Oklahoma case reveals the medical profession’s complicity in American executions

Aiding death states in the execution business is a little noticed but lucrative sideline for doctors and other medical professionals. This fact was made clear last Friday when news reports surfaced that the state of Oklahoma has been paying an unnamed doctor $15,000 for every execution in which they participate, plus $1,000 for each day of training that they provide to other members of the state’s execution team.

That doctor was recruited last year by Justin Farris, chief of operations for the Department of Corrections as Oklahoma geared up to resume executions after a 6 year pause.

According to the Death Penalty Information Center, “Under the agreement, the doctor stood to receive an estimated $130,000 over the course of the 19-week-period between October 28, 2021, and March 10, 2022, in which the state had scheduled the executions of seven prisoners.”

One bad apple? Hardly.

The common belief that doctors “cannot” participate in executions is false. What is happening in Oklahoma shows that they can — and they do.

Enlisting the help of doctors is one way to give modern forms of capital punishment — specifically lethal injection — the trappings of a medical procedure. Others include the use of IVs, injectable drugs, and EKGs. All create the illusion that the execution chamber is like an ordinary surgical suite.

The truth is that no execution method, including lethal injection, can ever live up to medical standards. Doctors are guided by an oath to “do no harm,” but the sole goal of the executioners whom these doctors help is to kill. 

Doctors and medical personnel should not lend themselves to such cruel deception by participating when the state kills. It does incalculable damage to the medical profession, and it does not prevent horrible execution mishaps. But the involvement of doctors, nurses and Emergency Medical Technicians lends an aura of legitimacy to the troubling practices surrounding lethal injection.

As shocking as the news from Oklahoma is, it reveals a familiar, though often neglected, part of the story of execution in the United States. Oklahoma is not alone in its reliance on medical personnel to help in the execution business. Today the laws or execution protocols in 17 death penalty states provide for some physician involvement in one or another part of the process.

But no doctor is, of course, required to help.

Right from the start, their willingness to participate in the execution process has been essential to the practice of lethal injection. And professional associations have been powerless to stop medical personnel from assisting in that process.

In 1977, when Oklahoma became the first state in the country to adopt lethal injection as its method of execution, a doctor played a key role. Dr. A. Jay Chapman, who is frequently called “the father of lethal injection,” was at the time the state’s chief medical examiner. He devised the drug protocol which quickly became the standard both in Oklahoma and across the country.  

Chapman proposed that massive doses of two drugs should be used. One, sodium thiopental, is an anesthetic, the other, pancuronium bromide, is a muscle relaxant which would paralyze the condemned inmate. Four years later before the first lethal injection was carried out he recommended the addition of a third drug, potassium chloride.

Chapman got involved in the lethal injection business despite the fact that the Oklahoma Medical Association (OMA) said at the time that doing so would violate medical ethics.

Since then, other professional associations have followed the OMA in prohibiting their members from participating in executions with the same limited success.

Several of those associations, including The American Medical Association (AMA), the American Association of Anesthesiologists (ASA), and the National Association of Emergency Medical Technicians (NAEMT), have issued public statements reminding members of their ethical obligation not to participate in executions.

The AMA explicitly prohibits doctors from “selecting injection sites for executions by lethal injection, starting intravenous lines, prescribing, administering, or supervising the use of lethal drugs, monitoring vital signs, on site or remotely, and declaring death.”

The ASA similarly prohibits anesthesiologists from helping in executions. It notes that “Although lethal injection mimics certain technical aspects of the practice of anesthesia, capital punishment in any form is not the practice of medicine.”

NAEMT says flatly that “Participation in capital punishment is inconsistent with the ethical precepts and goals of the EMT profession … EMTs and paramedics should refrain from participation in capital punishment and not take part in assessment, supervision or monitoring of the procedure or the prisoner; procuring, prescribing or preparing medications or solutions; inserting the intravenous catheter; injecting the lethal solution; and/or attending or witnessing the execution as an EMT or paramedic.”

Doctors and paramedics regularly ignore those admonitions even though they risk punishment, up to and including revocation of their licenses. They have helped in hundreds of executions since the advent of lethal injection, but no one has ever been disciplined for doing so. Until there is effective professional discipline for the practice of medicine in the execution chamber, the charade will continue.

Some of those who defy the ethical strictures of their profession claim not only that medical personnel should be free to participate in the execution process, but that doing so is necessary to make sure that inmates do not suffer unnecessarily.

Dr. Carlo Musso, dubbed a “death row doctor” by The New York Times, said that “instead of a carcinoma that individual is dying of a court order.” He contends that “the involvement of doctors and their ability to ensure what he calls ‘end of life comfort measures’ helps keep our capital punishment system as humane as possible.”

Another doctor, Sandeep Jauhar, while acknowledging his  opposition to capital punishment, wrote in a 2017 New York Times op-ed that, “Barring doctors from executions will only increase the risk that prisoners will unduly suffer. Participating in executions,” he continued, “does not make the doctor the executioner, just as providing comfort care to a terminally ill patient does not make the doctor the bearer of the disease.”

Dr. Jauhar may be right that doctors do not become executioners when they are involved in capital punishment. But as Musso notes, the medicalization of execution “probably … makes us more comfortable with capital punishment.”

That is why death penalty states like Oklahoma are willing to pay a premium to get doctors involved in their executions. But their involvement doesn’t just violate the standards of the medical profession — these doctors are doing something even worse: They are profiting when someone dies. It is hard to imagine a more egregious violation of ethical norms, for doctors or for anyone else.

Austin Sarat is the William Nelson Cromwell Professor of Jurisprudence and Political Science at Amherst College. He is author of numerous books on America’s death penalty, including “Gruesome Spectacles: Botched Executions and America’s Death Penalty.” Follow him on Twitter @ljstprof.