician?

Posted by: Scott A | Feb 28, 2007 11:07:25 AM

1. I think that the role of physicians in executions is a burgeoning topic of discussion at this time because the public opinion of the death penalty is (slowly) shifting towards being less tolerant of executions. I think an obvious point of contention is the method of execution and the pain associated therewith. As a result, the presence of medical personnel during the exeuction seems a likely place to focus.

2. I can't say why the AMA has seen fit to act as a moral compass for its members, but I agree with some of the earlier posts that it would seem to stifle those members who may believe, feel, or wish to act differently.

3. As for political machinations, I think I would refer to my first answer.

4. I understand that many physicians feel that they should follow the hippocratic oath and "do no harm." However, I think a similar responsibility of a doctor is to ensure that medical procedures are performed properly. This might be an issue of "do lesser harm." As long as state's continue to enforce death sentences, they will be putting inmates to death. In light of that, shouldn't physicians work to make sure the inmates suffer as little as possible? Especially given that physicians are in the best position possible to ensure that the procedure is done correctly. It is not the role of the AMA to legislate and put poltical pressure on states to review their capital punishment statutes.

Posted by: Kacey | Feb 28, 2007 11:08:29 AM

Scott - You say: "I submit to those who think that doctors should not be involved in the dying process that "death is not the enemy, suffering is" (author anonymous). Should you not like to take my word for this, I invite you to a tour of the medical ICU. If doctors' only imperative is to prevent death, then they shall turn a blind eye to countless cases of suffering in patients who are irrevocably dying and who need relief of suffering and pain."

I don't have near the experience in this area that you do, but it seems to me that if your suggestion were true, euthanasia would not only be more common and more public, it would be a required duty of the physician. As it is not, and in light of the (wretched) AMA's statement, "The use of a physician's clinical skill and judgment for purposes other than promoting an individual's health and welfare undermines a basic ethical foundation of medicine — first, do no harm. Therefore, requiring physicians to be involved in executions violates their oath to protect lives and erodes public confidence in the medical profession," I respectfully disagree that "in general physicians are hiding behind the Hippocratic oath and other anachronistic dictums as a pretext for their own repugnance and visceral abhorrence of capital punishment, and their lack of wherewithal regarding the possibility of their participation." I find it incredibly hard to believe that "in general," those physicians who would personally refuse to participate in state-sanction killing are all internally opposed to the death penalty anyway.

Also, lest I be accused of dodging your question - if I were being executed tomorrow, would I want a competent physician to perform it? Of course. But that's not really the question is it? The question is whether or not I would understand and appreciate the physician's refusal to so participate. And truthfully, I would.

Posted by: Brett T. | Feb 28, 2007 1:15:50 PM

Why, then, I ask you Brett, given what you have stated above, does not the AMA take a position in opposition to abortion?

In many cases, abortion does not conform to the AMA's precepts as you have quoted them.

I'll tell you why: because the AMA is a LIBERAL political organization, and their dictums are rationalizations twisted to conveniently support their political positions.

Posted by: Scott A | Feb 28, 2007 1:31:27 PM

To further this discussion, we need to do some digging to see if the AMA has taken a position against Oregon's (LIBERAL) euthanasia program....

I'll bet that they haven't. I'll bet that it has been ignored. But I don't know.

Posted by: Scott A | Feb 28, 2007 1:33:55 PM

Scott: without turning this into an abortion versus death penalty discussion (one that I actually think could be very interesting and fruitful for the blog), I would just suggest that it's possible (again, I do not hold myself out to be an expert on *anything* medical or doctor...ical) that the AMA or some doctors individually do not view unborn fetuses as patients and/or persons, the mother is the patient, and thus they fully comply with their oaths and duties by serving the patient - even if ultimately harming the fetus.

It is admittedly uncomfortable to set up a paradigm where sentenced-to-death murderers are held up in a higher regard than unborn fetuses (at least in terms of what constitutes "harm" and the central mission of doctors), but it is not implausible.

