Medical professionals and the death penalty

Atul Gawande has a very thoughtful piece about the involvement of doctors and nurses in carrying out death sentences. I can't really do it justice here, but it is well written and describes pretty graphically how the process can go wrong:

Gas chambers proved no better: asphyxiation from cyanide gas,which prevents cells from using oxygen by inactivating cytochrome oxidase, took even longer than death by hanging, and the public revolted at the vision of suffocating prisoners fighting for air and then seizing as the hypoxia worsened. In Arizona, in 1992, for example, the asphyxiation of triple murderer Donald Harding took 11 minutes, and the sight was so horrifying that reporters began crying, the attorney general vomited, and the prison warden announced he would resign if forced to conduct another such execution.

And the full text is free, so read it all. Most fascinating are his interviews with 4 doctors and a nurse who have participated in executions. Most are furtive, unwilling to be identified, but the final doc is not what you'd expect:

Dr. D is a 45-year-old emergency physician. He is also a volunteer medical director for a shelter for abused children. He works to reduce homelessness. He opposes the death penalty because he regards it as inhumane, immoral, and pointless. And he has participated in six executions so far.

Dr D, who is actually Dr. Carlo Musso, argues that a death sentence is like state-imposed terminal cancer. The doctor needs to keep the patient from suffering unnecessarily, whateve the cause of death.

As Gawande notes, there are problems with this position, not least of which is that doctors involved in executions remain anonymous in a way oncologists and pain specialists don't. But Gawande's view, that execution should be legal, but medical professionals not involved, and if that makes it humane, then it should be unconstitutional and illegal is more than a little convoluted. Gawande also makes much of the American Medical Association's code of ethics which prohibits almost all participation by physicians in executions. But the AMA is, in my view, nothing more than a lobbying organization for physicians. I don't belong to it and don't feel in any way bound by it's views. For example, the AMA code of ethics contains the following pearl:

Ethical medical practice thrives best under free market conditions when prospective patients have adequate information and opportunity to choose freely between and among competing physicians and alternate systems of medical care.

which would shock many of my colleagues who advocate for a single-payer system. And while I disagree with them, I wouldn't accuse them of being "unethical" for advocating for their beliefs, whatever the AMA code of ethics say. More powerfully, of course, right and wrong are not determined by majority vote, as I've discussed before and Gawande also notes.

My own feelings are, alas, muddled. I weakly support the death penalty as the only fitting punishment for some crimes. But I also wonder if all the negative aspects of executions (and let's be honest, that is what they are; "capital punishment" is just a euphamism), are worth it. Personally, I don't have problems with medical professionals participating in executions, if society has determined that they should occur.

My first thought is that I would participate in an execution, but if I actually faced that possibility I'd have to consider the issues more deeply. It seems a bit inconsistent to be pro-execution, but not want to be involved yourself.