The Lancet 2007; 369:343
Stop killing people who kill people
According to Amnesty International, 128 countries and territories have abolished the death penalty in law or practice. 69 other countries retain capital punishment. Amnesty counted 22 countries known to have executed prisoners in 2005. In that year, at least 2148 people were executed, but this number is almost certainly an under-estimate. As is usual, most executions took place in a few countries: in 2005, 94% occurred in China, Iran, Saudi Arabia, and the USA.
But there are fresh moves at high levels to achieve a worldwide ban on the death penalty. Last week, UN Secretary General Ban Ki-Moon was in Brussels, Belgium, on his first overseas visit since taking office. Talking to reporters, he gave a cautious nod in the direction of a worldwide moratorium. “There is some growing tendency to see some phase out of the death penalty and I encourage that trend”, he said. Not exactly tough talk, but the death penalty is due to go back on the agenda at the UN, thanks to Italian Prime Minister Romano Prodi, who plans to lobby hard to get a UN-sanctioned moratorium. Ki-Moon was regaining ground after the execution of Saddam Hussein, when he had said it was for individual countries to decide on the use of capital punishment or not. It was that execution which had incensed Prodi to bring the issue back to the UN.
Even in the USA, support for capital punishment is waning. Last year, for the first time in the 20 years Gallup has been polling the US public, the proportion in support of life imprisonment without parole is one point over that voting for the death penalty (48% vs 47%). Shown graphically, the proportions have been converging for most of the polled years, but now the lines have crossed. Several factors are behind this trend. There is a growing recognition that the death penalty does nothing to deter crime and too often punishes the innocent. Since 1973, 123 people sentenced to death in the USA have been shown to be innocent. More recently, horrific reports on botched executions by lethal injection have raised concerns, even with long-time supporters of the death penalty.
The use of lethal injection is facing major legal challenges in the USA, as Leni Koniaris and colleagues describe in a Comment in today's Lancet. After some recent badly mishandled executions by this method, several states have put the death penalty on hold. The Comment authors argue that the method cannot be “fixed”, as one judge is calling for, and that perfecting the method will need the involvement of doctors and scientists. They continue: “[Lethal injection] is an abominable perversion of the tools of healing. Participation by physicians and scientists in perfecting medical execution is morally wrong.”
Last year, Atul Gawande, journalist and physician, wrote a compelling paper about health professionals who participate in executions. He found four doctors and a nurse who would speak with him about their involvement, one later agreeing to be named publicly. Not all were unaware of the advice of their professional body to take no part. The latest edict from the American Medical Association is no involvement except for certifying death after someone else has pronounced it. Some had rather just drifted into their role, seeing it as almost community service and a type of terminal care. But as Gawande correctly points out, the condemned prisoner is not a patient. Although concluding that the people he interviewed took their moral duties seriously, Gawande added: “It is far from clear that a society that punishes its most evil murderers with life imprisonment is worse off than one that punishes them with death. But a society in which the government actively subverts core ethical principles of medical practice is patently worse off for it.”
The debate over capital punishment has reached a tipping point. Health professionals around the world should speak out now against execution, to use their influence to persuade the public and those in power that capital punishment is a cruel and senseless practice that has no place in the 21st century. A complete and worldwide refusal by doctors, nurses, and other health technicians to have any involvement would show that the tide of opinion has turned against capital punishment, a seachange that must not be stopped. The death penalty should be replaced by life imprisonment without parole, which would be good news for those later found innocent. Despite needlessly languishing on death row, at least they would have time to be exonerated. Put simply, ban the death penalty and there will be no ethical or moral conundrum for anyone.