Psychiatrists and the death penalty: Ethical principles and analogies

Abstract

A doctor's involvement in capital punishment is defined ethically according to the ‘proximity’ to execution per se. There are degrees of ‘proximity’ or ‘remoteness’ which vary according to participation in the criminal justice ‘stages’ of (1) investigation, (2) determination of fitness for trial, (3) verdict determination, (4) sentencing, (5) assessment and treatment for execution, (6) execution per se and (7) certification of execution death. Differing degrees of proximity potentially determine differing ethical dilemmas, both for individual clinicians and for corporate professional bodies. The World Psychiatric Association's Declaration on the Participation of Psychiatrists in the Death Penalty (1989), and also in the UK the Royal College of Psychiatrists' ‘Resolution’ (1992), can properly be analysed in terms of ‘pursuit of beneficence and avoidance of maleficence’, but substantial ethical ambiguities remain arising from the different degrees of ‘participation’ implied in relation to different criminal justice ‘stages’. Also, doctors may distinguish between medical practice directed towards a medical purpose, therefore Hippocratically requiring of beneficence, and such practice directed, as a ‘good citizen’, at a judicial purpose. Professional bodies may proscribe participation in some stages and they may also support a range of professional ethical decisions of individual doctors, albeit without prescribing them. Differences between the ethical positions of individual doctors and a particular corporate professional body are most likely to arise from differing views about whether a narrow or a broad definition of medical beneficence is appropriate, that is, restricted or not, according to whether the medical treatment is directed solely towards a medical purpose. In the UK it is generally accepted individual professional practice to participate in stages 1-3, with the absence of any corporate proscription; participation in stage 4 is similarly accepted, although the Royal College policy professional practice or expertise. Even in the United Kingdom the latter is common in the courts in relation to ‘diminished responsibility’ (Homicide Act 1957, s.2) and there has also long been debate over the dual responsibility of prison medical officers in relation to certification of competency for punishment. The ethical core of forensic psychiatric practice, not only in relation to capital punishment but generally, lies in distinguishing between the dual functioning of individuals as ‘doctors’ and ‘citizens’.