This is an important issue for members of the Puerto Rico Psychiatric Society. I have discussed this social issue with Dr. Kenneth Geil who is preparing to help us present an Action Paper at the APA Assembly sometime in the future.
psych@puertoricopsychiatricsociety.org
See Dr. Halpern’s and Dr. Freedman’s and Dr. Ray's recent opinions below.
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Abraham L. Halpern, M.D.
Wednesday, February 22, 2006
Re: First Do No Harm
The neurologist's opinion comes as no surprise. The fact is that studies done a few short years ago revealed that the vast majority of physicians were unaware of the actions prohibited by the AMA Code of Medical Ethics. It is absolutely essential that CEJA continue to be directly involved whenever a death penalty jurisdiction seeks physician participation in the planned execution.
Abe Halpern
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Many thanks to Dr. Abraham Halpern for bringing to our attention the courageous and ethical stand that the two anesthesiologists took in refusing to participate in an execution. This is in contrsdt to the"widespread,but carefully kept under wraps, involvement of physicians" in executions as pointed out by Dr. H. Professor Gunn of the Institute of Psychiatry in London has predicted that if the death penalty were returned to Western European democracies all the doctors would refuse to participate and thus, the program would fail. Whether or not such a resolve would be possible it indicates the potential if all physicians refused to participate in executions.
In the Maturana case in Arizona, Claude Maturana, an inmate on death row became psychotic and was transferred to an adjacent state hospital with orders from high authorities to treat Maturana with drugs so he could be declared competent and executed. The psychiatrist in charge refused to comply on ethical grounds. Rather, he elected to treat Maturana with a minimal dose that decreased his delusions but did not render him competent and resisted pressure from above to increase the dose.
One hopes that physicians in the USA will take heart from the refusal of the two anesthesiologists and the psychiatrist to never take part in legal executions.
Alfred M. Freedman, M.D.
Chair and Professor of Psychiatry, Emeritus
New York Medical College
1148 Fifth Ave
New York, NY 10128
On Feb 21, 2006 Abraham L. Halpern, M.D. wrote:
Kudos to psychiatrist Priscilla Ray and her fellow members of the AMA Council on Ethical and Judicial Affairs for issuing the statement that resulted in the refusal of two anesthesiologists to participate in the execution of Michael Morales in California. Given the publicity in this case, the statement, not heretofore issued prior to other executions in death-penalty jurisdictions (including federal) will surely alert physicians (and nurses, who have a similar ethics code relating to participation in executions) of their ethical obligations. Up to now the AMA has remained strangely silent in the widespread, but carefully kept under wraps, involvement of physicians.
With the reiteration of Opinion 2.06, CEJA should withdraw its support of the APA Council on Psychiatry and Law position that it is ethical to treat an incompetent death row inmate to render him competent to be executed when that inmate, at a time when he was competent, had made out an advance directive that he be treated should he become incompetent, so that his wish to be executed can be honored. It is the opinion of CEJA that "adhering to a prisoner's wishes and restoring competency may be consistent with the principle of respect for a patient's autonomy." As medical ethicist Edmund Pellegrino points out, not only does this carry autonomy beyond its legitimate interests, but to comply in such a request the physician is cooperating formally with an act that is intrinsically wrong. It constitutes an active, direct cooperation by a physician in the act of execution and clearly violates the code of medical ethics.
Abraham Halpern
On Feb 21, 2006
AMA opposes physician involvement in executions
For immediate releaseFebruary 17, 2006
Statement attributable to:Priscilla Ray, Chair, AMA Council on Ethical and Judicial Affairs
"The American Medical Association (AMA) is alarmed that Judge Jeremy Fogel has disregarded physicians' ethical obligations when he ordered procedures for physician participation in executions of California inmates by lethal injection.
"The AMA Code of Medical Ethics addresses physician participation in executions involving lethal injection. These ethical obligations are set out in detail in ethical opinion 2.06 authored by the AMA Council on Ethical and Judicial Affairs. In part, it states:
An individual's opinion on capital punishment is the personal moral decision of the individual. A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. Physician participation in execution is defined generally as actions which would fall into one or more of the following categories:
(1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner.
Physician participation in an execution includes, but is not limited to, the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution.
In the case where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.
"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.
"As the voice of American medicine, the AMA urges all physicians to remain dedicated to our ethical obligations which prohibit involvement in capital punishment."
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Editor's Note: For a full text of the AMA ethical opinion, E-2.06, Capital Punishment, please visit the Web site.
For more information, please contact:
Robert J. MillsAMA Media Relations(312) 464-5970
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