Posted by: Brett T. | Feb 28, 2007 1:46:52 PM

I would like to respond to question 2 and why the AMA decided to "be the moral compass." I feel what the AMA did was an attempt to protect physicians from a very hard choice, a choice that most people don't ever have to make: even if you are personally for the death penalty, can you professionally be involved in effectuating it? The average person never has to deal with this question because they are not involved in actually killing people on death row (though one can argue that inmates are killed in the name of the state and thus all people are involved, but this is a very tenuous link in most peoples minds). It is easy for the average person to be pro-death penalty when they never have to be involved or even witness the execution. When the idea of doctors being involved in this procedure came to the forefront, a new group of people (besides lawyers and the actual executioners who have been dealing with this tough question since the inspection of the death penalty) would be forced to make this tough decision, a decision most people would like not to have to make because it makes the death penalty too real. I believe the AMA wanted to protect their own, themselves, from having to make this very tough decision. Whether it was right for them intervene is an issue that I feel has been well covered by other bloggers, and I won't repeat anyone.

Posted by: Tiffany L. | Feb 28, 2007 1:48:23 PM

Doug, I think the anesthesiologists and pharmocologists would agree with the "lawyers/judges" (accurately) "that having doctors involved in executions will help ensure they are more humane."

You should check into the problems with Angel Diaz's execution in Florida. Those problems with veinous access and drug delivery wouldn't have occurred with a black-hooded doc, or even a decent phlebotomist.

Posted by: rothmatisseko | Feb 28, 2007 2:26:23 PM

Of course, my last post assumes that a "humane" execution makes conceptual sense at all.

Posted by: rothmatisseko | Feb 28, 2007 2:27:22 PM

Scott A: what is your specialty?

Posted by: Larysa | Feb 28, 2007 3:49:35 PM

SO, it turns out that my guess about the AMA position on PAS (physician assisted suicide) was wrong, although the position was drafted before the Oregon law went into effect, so who knows.

On a previous post, I confused PAS with euthanasia, the latter which the AMA has always opposed.

AMA ethical position statements can be found here:


It is true that they do not oppose abortion - which I mentioned not to start a debate about it, but merely to point out that, if in trying to determine the answer to the moral compass question we are considering that the AMA may be politically motivated, we should look for consistency of their positions as they relate to the promulgated ethical precepts - and abortion appears to serve as a counterpoint to the general "do no harm" principle.

Oh, and my "specialty" is pulmonary and critical care medicine.

HAS ANYONE EVER SUGGESTED THAT A VETERENARIAN CONDUCT THE EXECUTION? They are the most expert euthanasiasts of all, and I doubt their medical boards would have a problem with them participating in executions....

Posted by: Scott | Feb 28, 2007 4:23:41 PM

SO, it turns out that my guess about the AMA position on PAS (physician assisted suicide) was wrong, although the position was drafted before the Oregon law went into effect, so who knows.

On a previous post, I confused PAS with euthanasia, the latter which the AMA has always opposed.

AMA ethical position statements can be found here:


It is true that they do not oppose abortion - which I mentioned not to start a debate about it, but merely to point out that, if in trying to determine the answer to the moral compass question we are considering that the AMA may be politically motivated, we should look for consistency of their positions as they relate to the promulgated ethical precepts - and abortion appears to serve as a counterpoint to the general "do no harm" principle.

Oh, and my "specialty" is pulmonary and critical care medicine.

HAS ANYONE EVER SUGGESTED THAT A VETERENARIAN CONDUCT THE EXECUTION? They are the most expert euthanasiasts of all, and I doubt their medical boards would have a problem with them participating in executions....

Posted by: Scott | Feb 28, 2007 4:23:58 PM

Here in the Stanford Encyclopedia of Philosophy


is a good summary with examples of the "doctrine of double effect".

Prof Berman was indeed correct that this is attributed to St Thomas Acquinas.

For those interested in moral philosophy, here is another site that you may enjoy:


It turns out that Mark Hauser of Harvard, who studies the evolution of the "moral intuition" if you will, believes that the doctrine of double effect is an inherited intuition, common among humans of all cultures who have a keen sense of morality....

Posted by: Scott | Feb 28, 2007 6:20:41 PM

This is Eric Simms, a Tulane University Medical Student and class representative for the Hospital Ethics Committee.


