Participation in executions. (Guest Editorial).

Before the advent of lethal injection as a method of execution, the question of physician participation in capital punishment was not regarded by medical societies as a matter of concern since physicians did not function as hangmen, gun shooters, electric switch pullers, or releasers of poison gas.

Their role, if any, was considered necessary to relieve suffering in the event that the execution process went awry. When lethal injection was introduced as an ostensibly more humane method of execution, medical societies became alarmed at the likelihood that physicians would be directly involved and adopted policy statements opposing physician participation.

However, ethical prohibitions against physician participation continued to be ignored by physicians. Some were unaware of the prohibition. Others ignored it because they did not regard participation as the practice of medicine. Still others ignored it because they believed their involvement to be a societal duty.

Lethal injection might seem more palatable than other methods, but is not reliably humane. Lethal injection might appear peaceful because pancuronium, which paralyzes, is included. But despite the use of pancuronium, those injected still may suffer. If the sedative is ineffective, those injected may experience "the sensation of suffocation, the pain of cardiac arrest and other effects of potassium injection, and the frightening sensation of paralysis," as noted in a recent editorial. "Paralysis precludes the visions of wild death struggles, hanging bodies with protruding tongues, and steam emanating from the head of the person in the electric chair" (Ann. Intern. Med. 135[10]:922-24, 2001).

Even a slight error in dosage or administration, however, can leave a prisoner ...