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Neil Farber, MD; Elizabeth B. Davis, PhD; Joan Weiner, PhD; Janine Jordan, MD; E. Gil Boyer, EdD; Peter A. Ubel, MD

Arch Intern Med. 2000;160:2912-2916.

Background  Physicians could play various roles in carrying out capital punishment via lethal injection. Medical societies like the American Medical Association (AMA) and American College of Physicians have established which roles are acceptable and which are disallowed. No one has explored physicians' attitudes toward their potential roles in this process.

Methods  We surveyed physicians about how acceptable it was for physicians to engage in 8 actions disallowed by the AMA and 4 allowed actions involving lethal injection. Questions assessing attitudes toward capital punishment and assisted suicide were included. The impact of attitudinal and demographic variables on the number of disallowed actions deemed acceptable was analyzed via analysis of variance and multiple logistic regression analysis.

Results  Four hundred eighty-two physicians (51%) returned questionnaires. Eighty percent indicated that at least 1 of the disallowed actions was acceptable, 53% indicated that 5 or more were acceptable, and 34% approved all 8 disallowed actions. The percentage of respondents approving of disallowed actions varied from 43% for injecting lethal drugs to 74% for determining when death occurred. All 4 allowed actions were deemed acceptable by the majority of respondents. Favoring the death penalty (P<.001) and the acceptance of assisted suicide (P<.001) were associated with an increased number of disallowed actions that were deemed acceptable.

Conclusions  Despite medical society policies, the majority of physicians surveyed approved of most disallowed actions involving capital punishment, indicating that they believed it is acceptable in some circumstances for physicians to kill individuals against their wishes. It is possible that the lack of stigmatization by colleagues allows physicians to engage in such practices.

From the Department of Medicine, Christiana Care Health System, Wilmington, Del (Drs Farber and Jordan); and Department of Management and Information Systems, St Joseph's University (Dr Davis and Mr Boyer), Management Department, Drexel University (Dr Weiner), and Center for Bioethics, Division of General Internal Medicine, University of Pennsylvania (Dr Ubel), Philadelphia.

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