I wonder if your choleric attitude toward the AMA and perhaps even "liberals" isn't grossly distorting the points being made in this forum. The fact that not all physicians are members of the AMA is given, and doesn't seem germaine as I don't find any insinuation in the discussion above that people think that the AMA represents all physicians and their opinions. A better standpoint would probably be to view the ethical standards associated with Board Certification for different states, as these ethical standards DO represent the physicians, and they are expected to uphold them. The AMA's viewpoint is only as strong as any other organization that states principles or a charter. The public perception of the AMA's representation of physicians has no bearing on whether or not physicians should participate in death penalty practices as a moral issue. It merely clouds the issue with popular viewpoints. Whether or not physicians view the AMA's position as a "moral compass" likewise has little bearing on a moral argument-- the points that the AMA makes should be viewed not in terms of their popular believability, but by the merit of their declaration, or lack thereof.

Also, all of these activities of physicains: "autopsy, organ harvestation, abortion, pelvic examinations, colonoscopies, amputations, brutal surgeries like pelvic exenteration, and the like" are procedures employed to help the patient's life and livelihood, with the exception of autopsy, which is utilized to discern cause of death as part of an investigation (a neutral act with no harm to a person or their family). The comparison to assisting in an execution is a poor one-- assisting in an execution is not to be considered repugnant because it invloves large amounts of tissue or invasiveness, but because it straddles moral and ethical guidelines that have longstanding been part of a physician's initiation and oath. In particular, that (of course), of "doing no harm". If my physician walks in the room to initiate my anesthesia for my organ transplant surgery, I won't be bothered by the fact that he just ate spaghetti in an "unsavory" and stomach-turning manner, nor by his previous invasive and "unsavory" surgeries. Participating in an execution is a horse of a different color, and it is not unreasonable to say so.

The analogy of a physician disgusted by rotting flesh inexcusably refusing help to help save a patient's limb is an implausible situation. No physician would pass first year gross anatomy if they were disgusted by flesh. It is an unrealistic scenario and a poor piece of rhetoric used to confuse the issue of an argument based on a MORAL PEROGATIVE, NOT a mere sense of distaste or dislike. Also, "That this process resulted from "nature" as opposed to "human/societal intervention" [as an execution] creates an artificial distinction: humans are part of nature and their acts and those willed by society are as natural as anything else that occurs in nature" is an interesting perspective, but it is not a truth. It is a philosophical viewpoint that has been argued since Hobbes wrote Leviathan. it's a valid perspective, but it is not a absolute truth that we should use as a frame of reference for this argument. However, you're argument that the execution will occur anyway, so a physician's refusal to participate in a prisoner's comfort during the execution being cruel DOES bring up a very interesting point. I still see your logic as slightly flawed, however. Let's compare it to a similar situation, that being, one of moral question. If a physician was asked, compelled, or ordered to anesthetize 500 people for the purpose of executing them in an ethnic cleansing, and the physician believed this action to be morally wrong and contrary to his oath as a physician, should he still anesthetize the people so they they feel less pain, since the state-sanctioned execution is going to occur regardless? I would say certainly not, because the mere participation condones the act. Any argument of merely following orders are just doing it to relieve the suffering of those people smacks of the Nuremberg trial excuses. Standing against a practice that is believed to be wrong follows more closely with the physician's role to society, which you recognize in your previous statements.

This leaves a problem though-- what is to be done about the suffering of those people? There are definitely means by which executioners can obtain the procedures and protocols for proper administration of anesthetics, sedatives, anxiolytics, and muscle relaxants without requiring physician participation in the execution itself. It is a difficult problem though, and such a simple solution is both merely a technical band-aid, and a poor resolution to the larger moral issues surrounding the death penalty.

