Professional association policies

March 2015: “APC discourages its members from participating in the preparation, dispensing, or distribution of compounded medications for use in legally authorized executions.

“The issue of compounded preparations being used in the execution of prisoners sentenced to capital punishment continues to be a topic of significant interest. It is important to first understand the origin of this issue: states are turning to compounded preparations for this purpose because the companies that manufacture the products traditionally used have unilaterally decided to stop selling them for use in executions…

“Pharmacy, and compounding in particular, is a profession of healing and care that is focused on individual patients and providing the best and most appropriate medications at all times.”

March 2015: “The American Pharmacists Association discourages pharmacist participation in executions on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of healthcare.”

“Pharmacists are health care providers and pharmacist participation in executions conflicts with the profession’s role on the patient health care team. This new policy aligns APhA with the execution policies of other major health care associations including the American Medical Association, the American Nurses Association and the American Board of Anesthesiology.”

The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry (2013; Section 1(4)): “A psychiatrist should not be a participant in a legally authorized execution.”

APA Commentary on Ethics in Practice (December 2015, copyedited 2017; Topic 3.4.9: Execution): “Psychiatrists should not participate in a legally authorized execution and may not assume roles that lead them to facilitate, implement, develop or monitor any techniques involved in execution.”

Code of Medical Ethics Opinion 9.7.3: “Debate over capital punishment has occurred for centuries and remains a volatile social, political, and legal issue. An individual’s opinion on capital punishment is the personal moral decision of the individual. However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.”

Position Statement – Capital Punishment and Nurses’ Participation in Capital Punishment (2016): “The American Nurses Association (ANA) opposes both capital punishment and nurse participation in capital punishment. Participation in executions, either directly or indirectly, is viewed as contrary to the fundamental goals and ethical traditions of the nursing profession. This position is in alignment with the International Council of Nurses’ (ICN, 2012) position that “considers the death penalty to be cruel, inhuman and unacceptable. . .” (p. 2).

The Code of Ethics for Nurses with Interpretive Statements (Code) (ANA, 2015) brings to the forefront the importance of the nursing profession’s taking a stance against any action that is contrary to the respect for human dignity of all individuals. Since ANA represents individual nurses, the professional organization must communicate to the public the values nurses consider central to the nursing profession (Code, Interpretive Statement 9.1). Within the Code provisions 8 and 9 (ANA, 2015), the principles of social justice speak to the importance of the nursing profession’s taking a stance against the death penalty, due to the preponderance of evidence against the fairness and effectiveness of capital punishment as a deterrent.”

Statement – Non-Participation in Executions (8 July 2014): “The American College of Correctional Physicians has reaffirmed the inclusion of the following [in] its 1998 Code of Ethics statement—(members shall) “not be involved in any aspect of execution of the death penalty.” Several national medical organizations have adopted statements regarding physician non-participation in executions. We reiterate those strongest positions, particularly supporting the American Medical Association’s Opinion 2.06 <1> regarding capital punishment. The AMA’s opinion emphasizes the inherent conflict between a physician’s duty to heal and participation in a person’s death, even while that participation may not be active. The AMA definition of participation, which we affirm, states, in part:

“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.” <1>

Physicians who work with incarcerated people are likely to be called upon to participate in executions in some fashion. The incarcerated are clearly and directly our patients and our work is to care for their medical needs. ACCP members and all correctional medical providers have the strongest ethical imperative not to participate in executions in any way, including the direct or indirect supervision of other members of the health care team.”

Statement on Physician Nonparticipation in Legally Authorized Executions (18 October 2006, and reaffirmed on 26 October 2016):

“1) Execution by lethal injection has resulted in the incorrect association of capital punishment with the practice of medicine, particularly anesthesiology.

2) Although lethal injection mimics certain technical aspects of the practice of anesthesia, capital punishment in any form is not the practice of medicine.

3) Because of ancient and modern principles of medical ethics, legal execution should not necessitate participation by an anesthesiologist or any other physician.

4) ASA continues to agree with the position of the American Medical Association on physician involvement in capital punishment. ASA strongly discourages participation by anesthesiologists in executions.”

Commentary: Anesthesiologists and Capital Punishment (May 2014): “The majority of states in the United States authorize capital punishment, and nearly all states utilize lethal injection as the means of execution. However, this method of execution is not always straightforward (1), and, therefore, some states have sought the assistance of anesthesiologists (2).

For decades the American Medical Association (AMA) has been opposed to physician involvement in capital punishment on the grounds that physicians are members of a profession dedicated to preserving life when there is hope of doing so (3). Effective February 15, 2010, the American Board of Anesthesiology (ABA) has incorporated the AMA Code of Medical Ethics, Opinion E-2.06 (June 2000), regarding physician participation in capital punishment into its own professional standing policy. Specifically, it is the ABA’s position that an anesthesiologist should not participate in an execution by lethal injection and that violation of this policy is inconsistent with the Professional Standing criteria required for ABA Certification and Maintenance of Certification in Anesthesiology or any of its subspecialties. As a consequence, ABA certificates may be revoked if the ABA determines that a diplomate participates in an execution by lethal injection (4). What constitutes participation is clearly defined by the AMA’s policy.

