On 15th February 2010 the American Board of Anesthesiology (ABA) stated that anaesthetists may not participate in capital punishment if they wish to be “board certified.” To me, an American anaesthetist practising in the UK, this statement would seem surreal if it were not so necessary.  For years the American Society of Anaesthesiologists (ASA) has followed the American Medical Association’s (AMA) advice in its clear opposition to physician involvement in capital punishment. The most recent ABA commentary sends a more direct message to anaesthetists, the public, and judicial authorities in the United States.

I can see how the idea of involving anaesthetists in the use of lethal injection for capital punishment is attractive and logical to some. If lethal injection is going to be used for execution, why not make sure that venous access, timing of drugs, and monitoring is done as humanely as possible? To this end, why shouldn’t clinicians with appropriate skills be directly involved in the process? Atul Gawande interviewed nurses and doctors who have taken part in giving lethal injections to inmates condemned to death. Their stories are powerful and challenging. They should be read by anyone wishing to hold a view on this issue. These individuals care greatly about minimising suffering and take this role very seriously. They seem to be compassionate people.  

Atul Gawande’s interviewees also miss the point. The use of lethal injection for capital punishment is, of course, not part of any medical domain. There is no patient, harm is done on purpose, and there is no consent. So, no healthcare professionals belong here. Component parts of anaesthetic practice are being used in a certain sequence to try and achieve unconsciousness and death. That is all. If it were straightforward there would be no issue. The problem is that it is clearly not that easy, can be messy, and causes suffering. A District Court in California (1996) was concerned enough about this to rule that there should be reasonable assurance that unconsciousness is achieved during the execution. The court ruled that this could only be done by “a person with formal training and experience in the field of general anesthesia.” This put anaesthetists in a difficult position through no fault of their own. In response, the American Society of Anaesthesiologists sent out a newsletter strongly advising its members to be informed and not to help out. The recent ABA statement goes much further and all anaesthetists should welcome it. My concern is that the statement cannot protect nurse anaesthetists. I hope that their regulatory body takes a similar stance.
 
Mike Weaver is an anaesthetist at the Freeman Hospital, Newcastle upon Tyne.