False ‘Beneficence’: Physician Involvement in Executions and Torture

Abstract

Medical ethics prohibit physicians from using their special skills to serve in nonhealth related, state‐sponsored activities such as capital punishment and torture, yet physician participation has historically always occurred and continues to occur. Common arguments for physician participation in judicial execution by lethal injection include assertions that ‘killing’ is already part of the practice of medicine (e.g. abortion, physician‐assisted suicide and euthanasia), and therefore historical prohibitions no longer apply; that physician participation in executions respects ‘autonomy’; and that participation in executions and torture promote beneficence – in the former by providing a ‘humane’ execution, and in the later by promoting social safety and security. Strong evidence shows that neither beneficence argument is true, and that physicians both promote harm to others, and sustain severe harm to themselves and the profession as a whole when they become complicit. Key Concepts Despite universal condemnation, many physicians remain willing to participate in capital punishment and torture on behalf of governments. Medical professionalism encompasses the conduct, qualities and aims that characterise a person engaged in the practice of medicine and includes the competent completion of tasks as well as the context in which they occur. The practice of medicine is not defined by the use of specific technical skills but must meet requirements of serving some medically beneficial purpose and based on treatments that are backed by theoretical, clinical and experimental evidence. Physician participation in executions is not limited to performing technical tasks in the execution but includes any and all activities that might facilitate judicial executions. Arguments that physician participation in executions mirrors activities such as abortion, physician‐assisted suicide and euthanasia, that are acceptable activities within the practice of medicine should be rejected, since such activities are neither morally nor medically analogous. Current evidence supports that lethal injection executions are not more humane for prisoners: they are fraught with complications, take much longer than other forms of execution and may subject the prisoner to extreme suffering while being unable to signal awareness to the executioners. Torture itself is universally condemned by international organisations, as is physician participation, yet torture continues globally and is facilitated by physicians all over the world. There is no credible evidence that torture is effective in providing meaningful information for safety and security, while there is significant evidence that it is ineffective, and furthermore reduces safety and security. The ‘ticking timebomb terrorist’ scenario, used by many to argue for torture in certain situations, contains unrealistic propositions and assumptions and is therefore not a valid instrument for judging the moral acceptability of torture. Physician participation in torture includes activities that prepare the prisoner for torture, activities that design methods of torture, activities that treat the prisoner to enable him or her to be returned to torturers for further torture, and falsification of death certificates and medical records to cover up torture.