A Tale of Tennessee Ethics
Will physicians invoke the Medical Ethics Defense Act to prevent state-sanctioned killing?
Today,
at The Medicine & Justice Project published an essay on Byron Brown’s scheduled execution and how it has been complicated by Brown's implanted cardiac device, which keeps his heart in a regular rhythm through both a pacemaker and a defibrillator that shocks the heart back into rhythm when needed.
Physicians refused to travel to the prison to turn off the device.
The backup plan? To transfer Brown to Nashville General Hospital to have it turned off there. Then transfer Brown back to the prison for his execution.
A Doctor’s Code of Ethics
On the issue of capital punishment, the American Medical Association Code of Ethics states:1
Debate over capital punishment has occurred for centuries and remains a volatile social, political, and legal issue. An individual’s opinion on capital punishment is the personal moral decision of the individual. However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.
Physician participation in execution is defined as actions that fall into one or more of the following categories:
Would directly cause the death of the condemned.
Would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned.
Could automatically cause an execution to be carried out on a condemned prisoner.
Tennessee Medical Ethics Defense Act
I wrote earlier this week about the Tennessee Medical Ethics Defense Act and how a physician used their right to conscientiously object to care to refuse prenatal care to an unmarried patient. In that case, the physician put their beliefs over the needs of the patient.
Brown’s case provides an interesting and important use for this Act. Will physicians at Nashville General Hospital follow their ethical duty, as laid out by the AMA, to refuse to participate in state-sanctioned killing? Rather than jeopardizing Brown’s autonomy and access to healthcare, the physicians and hospital could use the law to object on moral and ethical grounds to the state execution.
People who are incarcerated are uniquely vulnerable to medical coercion, manipulation, and other dismissals of their autonomy. These people have rights.
Judges can write orders, but they can’t practice medicine. Following the judge’s order to turn off the implanted cardiac device violates the AMA Code of Ethics and the rights of incarcerated people to make their own health decisions. I will assume with my whole chest that Mr. Brown will not make an informed decision that involves helping the state execute him.
Ascension Saint Thomas Hospital - a Catholic hospital only 1.1 miles away from Nashville General - would never be willing to participate in this scheme on their property. They would use their doctrine and massive protections under both Federal Law and the Medical Ethics Defense Act to object. And no one would be surprised. As I’ve said concerning reporting on conscientious objection in reproductive care, there is an underlying assumption that people who object (the subtext is that these are all religious people) are inherently more ethical than non-objectors (often assumed to be secular and therefore unethical). Except now that the state wants to do something inherently unethical, they will attempt to rely on physicians at a secular facility.
To learn more about the rights of incarcerated patients, consider reading this essay I wrote back in 2023.
Medical decision making & incarcerated patients: What every healthcare worker needs to know
US healthcare workers must be prepared to care for incarcerated people.
Emphasis added is mine.