The Patient-Physician Relationship:

Should Physicians Participate in Lethal Injection?

The death penalty is still legal in 31 states, Arizona included. It is illegal in the remaining 19, as well as in Washington, D.C. The trajectory of capital punishment has been uncomfortable, with methods of death by firing squad, hanging, and electric chair being phased out in favor of lethal injection (gas inhalation is still a potential choice in Arizona). The rationale behind this shift generally stemmed from lethal injection being seen as more humane, although the methodology of choosing a three-drug protocol or a single-drug method is largely state-dependent.

Physician involvement in lethal injection has been a long-debated topic, and there are generally two diverging philosophies:

1. Physicians should preserve life whenever possible, and it is against this ethical principle for physicians to participate in the death of an individual. 

The American Medical Association is an especially large proponent of this doctrine, and an extensive list of actions which would violate the AMA’s Code of Medical Ethics can be found here: https://www.ama-assn.org/delivering-care/capital-punishment

A common cause for dissent involves AMA clauses such as the one below, which details that any participation in legal execution is medically unethical. This includes “relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution.”[1]

This brings us to the second school of thought:

2. Physicians should alleviate suffering, and this covers the suffering of a patient as he or she is expiring due to reasons beyond the physician’s control.

A physician did not make the decision that an individual is to undergo lethal injection, just as a physician did not make the decision that a patient would be terminally ill. Thus, the physician’s duty is to alleviate as much suffering as possible in the face of exceptional circumstances. A common argument is that if physicians do not participate in lethal injection, other individuals who may have less training would be called upon to do so, potentially resulting in more suffering of the patient.

I can see the validity in both arguments, and I am not well-versed enough in both medicine and law to meaningfully comment on their legal intersection. However, the most pressing question for me lies in not whether physicians should be ethically allowed to participate in lethal injection, but whether the patient would pursue that patient-physician relationship. In any patient who may have a potential diagnosis, he or she retains the right to refuse care, the choice of seeking medical attention, and the autonomy of personal decision-making. If the individual is declared mentally sound enough to be sentenced to lethal injection, then perhaps he or she is also mentally competent enough to make the decision of choosing a physician. If that relationship is established, the patient has the option of seeking medical attention regarding his or her symptoms. Of course, the participation of a physician in that patient-physician relationship is a personal decision as well, but I truly believe that a physician’s duty is first and foremost to the patient, not to the ethics of medicine.

Maggie Xiong

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Maggie Xiong is a medical student in The University of Arizona College of Medicine – Phoenix, Class of 2021. She graduated from the University of California, Berkeley, with a degree in Asian studies before taking a winding road to medical school. Maggie tries too many new restaurants (and subsequently Yelps about them), often cleans when she should be studying, and has a hopeless habit of opening too many tubes of mascara at once.

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