The Hippocratic Oath Dilemma: Are United States Nurses Involved in Executions?

Nursing is one of the professions that demands care, compassion, and a strong sense of ethical obligations. The Hippocratic oath obliges them to save the lives of every patient, regardless of their background. 

For most registered and inspiring nurses in the US, the first step in the healthcare world involves rigorous nurse practitioner clinical rotations where they learn the core principles of the discipline, including the ethical principle of 'do no harm.' And yet, during capital punishment via lethal injection, the participation or presence of nurses is frequently demanded, which raises serious questions. 

This issue has concerned senior nursing experts in the US, the U.K., as well as Australia, and has illustrated a growing concern about the conflicting roles of the healthcare professional and the law.

Ethical Conflict and the Professional Stance

There is a conflict between the ethical and professional duties of a nurse and the role that the state empowers them to play in an execution. A nurse's duty is to save a life, while execution is the opposite. Therefore, the role of nurses in execution, including direct assisting or overseeing the procedure, remains in conflict with the morals of the profession.

The American Nurses Association (ANA) and other organizations insist that direct participation in executions, such as assisting or monitoring a condemned person, is contrary to the core nursing principle of respect for human rights, dignity, worth and the rights of an individual to receive compassionate care.

The American Nurses Association's position statement on capital punishment is unequivocal in stating: 'No nurse should participate, in any capacity, in capital punishment' (ANA 2003), and for nurses to do so is a clear breach of the profession's ethical code (ANA 1995). This statement rests on the fact that involvement in execution, in any form, is contradictory to the very essence of the practice of nursing.

Besides these formal policies, there are several ethical arguments to consider. Many nurses have expressed that they feel moral distress being required to attend or participate in any part of the execution process. There can be professional and personal consequences from this internal struggle, including what one's role in healthcare may be, or stigmatization by colleagues or state entities.

Major Nursing Organization Policies

In the United States, all professional nursing organizations have opposed participating in executions. The American Nurses Association (ANA), an organization that represents more than four million nurses across the country, states that nurse participation in activities related to the death penalty is expressly forbidden based on ethical obligations and possible legal consequences. In the same spirit, the International Council of Nurses asserts that any and all procedures relating to capital punishment are inconsistent with the ethics of the nursing profession.

The policy statements of these organizations emphasize several key points, including:

1. Active participation is forbidden: No nurse can insert the IV lines, administer lethal fluids, or monitor the vital signs during execution, or else it'll be considered unethical.
2. Observation may constitute participation: For the nurses who are on correctional healthcare units or prison healthcare units, there is a risk of being legally and ethically held to be part of the execution by simply watching it.
3. Supportive care is separate from execution: It is within the bounds of the profession for nurses to give primary healthcare and mental healthcare to an inmate prior to being executed, but this doesn't extend to the execution process itself. 

These are not mere policy statements. There are potential consequences for a nurse's licensure and the ability to practice, and even professional status. Nurses who do not follow the policy statements may lose or be restricted from practicing as a nurse.

Practical Reality and Legal Challenges

Although professional policies are clear, in some states of the U.S.A., like Missouri, there is legislation that mandates or permits nurses to participate in executions. This has resulted in several legal disputes over who counts as a participant and whether there are any exceptions. For instance, in some states, nurses can place IV lines or observe the physiological responses of the condemned, but not in other states. This puts nurses in a gray area that raises ethical questions.

Courts have been called upon to settle these disputes. In some states, nurses have sued the states, contending that, combined with their professional ethical codes, mandatory participation in any execution or capital punishment is an infringement on their First Amendment rights. It is also a concern that most correctional facilities usually face a challenge in finding a medical expert who is willing to comply with the procedures of execution, which sometimes causes a delay in the scheduled executions. 

This legal and ethical dilemma raises a fundamental question: Can nurses ever square their professional duty with state directives that fly in the face of the "do no harm" ethos? Many healthcare and legal experts argue that to demand nurses contribute to such acts undermines the ethical and professional integrity of nursing and puts practitioners in an untenable position with regard to law and ethics.