Trevor Stammers

Moral flip-flopping over doctors and the death penalty

Trevor was a GP and a clinical teacher for over twenty years. He has worked in academia for the last fifteen years and was the editor of The New Bioethics from 2011 to 2022. He currently volunteers as a Public Policy Associate with CMF.
The views expressed do not necessarily reflect those of CMF.

I have long argued that ethicists who advocate euthanasia while at the same time being opposed to capital punishment have a morally untenable position and recent events have once again demonstrated why if you think it is wrong for doctors to administer death as a punishment, it is logically inconsistent to agree that they can administer it as a mercy.

One area of inconsistency relates to the fact that the drug cocktails used for administering death either by euthanasia or capital punishment are pretty much identical. Or at least they were until manufacturers were eventually persuaded to stop supplying it from the UK to the US after sustained pressure from campaigners against the death penalty in the US. Pfizer stopped supplying drugs to the US for lethal injections for capital offenders in 2016. Prior to that, sodium thiopental had been used to induce unconsciousness, followed by pancuronium bromide to paralyse respiratory muscles (and of course most other muscle movements as well), before potassium bromide was injected to cause cardiac arrest. Though protocols for countries where assisted dying by euthanasia is legal vary, the cocktail of drugs used is very similar to those used in executions in prisons. Advocates for euthanasia readily acknowledge that ‘execution by lethal injection mirrors euthanasia in the Netherlands and often uses the same drug combinations’. p239 of https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1467-8519.2009.01767.x

Virtually every ethicist (including this one) considers that executing people is a violation of a doctor’s ethical code and that administering a lethal cocktail in such circumstances is not permissible. Gerald Dworkin for example states, in the context of writing about capital punishment: ‘I believe it is incontrovertible…whether in specific oaths taken by physicians or in the principles adopted by the medical community or in the code literature, to ensure that participation in lethal injections by physicians would be contrary to their professional code of ethics’. Page 183 of https://www.jstor.org/stable/3329261

If it is wrong, then, for doctors to administer lethal injections for administering the death penalty, how can it be right to administer them for euthanasia? One immediate response is that patients request euthanasia but the death penalty is carried out against the person’s will. Except that in countries where euthanasia is legal, prisoners request it too.

The most recent case in the press is that of Genevieve Lhermitte, a Belgian mother convicted in 2008 of the murder of her five children aged between three and 14, who was euthanised at her request. She was serving a life sentence for her children’s murders, so it is not difficult to envisage that imprisonment for and guilt from such a heinous crime might well lead to ‘unbearable’ mental suffering. Since the Belgian law permits euthanasia for such suffering, it might well have been difficult to deny her request.

However, similar requests from prisoners in Belgium have been denied previously, the most well-known of which is that of Frank van Den Bleeken, a serial killer and rapist who, after serving 30 years of his life sentence, requested euthanasia on the same grounds as Genevieve Lhermitte. His request was originally granted by the then Belgian justice minister, Koen Geens, and his euthanasia was scheduled for 11 January 2015, with Dr Wim Distelmans, the head of the Belgian euthanasia review commission, reportedly willing to perform it himself. However, Distelmans withdrew from carrying it out, ‘for personal reasons’, a week before it was due to happen. Geens announced instead that van Den Bleeken would be transferred to the Netherlands – a request that had been denied to the prisoner before he then requested euthanasia.

The sisters of Van Den Bleeken’s last victim opposed his euthanasia request, saying that he should ‘rot in his cell’, and clearly seeing euthanasia as his attempt to escape justice.

Most jurisdictions which have legalised euthanasia have found it almost impossible to restrict it to the terminally ill – in part because terminal illness can be so unpredictable. Indeed the suffering of those who want to die but are not in the final months of death is likely to be much greater over time as natural death is likely to be a long time off. There can be little doubt that in countries where euthanasia is legal prisoners will continue to request it, though one might well wonder just how freely such requests are really made.

The logic of the following conclusion seems to me to be inevitable. If you are a doctor who is willing to administer euthanasia to your patients on the grounds that it relieves prolonged and incurable suffering, then if serial killers request it, you are morally obliged to administer it to them as well.

Moral flip-flopping over the issue is a sign of moral inconsistency. Perhaps the inconsistency is necessary because doctors actually violate their ethical code by deliberately administering a lethal injection to anyone – even if at their request?

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