Lastly, I would like to state that it is truly scary to hear of a critical care physician referring to the hippocratic oath and it's modern derrivatives as anachronistic. I'm going to assume you meant that the Hippocratic oath in it's original form is obsolete, and not that the initiatory oaths of physicians are obsolete and anachronistic, which I would agree with. But I don't think there are very many physicians whom use the original hippocratic oath as a thin shield against having to deal with the moral issues of the death penalty. That is a ridiculous argument. 62 out of 122 allopathic schools use an oath that is NOT the hippocratic oath or even a variation of it. The vast majority of the remainder use the modern version of the Hippocratic oath. All 19 of the osteopathic schools use the osteopathic oath. The osteopathic oath prohibits euthanasia, but euthanasia is not the same as the death penalty. If you show me any physician that stands behind the original Hippocratic Oath as their defense against participating in an execution, I'll be incredibly surprised. You will, however, find many a physician who will refuse to participate in an execution because of their personal moral standards, or based on their interpretation of the "do no harm" clause of the modern Hippocratic variant. To say that THIS clause is anachronistic or obsolete is ethically unsound for a physician, so I am not sure what your point is there.

Posted by: Eric | Feb 28, 2007 6:52:02 PM

Eric - you have made some good points and it is clear that you would like to delve into these issues a bit deeper. I fear that my own unconventional ramblings have already taken the discussion far from its intended path.

However, I do feel compelled to offer the gratuitious advice that you use this discussion as an impetus for further study of the issues that you have raised, as a proper understanding of moral philosophy, the deontological-consequential dichotomy, cross-cultural studies of disgust (what it is and what causes it), omission bias, etc will better inform any discussion we may have on these topics. These two books may prove fruitful for a start:

Moral Minds - Mark Hauser
Against Bioethics - Jon Baron

The "do no harm" clause of the Hippocratic Oath is probably it's most popular invocation, and my research and that of others has demonstrated how blind, unquestioning faith in this principle can lead to worse outcomes for patients and society. As you finish medical school and your training, I challenge you to look for cases in which devotion to this principle causes worse outcomes - when you find them, and when "do no harm" is blurted out in defense of practices wihch seem illogical or which can be expected to lead to worse outcomes, you too may develop a healthy skepticism for this principle.

What is scary to me is not when people DO challenge the status quo (e.g., by calling the HO anachronistic) but rather when they FAIL to challenge it.

I don't take the reference to my being scary as a CCM doc as an ad hominem attack. My patients don't know and don't care what oaths or principles I'm following when it comes down to the wire and the fit hits the shan. They want the best outcomes, all things considered - and that is why critical care docs have to become very comfortable with consequentialism, the doctrine of double effect, the dying process, etc. We are DAILY involved in the care of the dying. To overextend the "do no harm" principle and not employ the doctrine of double effect (e.g., in withdrawl of life support or administration of morphine) would create lots of needless suffering. But I cannot adequately reinforce the point that dying patients don't care about these distinctions - they don't want to suffer as they die PERIOD.

Were you to put aside for a moment the "principles" that you have been inculcated with and which you probably believe you ore obliged to unquestioningly follow and promote as a dutiful medical student, and put yourself in THE OTHER PERSON's SHOES (YOU are going to be executed. Who do YOU want to do it?), you will have a very hard time reconciling the principles which you are promoting with the very very very simple fact that only a fool would not want a physician to be involved in the process.

Regardless if physicians DO or do NOT frequently use the "do no harm" principle as a shield for their unwillingness to participate in an execution, I am saying that they SHOULD NOT do this. A poingnant counterpoint to the "do no harm" heuristic (which has its basis in omission bias) is the heuristic "Do NOT fail to do GOOD". Doing good is acting in a way that minimizes suffering.

What is YOUR answer to question #2 - why HAS the AMA seen fit...?

