February 23, 2006
Thursday

Physician refusal to help the state of California take the life of a death row convict has opened a lively debate about the role of doctors in other controversial procedures some deem tantamount to murder.

Can a doctor's injection of a lethal dose of sedative ever be humane? How does physician-assisted execution of a convicted murderer differ from a doctor's performance of an abortion? Does it make a difference if the person put to death had wanted to be killed?

Such questions are mounting in the wake of the state's indefinite postponement Tuesday of its execution of 46-year-old Michael Morales after officials failed to find a licensed medical professional willing to administer the lethal dose.

The answers, however, inevitably depend on whom is asked the questions.

To some, the matter is as transparent as a bag of saline solution dangling above a hospital bed.

"The bottom line is that physicians should not be in the position of killing, period," said Dr. Paul Hoehner, an anesthesiologist in Charlottesville, Va., and member of the Christian Medical and Dental Associations, a 14,000-member group based in Tennessee. "That is not central to the art and practice of healing, which is what we are about."

Hoehner cites the oath of Hippocrates, whose writings more than 2,400 years ago helped form the foundation on which modern medical practice was built.

"I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion," the classic version of the Hippocratic oath states. "... Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption."

Hoehner said in its day the oath was revolutionary. Most physicians today take a modern version of the oath that does not include many passages in the original, including those addressing abortion and euthanasia.

The oath "was held by a minority of physicians in an age when it was not unusual for physicians to be employed by higher authorities to do the killing," he said.

Hoehner said he thinks it's time the classical Hippocratic oath made a comeback. "When patients came to a Hippocratic physician, they could trust him," Hoehner said. "They knew exactly where he stood."

As far as the Christian medical group is concerned, he said, physician-assisted execution or suicide and abortion all cross the line with respect to a doctor's fundamental obligations.

"We as professionals need to toe the line and say, enough is enough," he said.

Others, however, say it is inappropriate to lump together the role of physician as executioner and physician as healer.

"Once a doctor takes someone on as a patient, their obligation is to do what is best for them as well as to respect their patient's decision-making autonomy," Stanford University bioethicist David Magnus said. "That really isn't compatible with euthanizing someone against their will."

Doctors in wartime or working in emergency rooms frequently are in a position of taking care of someone deemed an enemy, said Karen Nikos, a spokeswoman for the California Medical Association.

"Even if a physician had a moral objection to what a convict had done, we would treat them as a patient," she said. "We save gang members' lives so they can be tried by a jury. We are not in the criminal law business; we are in the healing business."

As for abortion, she said, the procedure is legal and doctors can choose to perform one at the request of their patient - or not, based on their scope of practice and their personal beliefs.

Magnus emphasized that the law does not recognize that a fetus is a person so although an abortion elected by the mother terminates her pregnancy, it does not constitute murder.

"An oak tree is not the same as an acorn, and we don't treat them the same way," said Erich Loewy, a bioethicist at the University of California-Davis. "A medical student is a potential neurosurgeon, but he is not going to be able to go and operate on a brain tumor."

Loewy, and his wife, Roberta Loewy, also a bioethicist, acknowledge that there's a slippery slope when it comes to a doctor's role in another's death, but they differentiate between what is done during an execution, an abortion and an assisted suicide.

"A person on death row is not a patient in any sense of the word so there should be no role for any physician," said Roberta Loewy. "The closest thing to the patient would be the state. Doctors don't treat states."

Even if a convict said he would rather be dead than live the rest of his life in jail, a physician has no business assisting in his death, Erich Loewy said.

"He doesn't know the options in front of him," he said. "He may escape. He may be pardoned."

That contrasts with physician-assisted suicide, he said, which would be done for someone who has only two options: to live a little longer and have pain for a longer period, or to live a little less long and have pain for a shorter period of time.

Hoehner disagrees. "Killing is not a cure; it's not a care," he said. "It's such an easy way out that we miss serious issues that are going on such as depression and pain that can be taken care of."

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