The ABA has not taken this action because of any position regarding the appropriateness of the death penalty. Anesthesiologists, like all physicians and all citizens, have different personal opinions about capital punishment. Nonetheless, the ABA, like the AMA, believes strongly that physicians should not be involved in capital punishment. The American Society of Anesthesiologists has also supported the AMA’s position in this regard (5), as have others including the American Nurses Association (ANA) and National Association of Emergency Medical Technicians (NAEMT). (6,7,8).

Patients should never confuse the death chamber with the operating room, lethal doses of execution drugs with anesthetic drugs, or the executioner with the anesthesiologist. Physicians should not be expected to act in ways that violate the ethics of medical practice, even if these acts are legal. Anesthesiologists are healers, not executioners.

In conclusion, the ABA’s policy on capital punishment is intended to uphold the highest standards of medical practice and encourage anesthesiologists and other physicians to honor their professional obligations to patients and society.”

Participation of Health Professionals in Capital Punishment (1 January 2001): “Resolves, that the APHA publicly reaffirm its March 1994 collaborative statement to all health professional societies and state licensing and discipline boards that health professional participation in executions or pre-execution procedures is a serious violation of ethical codes and should be grounds for active disciplinary proceedings including expulsion from society membership and license revocation.”

ACP Ethics Manual Sixth Edition – The Physician and Society: Relation of the Physician to Government (January 2012): “Physicians must not be a party to and must speak out against torture or other abuses of human rights. Participation by physicians in the execution of prisoners except to certify death is unethical.”

Statement of Ethics – Principles: “The correctional health professional should … Not be involved in any aspect of execution of the death penalty.”

Position Statement: EMT or Paramedic Participation in Capital Punishment (26 January 2010): “NAEMT is strongly opposed to participation in capital punishment by an EMT, paramedic or other emergency medical practitioners. Participation in executions is viewed as contrary to the fundamental goals and ethical obligations of emergency medical services.”

2017-2018 Policy Manual (adopted 1984, amended 2000, reaffirmed 1990, 1995, 2005, 2010, 2015; External Policy, Human Rights, General – HX-4100.1.9): “A PA, as a member of a health care profession, should not participate in an execution.”

July 2018: “The Association for Accessible Medicines (“AAM”) is a nonprofit, voluntary association representing manufacturers and distributors of generic and biosimilar medicines, active pharmaceutical ingredients, as well as suppliers of other goods and services to the generic and biosimilar pharmaceutical industry. AAM’s members provide patients with access to generic and biosimilar medicines that are as safe and effective as their brand-name counterparts at a substantially more affordable price . . . AAM takes no position on the propriety of capital punishment. But AAM and its members strongly oppose the use of their medicines—which are researched and developed to enhance patient health—to carry out executions. Indeed, many pharmaceutical companies, including numerous AAM members, prohibit the sale of their products for the purpose of lethal injection, either directly or indirectly through distributors. These AAM members recognize that the diversion of their medicines for use in execution protocols is contrary to their business interests as well as their ethical duties. Using drug products for lethal injection is inconsistent with the rigorous process for studying and approving prescription drugs in this country, as administered by the U.S. Food and Drug Administration (“FDA”). The drugs that are used for lethal injection— such as sedatives, anticonvulsants, barbiturates, muscle relaxants, and potassium supplements—are approved to treat or aid in the treatment of particular health conditions. The off-label use of those drugs to kill rather than to heal is a perversion of their therapeutic purpose, which AAM firmly opposes.”

2019 Policy Compendium: H640-A/15 Executions in Capital Crimes Criminal Cases: “The American Osteopathic Association deems it an unethical act for any osteopathic physician to deliver or be required to deliver a lethal injection for the purpose of execution in capital crimes. 1995; revised 2000, reaffirmed 2005; 2010”

“17.100 – Physician Participation in Legal Executions: ArMA support the AMA’s position by opposing any and all attempts by state law, rules or regulations which would enable or require physician participation in executions, except for the legal determination and certification of death. (Resolution 04-92; Readopted 26-96, 16-00, 19-04; Amended 34-08; Readopted 43-12; Amended 50-16)”

‘CMA objects to proposed regulations requiring physician participation in lethal injections’ (27 June 2010): “CMA believes that a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not participate in executions. Regardless of its method of delivery, capital punishment is not a medical task, it does not require medical skills, and the use of a physician’s medical skills for this nonmedical task is inappropriate and a breach of one of the medical profession’s most important ethical boundaries. CMA believes that physician participation in capital punishment threatens the public’s trust in physicians. This trust is central to the physician-patient relationship.”

“315.998 Executions: 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…”

“Capital Punishment: Committee on Ethics recommended that the Society’s opinion on physician participation in capital punishment be consistent with the current AMA opinion, opposing physician participation in executions (H-140.898) because it is a clear violation of medical ethics codes. (12/10/2009 Board of Trustees approved recommendation made by Committee on Ethics at its September 2009 meeting.)”

