Death Row

Should doctors cooperate?

Capital punishment is most humane when carried out by 1) hanging, 2) firing squad, 3) electric chair, 4) gas chamber or 5) lethal injection

Since 1977 four states have opted for the fifth choice, and others may soon be doing the same.* The state legislators have practical as well as humanitarian motives; they believe that juries will be less reluctant to view the death penalty as "cruel and unusual punishment" if it is carried out by injection. But the lethal substance, probably a fast-acting barbiturate mixed with a paralyzing chemical agent, would have to be administered at least indirectly by a physician. And that, charge a Boston doctor and a lawyer, would constitute a cruel and unusual breach of medical ethics.

Writing in last week's New England Journal of Medicine, William J. Curran, 52, professor of legal medicine at Harvard Medical School, and Ward Casscells, 28, a resident at Boston's Beth Israel Hospital, maintain that death by injection, however carried out, violates the Hippocratic oath, by which all doctors vow never to harm their patients willfully. In fact, the oath specifically forbids using or suggesting the use of poisons. The policy adopted by Oklahoma tries to avoid any conflict with medical ethics by requiring "trained medical employees" to insert a drug-carrying catheter and inject the lethal substance. But does that relieve doctors of their responsibility? Not really, say the authors. They point out that a doctor must still prescribe the drug, supervise the lethal injection and pronounce the prisoner dead.

Advocates of lethal injections counter that doctors should offer the comfort of a merciful death to a condemned prisoner. But, argue the authors, "surely this is begging the issue, as the person soon to be killed by the state is hardly analogous to the dying patient." Curran, who with other members of a Harvard committee conceived a "brain death" ethic (which calls for the cutting off of artificial life supports after brain activity ends), brands the doctor's role in death by injection one of "active killing." Adds Casscells, perhaps as an appeal to unconvinced colleagues: "The moral issue is difficult. But the political issue is that it's bad public relations--and doctors have enough trouble with their image these days."

*The four, with their respective numbers of death row prisoners, are Texas (130), Oklahoma (25), Idaho (1) and New Mexico (0). Florida (144), the only state with a higher count than Texas, is also the likeliest addition to the group.

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