N.C. law at odds with medical ethics rules

Lethal injection puts doctors in tricky spot

Doctors take an oath to save lives. North Carolina's prison doctors help end them by participating in executions.

Prison officials say doctors attend executions and monitor the vital signs of the condemned while other employees inject a series of lethal drugs. Such participation violates medical ethics guidelines, but no execution doctor has ever gotten in trouble in North Carolina. A state law shields the doctors' identities.

On Friday, North Carolina plans to execute its 41st inmate since a state law in 1977 restored the death penalty. That inmate is Patrick L. Moody of Davidson County.

The ethical codes set out by the American Medical Association and the N.C. Medical Society prohibit doctors from "attending or observing an execution as a physician" and "monitoring vital signs on site or remotely [including monitoring electrocardiograms.]" The state and national medical ethics rules allow doctors only to certify an inmate's death or prescribe drugs to alleviate acute pain or anxiety suffered by the condemned before execution.

Dr. Priscilla Ray, who heads the AMA council on ethical and judicial affairs, says a doctor's monitoring an inmate's heartbeat contradicts the medical profession's most basic tenet: First, do no harm.

"Look, his heart's still beating -- what you are saying is, 'Give him more lethal drugs,' and that we can't do," said Ray, a Houston psychiatrist.

Keith Acree, a spokesman with the N.C. Department of Correction, would not speak in detail about doctors' involvement in executions at Central Prison in Raleigh, citing a lawsuit in federal court that challenges the state's lethal injection protocol.

"North Carolina law requires that a doctor be present at executions," Acree said in a prepared statement. "The department's execution procedure is consistent with state law."

Last fall, Central Prison Warden Marvin L. Polk told reporters during a tour of the death chamber that a doctor and nurse watch a heart monitor during executions in a room next door. The room has a window that looks into the execution chamber and allows the pair to watch other prison employees conduct the lethal injection process.

The N.C. Medical Board, which disciplines doctors, has never received a complaint about a doctor's role in an execution. There is no set consequence for doctors who violate ethics rules, but the medical board uses the rules to decide whether to punish a doctor for unprofessional conduct.

"No North Carolina physician that we're aware of has ever been involved directly or indirectly in an execution," said Dave Henderson, the board's executive director. "If we got a complaint, the board would have to look at that, consult with outside people and come to some decision."

Dr. Paula Smith, the prison system's medical director, didn't respond to messages seeking comment.

Secret identities

The identities of the doctors and nurses who participate in executions are confidential, thanks to a 2004 state law. Only Wake's senior resident Superior Court judge, a job now held by Donald W. Stephens, can order the disclosure if it serves the proper administration of the justice system. It's unclear which legislator sought the change, because it was tucked anonymously inside that session's "technical corrections" bill.

The N.C. Department of Correction has eight doctors on staff at Central Prison. Efforts to reach them failed last week.

A nurse who participates in an execution is not violating any state code of ethics. In 2003, after almost two decades of opposing nurses' participation in executions, the N.C. Nurses Association broke ranks with the national body and other state nurses associations by leaving the decision to individual nurses.