Participation in executions. (Guest Editorial).

Before the a vent 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.

The American Medical Association (AMA), for example, held that a physician should not be a participant in a legally authorized execution. American Medical Association (AMA), for example, held that a physician should not be a participant in a legally authorized execution. The American Psychiatric Association (APA) likewise stated that it strongly opposed any participation by psychiatrists in capital punishment.

But the ethical prohibition 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.

It soon became recognized that lethal injection, though it might seem more palatable than other methods, 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. For example, 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 (Ann. Intern. Med. 135[10]:922-24, 2001).

As more states in the 1980s adopted lethal injection as the preferred method of execution, the AMA ...