Do No Harm? The issue of capital punishment has long been controversial. It is especially thorny for physicians who wrestle with the question of whether to support the practice and the ethical questions raised by a physician's participation. A recent article and reader poll examined this issue. Medical professionals responded with a range of lively opinions and experiences. Some took the opportunity to condemn the institution itself. One healthcare professional wrote: Maybe if more was invested in children and creating supportive environments for the poor, there would be fewer people executed. This is a moral issue where society has created the problem. In regards to execution, no health professional ought to be involved as it is death sanctioned by society. Many respondents cited the Hippocratic Oath as the simplest reason why physicians should refuse to be involved in carrying out the death penalty. An internist wrote, "'Do no harm' is an oath we take. No doctor should be assisting in the killing of a healthy individual." A nephrologist agreed and added, "[The state] must employ trained technicians to carry out the act of killing. Physicians who allow themselves to be caught up in this are in violation of our professional code of ethics." But some saw this attitude of "let someone else do it" as little more than passing the buck. A healthcare professional asked, "[How is it] different from nurses, PAs, APRNs, or medics setting aside their ethical and professional responsibilities to assist in prisoner executions?" A nurse practitioner was adamant: There is no place for a physician (or nurse, NP, PA, or other health professionals) in a procedure designed to kill a human being. If the state insists on continuing the barbaric practice of executions despite the myriad of ethical and practical problems associated with capital punishment, they must do so without the healthcare community's consent or involvement. A primary care physician drew some nuanced distinctions: Physicians definitely should not be involved in the administration of lethal drugs or other means of terminating one's life. However, in places where executions are practiced, physicians may have a role monitoring the process to minimize unnecessary suffering. A colleague, however, thought that keeping all medical personnel out of the process would help focus society's perception of capital punishment: Many countries practice execution of its citizens but do not pretend that the practice is humane. So rather than damage a physician, make it a military killing by using one trained to take human life. At least there is no hypocrisy in a firing squad, a noose, or an ax. Let the observers wince in pain and feel the insomnia of troubled sleep. The Other Side of the Argument But there were some who disagreed and saw room for physicians in putting people to death. A primary care physician wrote: Capital punishment is a societally determined deterrent for the killers and a balm for the victims and their families and loved ones. The physician's role in this is to alleviate suffering. It is palliative and we should play a big role in assuring that is so. A psychiatrist also saw a role for the physician in the death chamber and even felt that the moral squeamishness some others felt was misplaced: It is the state which makes the decisions around capital punishment. At most a physician's role should be palliative, assisting death with a minimum of pain and distress. We are not philosophers or law-makers and should accept that we are not experts on crime and punishment. And a nurse practitioner even saw a way around the Hippocratic Oath, writing, "It could be argued that they [physicians participating in executions] are practicing public health." Some medical professionals raised the issue of procedural errors, which in some cases resulted in lengthy or painful executions. In particular, a number of anesthesiologists were disgusted with the relatively high frequency of botched executions. One wrote: Those of us that practice anesthesia know that executions can be carried out without pain and suffering when done by someone having the knowledge and skill. Several other physicians cited veterinary practices as an example: Both veterinarians and trained technicians successfully and humanely euthanize hundreds to thousands of animals of all species daily without pain. I can't understand why the Supreme Court and prison systems don't consult them for advice and protocols. Another anesthesiologist had a different solution: "A large-caliber bullet to the base of the skull is as painless and instant as you can get. It's just messy." Some respondents, however, had little interest in the well-being of the inmate on death row. One registered nurse reasoned: The executed person did not use medical knowledge to commit their crimes, so execution should be done by a lay-person. It does not take any special training to execute people who have committed the most heinous crime. An internist agreed and added: I am particularly unsympathetic to the descriptions of botched executions. The condemned didn't get there by accident and their demise is much easier than that of their victims. A pharmacist went even further: "First off, I would be fine pushing the plunger. Second, why not harvest organs for people in need?" The last word goes to a primary care physician who spoke up for humane executions and cited an often overlooked factor: The humane treatment surrounding executions is partially to minimize trauma on those carrying it out. I'm sure it's very traumatic to see a botched execution, seeing the terror in an inmate's eyes as s/he silently suffocates because s/he's paralyzed, and unable to breathe but very lucid. 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