Doctors and nurses are coming under pressure to break their ethical oath by participating in lethal injections.
At the same time, a series of botched executions have put prisoners at risk of suffering extreme pain.
A new Amnesty International report, Execution by lethal injection – a quarter century of state poisoning, reveals that governments try to hide the identities of medics involved in executions, which are considered unethical by the medical profession.
"The involvement of health professionals in carrying out an execution, particularly by a method using the technology and knowledge of medicine, is a breach of medical ethics," said Jim Welsh, Amnesty International's Health and Human Rights coordinator.
"Professional bodies have spoken strongly about this abuse of ethics, but governments want to hide the identity of participating doctors to shield them from the scrutiny of professional colleagues."
Lethal injection is the most widely-used method of execution in the USA. Along with the USA, four other countries also use doctors and nurses to kill. Since 1982, at least 1,000 people have been executed by lethal injection globally. This includes three in Guatemala, four in Thailand, seven in the Philippines, more than 900 in the USA and up to several thousand in China, where executions are a state secret.
In lethal injection executions, prisoners are commonly injected with massive doses of three chemicals: sodium thiopental to rapidly induce unconsciousness, pancuronium bromide to cause muscle paralysis and thus respiratory arrest, and potassium chloride to stop the heart.
The report cites several cases of botched lethal injection executions, such as that of Joseph Clark, who was executed in Ohio in December 2006. It took 22 minutes for the execution technicians to find a vein to insert the catheter.
Shortly after the start of the injection, the vein collapsed and Joseph's arm began to swell. He raised his head off the stretcher and said five times "it don’t work, it don't work."
The curtains surrounding the stretcher were then closed while the technicians worked for 30 minutes to find another vein.
In China, the world’s top executioner, many executions by lethal injection are carried out in mobile vans. The windowless chamber at the back of the vans contains a metal bed on which the prisoner is strapped down.
Once the needle is attached by the doctor, a police officer presses a button and an automatic syringe inserts the lethal drug into the prisoner’s vein. The execution can be watched on a video monitor next to the driver’s seat and can be videotaped if required.
Doctors have expressed concern that, if inadequate levels of sodium thiopental are administered, the anaesthetic effect can wear off before the prisoner’s heart stops. This places them at risk of excruciating pain as the chemicals enter the veins, producing cardiac arrest. Due to the paralysis induced by the pancuronium bromide, they would be unable to communicate their distress.
For these reasons, the chemicals are not used by veterinary surgeons for euthanasia on animals. In Texas, the biggest user of lethal injection in the USA, the same drugs used on humans are prohibited on cats and dogs because of the potential dangers.
"Governments are putting doctors and nurses in an impossible position by asking them to do something that goes against their ethical oath," said Jim Welsh.
"Medical professionals are trained to work for patients' well-being, not to participate in executions ordered by the state. The way of resolving the ethical dilemmas posed by involving doctors and nurses in executions is by abolishing the death penalty."
The agreement by the US Supreme Court to hear the appeal of two Kentucky death row inmates (Baze et al v. Rees et al) challenging the constitutionality of lethal injection procedures in Kentucky, is amongst several recent judicial developments in the USA –- in Alabama, California, Kentucky, North Carolina, Tennessee and Texas -- that highlight serious concerns with the use of this method of execution, and show this to be a current and critical debate.
Amnesty International calls on world leaders to abolish the death penalty and urges them to take the opportunity to begin with a vote for a moratorium at the UN General Assembly in October.
World Psychiatric Association
-- "Under no circumstances should psychiatrists participate in legally authorized executions nor participate in assessments of competency to be executed."
International Council of Nurses
-- "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."