Nurses and Capital Punishment-essay

In the United States 37 states utilize lethal injection as the primary or secondary means of capital punishment. Over 85% of executions in the world occurred in the United States, China and Saudi Arabia. Of the juvenile offenders, the United States executed half of them (Amnesty International, 2003). California reinstated the death penalty in 1978 after a moratorium. Since 1992, 11 prisoners have been executed in California with the first lethal injection taking place in 1996 (California Department of Corrections, 2006). Michael Morales was the last scheduled to be executed. His execution is temporarily delayed over claims that the state's system of administering lethal injections amounts to cruel and unusual punishment. The only way that it can be assured that lethal injection is not painful is by injections being administered by healthcare personnel including physicians and nurses.

At the same time the Morales case was in court, the California Medical Association created assembly bill 1954 banning physician participation in executions. “Existing law provides certain procedures for carrying out the death penalty. This bill would prohibit the state or any local governmental entity from using a licensed physician and surgeon to participate in an execution” (AB 1954 (Lieu),2006). These events allow healthcare professionals and myself to examine the role of nurses in capital punishment.

Historically executions were performed by a hooded executioner. To neutralize public opposition on modes of execution like the electric chair, lethal injection was introduced. Thus the hooded executioner has been replaced by respected, caring medical personnel (physicians and nurses). “By replacing the electric chair with a gurney and a hooded executioner with a nurse or physician, lethal injection offers the spectacle of the calm” (Federman & Holmes, 2000). “Healthcare personnel help make lethal executions humane, faster, and perhaps constitutional” (Federman & Holmes, 2003).

The state enlists healthcare professionals, mainly nurses and physicians, to select lethal injection sites, start intravenous lines to serve as ports for lethal injections, inspect, test, or maintain lethal injection devices, consult with or supervise lethal injection personnel and participate directly in the administration of the lethal solution. Healthcare knowledge is crucial for the performance of the new killing technique of lethal injection (Federman & Holmes, 2003).

According to the American Nurse Association, 2001 the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. To uphold this, nurses must engage in promotion, preservation and protection of human life. However, this is clearly incongruent with the nurse participating in capital punishment.

One could argue in support of nurse’s participation in the death penalty form the principle of beneficence and nonmaleficence. Nurse can comfort in times of high anxiety and provide quality care by proper placement of the IV decreasing inhumane suffering for the inmate (Puglisi, 2004). However, inserting the IV which will directly deliver lethal drugs violates beneficence and nonmaleficence. In this situation, the nurse’s fidelity is in question. S/he is being employed by the State which means s/he is ultimately serving the interests of the state and not the inmate. If s/he were independent of the state and supporting the inmate then this argument would be appropriate.

There is no benefit to a human dying against his or her choice. According to the American Nurses Association, the nurse does not deliberately terminate the life of anyone. One could also argue in support of nurse participation in executions from a utilitarian perspective in that the nurse is protecting the community, however, again this is against medical and nursing ethics. The code of ethics guide us to practice humanely.

The position statement of the American Nurses Association (1994) states, “The American Nurses Association (ANA) is strongly opposed to nurse participation in capital punishment. Participation in executions is viewed as contrary to the fundamental goals and ethical traditions of the profession.” The position statement continues to discuss the background of the position including the role of the nurse. It presents the history and the details of what the nurse can and cannot do while acknowledging that a nurse can hold a different personal view of the death penalty. However participation is against nursing.

The position of the International Council of Nurses (1989) states: ”ICN considers the death penalty to be the ultimate form of inhumanity. Participation by nurses, either directly or indirectly, in the preparation for and the implementation of executions is a violation of nursing ethical code.” This position statement discusses the nurse’s responsibility along with advocating that national nurses associations lobby to abolish the death penalty. They support a mechanism in which nurses can support death row inmates and victims of torture.

In a larger social context an acceptable practice by the state and society may not be acceptable within nursing. As “health care professionals, including nurses, continue to be called upon to participate in capital punishment, particularly lethal injection executions” (American Nurses Association, 1994) we are faced with a situation of potential moral distress. Directly involved or not, the moral distress affects the individual and the profession of nursing. “Efforts to regulate and ‘humanise’ the death penalty or even to ‘medicalise’ it have led to contradictory legal and ethical problems”(International Council of Nurses, 1989) . Participation in executions can be demeaning tot he profession. In doing so, we are directly opposing the role of the nurse in protecting the patient. Utilizing position statements such as those form the American Association of Nursing and the International Council on Nursing will help to guide nurses and alleviate moral distress.

References

American Nurse Association (2001). Code of Ethics for Nurses – Provisions. Retrieved May 5, 2006 from http://www.ana.org/ethics/chcode.htm

American Nurses Association (1994). Nurses’ Participation in capital Punishment. Ethics and Human
Rights Position Statements. Retrieved May 5, 2006 from http://www.ana.org/readroom/position/ethics/etcptl.htm

Amnesty International (2002). Annual Report 2002. Retrieved May 5, 2006 from http://www.amnesty.org

California Department of Corrections (2006). History of Capital Punishment in California. Retrieved May 5, 2006 from
http://www.cya.ca.gov/ReportsResearch/historyCapital.html

Federman, C. & Holmes, D. (2003). Killing for the state: the darkest side of American nursing. Nursing Inquiry, 10(1):2-10.

International Council of Nurses (1989). Torture, Death Penalty and Participation by Nurses in Executions. Position Statement. Retrieved May 5, 2006 from http://www.icn.ch/pstorture.htm

Physicians: participation in executions, State Bill AB 1954 (Lieu), California State Assembly (2006). Retrieved May 5, 2006 from http://info.sen.ca.gov/pub/bill/asm/ab_1951-2000/ab_1954_bill_20060404_amended_asm.html

Puglisi, P.M. (2004). Lethal Injection-could you? Nursing News, 28(1).