“P 175.002 Capital Punishment: The Florida Medical Association supports the position of the American Medical Association’s Council on Ethical and Judicial Affairs regarding capital punishment as follows: 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. A physician may make a determination or certification of death as currently provided by law in any situation. (BOG October 1991) (Reaffirmed HOD 2002) (Reaffirmed HOD 2011)”

“140.984 Capital Punishment (Death Penalty) HD 4/1/1983: The participation of physicians in the implementation of the death penalty, particularly by the method of lethal injection, should not be required by the State of Georgia, inasmuch as a physician’s primary responsibility is to sustain and prolong life. (Reaffirmed 05/2000, 10/2009; 10/2014)”

“Physician Participation in Capital Punishment: In accordance with the AMA current ethical opinions, which have been adopted by the Kentucky Board of Medical Licensure as conditions of Licensure, physician participation in executions, except to certify cause of death, provided that the condemned has been declared dead by another person, is a serious violation of medical ethics. (Res 97-131, 1997 HOD, p 564; Reaffirmed 2007, 2017)”

“Capital Punishment: The Massachusetts Medical Society adopts the American Medical Association Council on Ethical and Judicial Affairs Opinion E-9.7.3 Capital Punishment, adopted in 2016, with the exclusion of the provision of the opinion regarding organ donation by prisoners, to read as follows: Debate over capital punishment has occurred for centuries and remains a volatile social, political, and legal issue. An individual’s opinion on capital punishment is the personal moral decision of the individual. However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution…”

Policy Compendium (2015-2016; 1996-07(a) – Physician Participation in Executions): “That the NSMA reaffirm its policy stating physicians should not actively participate in executing prisoners. (Reaffirmed 2001, 2009, and 2015)”

Death Penalty / Capital Punishment: “RESOLVED, that the New Hampshire Medical Society join with the American Medical Association in strong opposition to physician assisted executions.”

“95.985 Physician Participation in Capital Punishment: MSSNY has adopted the following policy statement relative to Physician Participation in Capital Punishment: (1) 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 state execution. “Physician participation in execution” is defined generally as actions which would fall into one or more of the following categories: (a) An action which could automatically cause an execution to be carried out on a condemned prisoner; (b) An action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (c) An action which could automatically cause an execution to be carried out on a condemned prisoner…”

Position Statements (adopted January 2007, amended June 2009): “…the Board will not take any disciplinary action against a physician for participation in an execution. The North Carolina Medical Board does, however, continue to take the position that physician participation in capital punishment is a departure from the ethics of the medical profession. The North Carolina Medical Board cites the provisions of AMA Code of Medical Ethics Opinion 2.06 … as an accurate statement of the professional ethics of physician participation in executions.”

“Capital Punishment: 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. A physician may make a determination or certification of death as currently provided by law in any situation. (I-84, Reaffirmed A-11)”

“105.004 Execution by Chemical Injection: No physician employed by the Department of Corrections or providing professional services to the department under contract shall be required, as a condition of that employment or contractual obligation, to be in attendance at or to participate in executions. “Participation in executions” shall include not only personal preparation of convicts and the mechanism for their execution, but also supervision of the activities of nonphysician personnel. Certification of the death of a convict shall not constitute participation in an execution (BOC, p 43, A-93; reaffirmed BOC Rep. 3-A-03; reaffirmed BOC Rep. 6-A-13).”

“Participation in Authorized Executions: The WSMA supports the physician as a member of a profession dedicated to the preservation of life when there is a hope of doing so. Therefore, participation in a legally authorized execution is discouraged by the WSMA. (JC 2.06-87) (Reaffirmed A-17)”

“ETH-014 Death Penalty: An individual’s opinion on capital punishment is the personal, moral decision of that individual. The Wisconsin Medical Society opposes any legislation or policy that requires a physician to assist in, witness or attend an execution. (HOD, 0418)”

October 2018: There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine. The WMA Declaration of Geneva states: “I will maintain the utmost respect for human life”, and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat”.

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

Therefore, the World Medical Association

AFFIRMS that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.

REQUESTS firmly its constituent members to advise all physicians that any participation in capital punishment as stated above is unethical.

URGES its constituent members to lobby actively national governments and legislators against any participation of physicians in capital punishment.

Statement on World Day Against the Death Penalty (10 October 2014): “Today on World Day Against the Death Penalty, the International Council of Nurses (ICN) strongly affirms its position that nurses should play no voluntary role in any deliberate infliction of physical or mental suffering and should not participate, either directly or indirectly, in the preparation for and the implementation of executions. To do otherwise is a clear violation of nursing’s ethical code of practice.”

Prison Public Health Position Statement (11 February 2017; Punishment and solitary confinement): “Health care workers are prohibited from involvement in torture or other cruel, inhuman or degrading treatment or punishment. This is includes the administration of lethal injections as part of a death sentence.”