from The Rhode Island Medical Journal, 1995


     Should a physician participate in an execution? For centuries, the executioner wore a black hood. Had his identity been known, he would have been shunned. It was a dirty job, but someone had to do it. Should we exchange our white coats for black hoods?

     To me, it seems fairly straightforward and simple: a physician who participates in an execution is doing something unethical, immoral, and wrong. A physician's task is to alleviate suffering; to bring comfort; to heal, if not to cure. Executions, if they are sanctioned by the state, are carried out by executioners, not by physicians. To say that lethal injection is a more humane way of killing a human strikes me as absurd.

     There are times when a physician acts to facilitate death. But euthanasia, as practiced with safeguards under the law in Holland or in Oregon is not the same as killing. A person has a terminal and painful disease that doctors certify will end in death. The person requests repeatedly to die a painless dignified death, with the concurrence of those who love her/him. The person is found to be competent to make the decision to die. Under such circumstances, a physician may assist a patient through medical intervention to die. I use the word patient advisedly, for a doctor-patient relationship has been established. This is not an execution. This is not killing. It is consistent with the physician's obligation to relieve suffering.

     Following an accident or a medical catastrophe, a patient may be rendered helpless and unconscious, with no hope of recovery. The person has left a living will and/or a power of attorney, with instructions that s/he does not wish to live in such a condition. A physician may, with the concurrence of those who love the patient, withhold or discontinue extraordinary life support measures, such as ventilators, intravenous fluids, antibiotics, or nasogastric feedings. This is not killing. This is the alleviation of suffering, part of a physician's role.

     Of course, a physician must treat prisoners on death row, awaiting execution. But suppose a prisoner awaiting execution goes on a hunger strike, refusing to eat. Suppose the prisoner is found competent to make such a decision--should the physician insert a feeding tube or administer intravenous fluids against the prisoner's will, so as to keep the patient alive until his execution date? What if a judge orders a feeding to be inserted, but the physician considers the prisoner competent? Do we remove from the prisoner all autonomy? Is s/he less than human?

     Things can become even more complicated for the psychiatrist who is asked to treat a prisoner on death row who has developed a psychosis, delusional and hallucinating. Under the law, a person must be competent and aware in order to be executed. Shall the psychiatrist undertake the treatment of an obviously ill person with a view towards restoring his mental health and competency so that he may be executed? No? But the man is mentally ill, not malingering. Does he not deserve treatment?

      So, things are not so simple and straightforward after all.

Should the death penalty be reestablished in Rhode Island?

      The word "sacred" intrudes on my consciousness. Life is "sacred." We physicians have a "sacred trust," a "sacred obligation." In fact, we have no monopoly on decisions about life and death. We think we are more familiar with death than most, but homicide detectives and soldiers are more familiar with death than we are. Nevertheless, we doctors are a potent political force, and we can exert moral leadership, if we choose to. And this is a moral, not a medical question.

     Capital punishment should remain abolished in Rhode Island. Not just because John Gordon may not be the only falsely accused man we execute. Not just because we kill far more minorities and poor people than their representation in the population. Not just because the legal system is not always just and fair. We should oppose executions because it is wrong to kill a human being when we
have alternatives. A dangerous person can and should be locked up for as long as s/he is dangerous. A life sentence without possibility of parole already exists in Rhode Island.

      And what of revenge? Does not the Bible offer us the lex talionis, "an eye for an eye, a tooth for a tooth?" The same Bible begins, however, with Cain slaying his brother Abel. He is cursed and punished by God, banished to wander the world, but he is not executed. Abraham is on the verge of sacrificing his beloved son, but an angel intervenes, crying out against human sacrifice. The Bible offers many remedies and institutions that are no longer acceptable today. No one today calls for the death penalty for the adulterous woman (the man's punishment was generally less severe), nor for the stoning of the rebellious son at the city gates. No one calls for the re-establishment of slavery under the laws codified in the Bible. In fact, the rabbis of the Talmud modified the dictum, "an eye for an eye," to mean "the value of an eye for an eye."

     In spite of the despair that sometimes makes us feel that a latter day Gibbon will soon document the decline and fall of our
civilization, it is important to keep in mind that we have taken some steps forward in the continuum of moral development since Biblical days. We have begun to question the wisdom of brandishing weapons of mass destruction as a means of maintaining political and economic dominance. Our treatment of children and the poor, bad as it may be, is infinitely better than it was two centuries ago. Slavery has been abolished in Rhode Island. The death penalty has been abolished in Rhode Island. Let's leave it dead and buried.

Michael A. Ingall, M.D. is a psychiatrist in private practice, and Clinical Associate Professor of Psychiatry at Brown University School of Medicine.