It is said that death is certain, its hour is uncertain, but when capital punishment is in place, a prisoner on death row’s hour is known. Could you knowingly assist in another human’s death? As nurses, we are trained to save lives, not take them. Currently, according to the website belonging to World Population Review, we have thirty states in America that actively use capital punishment. Of these states, lethal injection is the current method of death. Lethal injection cannot be carried out properly without the assistance of a medical professional such as a nurse, doctor or anesthesiologist. This brings about the question of where these medical professionals stand morally and ethically. (2016- http://www.deathpenaltyinfo.org/lethal-injection October 2016)
The code of ethics of the International Council of Nursing states that “nurses promote health to prevent illness, to restore health and alleviate suffering.” (International Council for Nurses, Code of Ethics for Nurses. Geneva: ICN.http: //www.icn.ch/images /stories/documents/ about/icncode_ english.pdf 2012, accessed October 2016) Since 1983, the American Nurses Association has publicly opposed nurses assisting in the death of inmates associated with the death penalty. But in February 2017, the association took their stance even further and for the first time they stated they completely oppose all aspects of capital punishment. (Press Release- “ANA Releases New Position Statement Opposing Capital Punishment” February 21, 2017, American Nurses Association)
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Other medical organizations, including the International Council of Nurses and the American Medical Association, also oppose any of their members from participating in executions, especially by lethal injection. This includes giving injections, starting intravenous medications, assessing patients or even just witnessing the act. This creates serious ethical questions for nurses and other medical professionals surrounding the death penalty. As stated in the journal article, “Nurse Participation in Legal Executions: An Ethics Round-table Discussion” (Sage Publications, Nursing Ethics Journal, Volume 25, Issue 7, November 1, 2018) the current situation is unique for nurses.
Lethal injection has been in practice only since 1982. Prior means of capital punishment such as hanging, firing squad and electrocution, didn’t require expert medical care. No nurses needed to assist and usually doctors were only there to verify the death. Despite the concerns and statements put out by the various medical organizations, there are medical experts that do participate in capital punishment. One of the arguments for participation is that if a technician performs the duties needed then the procedure could be done wrong leading to a possible detrimental scenario of suffering for the prisoner. Another argument is that lethal injection is not a medical procedure therefore; when they assist they are not committing anything ethically or morally wrong. Others disagree with both arguments and say that any means of participating is unethical.
What is ethics as related to nursing? According to Nursing Ethics by Janie B. Butts and Karen L. Rich (Nursing Ethics Fifth Edition, Across the Curriculum and Into Practice, Copyright 2020 by Jones and Bartlett Learning) ethics is a systematic approach to understanding, analyzing and distinguishing matters of right and wrong, good and bad, and admirable and dishonorable as they relate to the well-being of and the relationships among sentient beings. Today, even relationships between people and their environment have entered the realm of ethics. Ethical determinations are applied through the use of theories, approaches, and codes of conduct, such as codes for professions and religions.
There are many ethical and moral issues that nurses must consider with the topic of capital punishment. First, a nurse must consider whether they believe the death penalty is a violation of prisoners’ rights. Does it violate the constitution? If a nurse opposes it, they may find the death, often by lethal injection, inhumane. Nurses may at that point decide they do not want to assist in any way. If opposition is their standpoint, they may also look at assisting in a different, more ethical or accepting way. The nurse could feel as if they are being there for the prisoner in their darkest hour. They want to ensure he or she doesn't endure any undue pain or suffering. If they do not provide this care at the end of their life, who will? In some cases, untrained persons could be performing the procedures that are normally performed by trained medical professionals and the patient may suffer prior to dying. In the book Gruesome Spectacles: Botched Executions and America’s Death Penalty by Austin Sarat (Stanford, CA: Stanford Law Books, 2014. Pp. i, 273), it states that three percent of executions from 1890-2010 were “botched”. Botched means that the expected outcome is not achieved. In the event of a botched lethal injection, the patient does not die immediately or does not die at all. Either way, the inmate may suffer inhumane consequences. This can be attributed to different reasons, one such could be not having the right combination of medications. A nurse often provides comfort to dying patients and would have the opportunity to make sure the prisoner doesn’t die scared and alone. A nurse brings a sense of compassion to what otherwise could be a cold process.
I conducted my own interview with a former emergency room nurse that is currently employed as a nurse at a local Ohio correctional facility. He has worked in this facility for four years and wished to remain anonymous. The first question I posed was if he supported capital punishment or not to which he replied he did. I then asked if he would ever agree to be the nurse assisting at a lethal injection if called upon in his job. After a moment or two of silence he replied, “yes.” I could tell he somewhat struggled on his answer. He explained to me that even though the nursing ‘code’ says he should never willingly participate in ending a life, he would assist for a couple of reasons. He said, “First, the courts have determined the prisoner should die, not me. By assisting, I have the opportunity to make sure he dies with as much dignity as possible, someone else may not.” He also added, “I know some of the background of my patients. Some of them have committed horrendous crimes against innocent victims. I believe in the justice system that put them there, on death row. A jury found them guilty and they are there for a reason.” Finally, I asked him if he assisted would he feel he morally or ethically let anyone down. He replied, “I understand people wrestle with the moral and ethical issues of capital punishment, but I don't feel that by assisting in a lethal injection I would be giving my profession a black eye and I don’t feel I would be doing anything wrong, anything that I would need forgiven for.” (Interview with John Doe, March 17, 2020)
The dilemma of a nurse assisting in ending the life of a death row inmate will continue as long as states still mandate capital punishment, in particular, by lethal injection. A nurse’s personal beliefs versus what they have been taught will always come into play. These prisoners are going to die, it’s court ordered, it’s up to us, as nurses, as human beings, to decide if assisting in their death goes against everything we have learned or not. It has been embedded in us that we are only to save lives not end them. Some argue that if nurses and other professionals refuse to participate in capital punishment that the system will be forced to do away with it. Whether or not that is true, it still causes a huge dilemma because the practice is legal and it exists and inmates are put to death every year.
So, is it ethical or not? Should we participate or not? I personally can see the arguments on both sides. I wouldn’t want to abandon the prisoner that I have cared for when he or she is most vulnerable and needs me the most. I don’t know if I could assist or not, and I hope I am never faced with having to make that decision.
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