Posted by: Scott | Mar 1, 2007 10:21:13 AM

Hi Scott--

I'm glad you didn't take any of my previous discussion as an ad hominem argument, none of it was meant to be so. You have brought up some good points. I'll be presenting them to the Tulane Hospital Ethics Committee at the Ethics Committee Meeting this afternoon, for discussion of current principles and the viewpoints of the Committee members. It's a good committee-- we deal quite a bit with end of life issues, DNARs, lack of DNARs for an unresponsive pt when the family has strong viewpoints with the continuation of care deemed by 3 physicians to be futile, the principle of double effect, and the works. The Committee is made up of a 1st year med student rep, 2nd year med student rep (me :)), 3rd year med student rep, Heme-Onc physician, the head of the Pediatric critical care unit, a chief attending, the Chaplain of the Health Sciences division of Tulane, an MSW, the head of Quality control and risk management, 2 PhDs, the head of ICU nursing, and several Hospital administrators and school administrators that are also practicing physicians. It is a really good sounding board for these issues, and they all stay abreast of topics of medical ethics impeccably. I've been granted a good hunk of the Committee Meeting time today to present these issues, and I'll bring this blog's dialog in to the committee meeting, with names removed, for discussion with these professionals. If there are any pertinent points to be expounded upon further based on the Committees opinion (which I value more than both yours and mine!) I'll be sure to post. If you'd like me to send it as an email to you instead, let me know-- I don't want to clog the blog with discussion after the initial purposes of the blog have already been fulfilled. Let me know! I am at esimms@tulane.edu

Take care, and I'll be in touch!


Posted by: Eric | Mar 1, 2007 12:14:20 PM

Eric - Well this is a Great opportunity for us to have an Ethics Committee at a major university medical center take up the debate that Professor Berman started! We'll be interested in your report.

I've had some further thoughts about question #2 regarding the AMA's position as regards consistency of logic.

It seems to me that the AMA's position could be based one one of four (perhaps more) underlying guiding principles:

1.) A deontological insistence to "do no harm."

If this is the logic, it is undermined by their lack of opposition to abortion, or to military service of physicians, or to organ donation from brain dead donors - other cases where killing is legal or societally condoned because of special circumstances.

2.) A moral opposition to capital punishment that is intuitive and which they cannot explain or otherwise justify. It is simply so because they say it is so. Capital punishment is wrong and therefore so is physician participation.

If this is their position, then Prof Berman is correct, they have established themselves as a moral compass of sorts for the medical establishment.

However they have taken various other positions, e.g., gun control, which do not appear to have moral underpinnings:

3.) A political position, such that their stances on various topics conform predictably to a certain political viewpoints.

I have, throughout this thread, offered substantial evidence that the AMA's positions have predictable political patterns. The abortion/capital punishment one is the most provocative to me.

4.) They are actually behaving in a consequentialist fashion, but it is not outwardly apparent. This could be so IF they truly believe that the harm that is done to the PERCEPTION of physicians and the resulting erosion of public trust in doctors is so great that it OUTWEIGHS the harms that result from having no medical oversight to executions.

This position is also difficult to reconcile with the abortion stance.

So I rest my case that of all of the perspectives that I can come up with, the only one that seems to withstand scrutiny is the political argument.

Posted by: Scott | Mar 1, 2007 1:29:19 PM

I will reiterate, Scott, that to suggest it is impossible outside of a political explanation for the AMA to be publicly opposed to the death penalty and espouse no public position (or even endorse the procedure, as the case may be) on abortion, is incomplete. It is a fair point worth discussion, but it is not the QED you seem to think it is. In one situation (death penalty), there is only one party that could be deemed the patient. In the other (abortion), there are perhaps two. Depending on whom the AMA deems the patient in the latter situation, the positions are plainly reconcileable without a political explanation.

Posted by: Brett T. | Mar 1, 2007 1:46:40 PM

But I never said that it is impossible! Quite the contrary - I listed it as one among 4 possibilities!

After we determine what the possibilities are (and I'm sure there are others) we have to evaluate them based on either evidence or consistency of logic, or some other rational standard that we can agree upon.

It's only my judgment (the rationale for which I have tried to clearly delineate) that most of the possibilities suffer more or less on various levels of logic and evidence.

We can forget about the abortion example - but I think that even if we do, it will be difficult to arrive at an alternative conclusion.

Posted by: Scott | Mar 1, 2007 4:39:45 PM

Here I quote the original AMA report:

"Resolution 5 (1-91), which was referred to the Board of Trustees, asked the Council on Ethical and
Judicial Affairs to (a) develop a guideline which prohibits physician participation in state executions and
(b) specify exactly which actions by physicians would constitute participation. The Council responds to
the resolution with this report."

What I find interesting about this is the statement that some body/committee within the AMA decided somehow (how they decided is not clear) that physician participation in executions was to be prohibited and the CEJA was MANDATED to make a guideline that PROHIBITS participation!

