Doctor, Reread Your Oath

A physician is a member of a profession “dedicated to preserving life when there is hope of doing so.” That’s from the American Medical Assn.’s Code of Medical Ethics. The recent reports of physician participation in prisoner torture in Abu Ghraib and Guantanamo are shockingly reminiscent of Nazi doctors’ flagrant violations of the codes of their profession.

But there is another case worth examining, closer to home. On Nov. 8, Kentucky Gov. Ernest S. Fletcher signed a death warrant for convicted murderer Thomas Clyde Bowling, an order later temporarily stayed until the Kentucky courts had more time to consider the issues presented to them. Evidence had been offered that Bowling, who killed two people in 1990, was mentally retarded.

A pending execution always prompts expressions of dismay and calls by anti-death penalty groups for commutation of the sentence, as well as approval by death penalty supporters.

In this instance, however, Fletcher’s action elicited more than the usual reactions from death penalty opponents because the governor is a licensed physician.

Objections flooded his office, and complaints were filed with the Kentucky Board of Medical Licensure, charging him with violating the AMA’s ethics code and Kentucky law. The licensure board is expected to consider the matter in January.

The code of the AMA, and of almost every national and international health-related organization, states that physician participation in executions is prohibited. Originally formulated in 1980 and updated in 2000, the AMA principle is clear: A physician should not be a participant in a legally authorized execution, and it defines participation to include an action that could automatically cause an execution to be carried out on a condemned prisoner.

In a case in which the method of execution is lethal injection -- the method now used in all 38 states with the death penalty -- the code proscribes any involvement with the procedure, including consulting with or supervising lethal-injection personnel.

Fletcher, by signing the death warrant, violated not only the AMA code but Kentucky law as well (KRS 431.220), which echoes the code: No physician shall be involved in the conduct of an execution except to certify cause of death provided that the condemned is declared dead by another person.

In March 1994, the American College of Physicians, the AMA, the American Nursing Assn. and the American Public Health Assn. issued a joint statement calling for state licensure and discipline boards to treat participation in executions as grounds for disciplinary proceedings. The organizations wrote that participation in state executions contradicted the fundamental role of the healthcare professional as a healer and comforter.

Fletcher’s legal advisor says the governor did not violate AMA guidelines or other ethical standards in signing the death warrant. Fletcher’s role under the law is consistent with the roles of judges fulfilling their legal duty and jurors fulfilling their legal obligations regardless of their professions, he said.

But I believe that a physician is not freed of his obligation to comply with his profession’s ethical mandates. If Fletcher wanted to forgo that obligation, he should have surrendered his license when he was elected.

Fletcher will remember, I’m sure, the day he graduated from the University of Kentucky College of Medicine and, like generations of medical students before him and since, took the sacred Hippocratic Oath. And he will recall in that oath the statement, “I will not give a fatal draught (drug) to anyone if I am asked, nor will I suggest any such thing.” And, finally, he will of course recall the famous Hippocratic injunction: “Above all, do no harm.”