Nowhere did anybody MANDATE that some council/committee/body INVESTIGATE reasons BOTH FOR AND AGAINST participation, nor did they mandate that somebody take steps to determine what the collective conscience of physicians was, rather they appear to have WILLED BY DECREE that this guideline be created. Prohibition was a foregone conclusion. The conclusion appears to have preceeded the evidence and evaluation. these were rather used simply to support the conclusion.

It would be interesting to know what, if any, deliberations took place while this conclusion was being formulated. I have searched the web and have not been able to find out yet how resolution 5(1-91) came about.

Posted by: Scott | Mar 1, 2007 4:54:20 PM

I have had continued thoughts on the prisoner's perspective regarding a physician's participation in his execution.

We take care of many prisoners including death row inmates at OSUMC. It is my feeling, anecdotal and unsupported by empirical evidence, that the prisoners are (generally) grateful for the care that the physicians and nurses provide for them. While this may seem a natural and expected response to being cared for in a time of need, I think there is more to it than that. These men are constantly surrounded by large, dare I say terrifying, antagonistic, and controlling "guards" ("corrections officers" or "COs" for short) - and the (caring) physicians and nurses provide a sample of humanity that is starkly contrasting to that to which they are generally accustomed. I imagine that, the Stockholm syndrome notwithstanding, such prisoners, at the time of their execution, would like to have a medical ally at their side, much as they have a spiritual ally, to assure that the state does not botch their execution, to make sure that everything goes right.

There are two things that people fear when they're dying (at least a "natural" death): being alone and suffering. It seems to me that the first has generally been covered by having the prison chaplain or whoever attend to the inmate in his final hours. The latter is currently not being covered - they have no one there to provide assurances of physical comfort and avoidance of suffering.

It is my view that the AMA's position amounts to ABANDONMENT of these men in their final hours. Whether this results from a desire to make a political statement, because of a (sanctimonious) moral stance that has a higher regard for abstract principles than for hard outcomes like real suffering, or for some other reason, I can't be sure. But I am confident that it is abandonment.

This abandonment is easiest to perceive when you imagine YOURSELF in the condemned's shoes....and the comfort, albeit minimal, that you may have knowing that beside your spiritual counsellor is a person with th eknowledge and ability to make sure your execution is not botched - someone to offset the burly grotesque captors (COs) who have never really been your ally.....

Posted by: Scott | Mar 2, 2007 3:19:30 PM

ok, to be honest, I didn't read the entire dialogue on this particular subject, but I still have something to say about doctor-assisted executions. Firstly, in response to Eric and his first comment about the difference between certain medical procedures and assisting in execution - yes, it's very true that many physicians may be morally opposed to administering pain-relieving medication prior to, say, a lethal injection or some other execution method. But, you know what? There is also going to be a physician who ISN'T against that. Within any profession, there are the people who serve as the "moral model" and then there are the others. I think it's idealistic and pompous to presume that doctors are above such stereotypical hierarchies. There are lawyers who are abulance chasing pieces of sleaze, and there are lawyers out there fighting, without compensation, for homeless kids and abandoned animals (or vice versa!). Anyway, I think that anything within the legal realm should be, well, legal. I compleley agree with the young woman in class on Wednesday - everything she said I second-ed. Especially the fact that doctors are permitted to "pull the plug" on suffering individuals and allow them to pass. Well, what is a death row person if not suffering? Who gets to define suffering, anyway? If we simply alter our definition of suffering, then this whole "moral" dilemma gets a whole hell of a lot easier. These are manmade differentiations.

Bottom line: who cares if some doctor out there thinks it's ok to assist in the administration of the death penalty? Who cares if you're pro-choice and someone else is pro-life? Who cares if you voted for Kerry and someone else voted for Bush? Let it be - all of those things are legal, so we are all within our discretion to choose within those legal boundries. Let's not falsely create walls based on our narrow beliefs. That's small minded.

Posted by: Stephanie F. | Mar 2, 2007 10:13:08 PM

Stephanie - we aren't talking about doctors who want to play some poker on the side, or want to do some vetrinary work on the side... we're talking about doctors acting in direct conflict with the oaths that MAKE them doctors in the first place. Just as the legal profession tells me that in order to BE a lawyer, I need to do and be x, y, and z, the medical profession is fully within its authority to say that in order to BE a doctor, you need to do and be a, b, and c.

Posted by: Brett T. | Mar 2, 2007 11:16:10 PM

OK, here's another provocative analogy (and one that Brett probably won't like because he wants to keep abortion out of this perhpas because it's hard to have consistency of logic if we are allowed to consider abortion in this discussion :-)

Suppose that anesthesiologists have board certification and licensing procedures that make them separate and distinct from other physicians (this is not terribly unrealistic - alternatively you could say PAs or CRNAs, or RNPs or whatever). Suppose also that they are necessary to provide anesthesia for women who are undergoing abortions. Suppose further that they decide that they are a moral compass of sorts and that they oppose abortion and therefore refuse to allow their own to provide anesthesia during an abortion. And suppose that nobody else can do it properly. And suppose finally that as a result of sub-optimal anesthesia during abortions, many women suffer tremendously, have terrible fear of the procedure, and are harmed as a result of this lack of proper anesthesia administration.

What do we think of these anesthesiologists and their "moral compass" leadership?

Posted by: Scott | Mar 2, 2007 11:54:36 PM

OH, and PS, an oath doesn't make me a doctor. A skill set does. And the AMA, as we have already clarified, has no authority. Thank God.

Posted by: Scott | Mar 2, 2007 11:59:34 PM

PSS - we're too caught up in this "oath" thing. It is largely misunderstood. The oath is taken only once, during medical school graduation as part of the pomp, circumstance, and ritual of the graduation. Some bilious and choleric folks might well call it an anachronism. Nobody who happens to miss graduation and not take the oath is denied "doctorhood" as a result of this failure. Never again during any board examination, or state licensing application is reference made to this "oath". It is simply exploited by the righteous when it is convenient for them to do so.

Posted by: Scott | Mar 3, 2007 12:05:18 AM

an oath doesn't make a doctor a doctor. years of medical school and residency make a doctor a doctor. an oath is what they take becuase they have to. sure, some doctors believe in it; but others just take it because it's another required step to "becoming a doctor." it's like some religious sect repeating a creed. it doesn't mean it's true, it's just what you say.

it's ridiculous to think that the oath would bar doctors from participating in an execution, or an abortion. it's what the doctor personally believes that he or she should do. why take abortion out of any analogy? i agree with scott here, and i think i might consistently agree with scott. doctor poker? that's like saying that repeating some creed makes you a member of some religion. i repeated some silly shit to be in a sorority (which i later withdrew from, thankfully!), and i know that plenty of law students make some statements that they probably may not keep. that's not a reason to discount your education and opinions. anyway, i would love to hear more from you, brett, it's just hard for me to be convinced when the death penalty is legal in so many states. i don't think that it should be legal, i'm just speaking in terms of the current realities. thanks and i think i might go to bed now!!! so glad i was interested enough to stay up!! haha

Posted by: Stephanie F. | Mar 3, 2007 12:22:00 AM

awww, sorry scott, you made my point a lot better than me!!! i posted after you without checking what you said!!! sorry! but you are TOTALLY right in my opinion!!! ? :}

Posted by: Stephanie F. | Mar 3, 2007 12:25:20 AM

So many good points ripe for response... but for organization and personal convenience, I will only respond to a couple:

"Make" was a poor choice of word in my oath-makes-doctor statement. My point was - and remains - that a self-governing profession can set the standards by which all members must comply in order to be a part of the profession. Thus, complying with the oaths speaks to what it means to BE a doctor. Of course as a practical matter it takes more than simply taking an oath to be able to PRACTICE medicine, but that is a torturing (no pun intended given the discussion) of my point. My point is simple: be by the AMA or the local certifying board, a self-governing profession may define the standards by which a member may operate.

The abortion analogy: it is inapposite, in my opinion, as I have explained before. It is plausible in my mind for a doctor or a group of doctors or a governing body to determine that with regard to abortion procedures, the woman/mother is the patient - a patient for whom the ultimate goal of the procedure is NOT death. In the execution setting, the ultimate goal of the procedure is death. Thus, in the latter situation, it is appropriate for a governing body to believe that assisting in a procedure for which the goal is death is inconsistent with what it means to be a doctor. And again, if that body believes the woman/mother is the patient, it may reasonably believe the actions of doctors who refuse to ensure safety and little suffering in a procedure *which is not inconsistent with their belief of what it is to be a doctor* is INappropriate.

Again I'll say: if you are correct that doctors have a duty to minimize suffering on the immediate path to death where death is both certain and imminent, then doctors should have a DUTY to euthanize patients who are suffering a painful, certain, imminent death. I am not prepared to place such a duty on doctors.

Posted by: Brett T. | Mar 3, 2007 9:52:04 AM

Stepharoo! Thanks, I was getting exhausted "going it alone".

Brent - I offer a non-abortion analogy:

Probably as a result of lobbying from groups in support of organ donation (advocates for those in need of organs), for some time (decades) brain death has been legally equated with physiological death. When we determine cessation of all neurological function and document this in the chart, the patient is legally dead at the moment of charting confirmation, in spite of a heart that remains beating and will continue to do so for hours or days or perhaps weeks (with life support of course). THe heart is beating, but the patient is considered legally and medically dead.

So, if you have ever wondered where organs for transplantation come from, now you know. Surgeons take these "brain dead", legally dead, but physiologically alive patients, hearts still beating, to the operating room and remove their organs, thereby killing them physiologically, i.e., causing their hearts to stop.

So it follows that the state, through the legal system, allows doctors to pronounce you dead even though you aren't (the history of how this came to be is very interesting I bet), and then kill you physiologically (family consenting) to take your organs. I see an analogy here. Perhaps the state should allow doctors to declare the condemned dead prior to their actual execution and then we wouldn’t have a problem. The phrase “Dead Man Walking” is suddenly infused with fresh and chilling meaning…

So, I ask you: do you think this has relevance to what we're talking about? If you don't, can you explain why in a way that's consistent with the positions you've defended thus far? It seems to me that the AMA should oppose this brain dead organ procurement thing, shouldn't they???

Posted by: Scott | Mar 3, 2007 12:19:32 PM

Sorry, Scott, I don't see this one, either. Doctors aren't participating in the incident that *made* the patient brain dead. They were brain dead before the doctor ever got involved - and no, I'm not prepared to equate death-sentenced prisoner with brain-dead patient. I assume there is a good medical foundation on which to rest the opinion that a brain-dead patient is legally and medically dead. I know of no medical opinions which would find a death-sentenced prisoner legally and medically dead.

Posted by: Brett T. | Mar 3, 2007 6:32:24 PM

Dude, it's because the doctor is involved in and in fact carries out the actual action that causes the death of the brain dead patient...

We're not going to make it any further with this, I can see. I submit that I have failed.

Posted by: Scott | Mar 3, 2007 11:30:07 PM

"Failed" has such a negotive connotation - I suggest that you "respectfully dissent" as an alternative. I agree with Scott, by the way. The mere fact that there is such healthy debate on this issue intimates, in my opinion, that neither side can rightfully serve as a "moral compass." The AMA can take whatever position it wants, but to take this position and then use it as a means of decertifying doctors who do not conform is untenable. It's political strong-arming at its worst and nothing more than an attemt to make an end-run around the larger Death Penalty debate. It is on the merits of that issue that the debate should be won or lost. And if that cannot definitively be done, then that's precisely the type of issue that belongs in the hands of the voters, i.e., the individual states.

Posted by: Ben D | Mar 4, 2007 6:25:10 PM

Just read the CMA (previously I thought it was tha Canadian Medical Association) position on PAS - similar to the AMA, they do not describe the ethical principles upon which they based their determination - they merely call PAS it, "unethical", "unacceptable", and "incompatible" and then they follow with a posteriori justifications, rationalizations, and contrived, one-sided hypotheticals....

But I'm not surprised - I was disabused long ago of my naive notion that doctors, highly selected for entry into medical school, would be free-thinking, open-minded, unbiased, cogent, and rational.

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