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04/06/2015

American Pharmacists Association Votes to Discourage Pharmacists from Participating in Executions

On
March 30, 2015, the American Pharmacists Association (APhA) House of Delegates
– the group’s representative assembly – adopted a policy discouraging
pharmacists from participating in executions.
The
APhA policy is only one sentence long: “
The American
Pharmacists Association discourages pharmacist participation in executions on
the basis that such activities are fundamentally contrary to the role of
pharmacists as providers of health care.”

In defending the new policy, APhA
Executive Vice President and CEO, Thomas E. Menighan, BSPharm, MBA, ScD (Hon),
FAPhA, stated, “Pharmacists are health care providers and pharmacist
participation in executions conflicts with the profession’s role on the patient
health care team. This new policy aligns the APhA with the execution policies
of other major health care associations including the American Medical
Association, the American Nurses Association, and the American Board of
Anesthesiology.”

However, one of the headlines used
in an article that appeared on a trade press Web site American Pharmacy News announcing the new policy went further than
the policy itself: “APhA: Pharmacists Shouldn’t Assist with Criminal
Executions.
” Also,
in a subheading used by another trade journal Internet site AssociationsNow.com, the same
interpretation is extended more: “In a newly adopted policy, the American
Pharmacists Association says that participating in the creation of chemicals
used in lethal injections is contrary to the role pharmacists play as
healthcare providers.” Clearly,
one of the indirect messages circulating as a result of the policy is that the
APhA opposes state execution by lethal injection and that pharmacists should
not be involved in any way. Moreover, aTexas
Monthly
article even used this headline to report the new policy: “The
American Pharmacists Association Says It’s Unethical to Manufacture Execution
Drugs.
” 

In regards to the last implication
of the policy – that it’s “unethical” for pharmacists to be involved in
supplying lethal drugs for state executions – one may wonder if there is some professional
standard other than this association policy which may be violated if a
pharmacists is involved in executions? Asserting that such conduct is
“unethical” is serious. Licensed pharmacists in many jurisdictions are subject
to disciplinary action and sanction for engaging in “unprofessional” conduct. (See the National Association of Boards
of Pharmacy (NABP) Model State Pharmacy Act § 402(a)(1)).

Of course, APhA CEO Menighan is
correct in asserting that pharmacists are respected members of the health care
team called to heal patients. This obligation or responsibility is clear both
the APhA’s Oath of a Pharmacist and the APhA’s Code of Ethics. But
this too is the same line of argument and thinking that some physicians have
used to oppose physician-assisted suicide: “Doctors must not kill.” [Willard
Gaylin, MD; Leon R. Kass, MD; Edmund D. Pellegrino, MD; Mark Siegler, MD. JAMA.
1988;259(14):2139-2140.] The reasoning flows that it will cause public and
professional role confusion if physicians – and now pharmacists – are involved
directly in patient’s deaths. Physicians and pharmacists are to help people and
not hurt them or cause harm.

But
in reviewing the APhA policy and relevant professional standards documents, one
may only extrapolate from general principles. For example, some may be hard
pressed to classify condemned prisoners under sentence of death as “patients”
in the traditional sense as reflected in most of the provisions of the APhA Oath
and the Code of Ethics which address obligations and duties to individuals.

Even
so, Section VII of the Code of Ethics reads:“A pharmacist serves individual,
community, and societal needs.The primary obligation of a pharmacist is to
individual patients. However, the obligations of a pharmacist may at times
extend beyond the individual to the community and society. In these situations,
the pharmacist recognizes the responsibilities that accompany these obligations
and acts accordingly.” This provision may have been included in the Code to
assert an obligation to balance conflicting justice responsibilities at times.
But some might interpret this provision to allow pharmacists to provide drugs
to the state so that prisoners may be executed humanely, in a manner that
reduces the likelihood of pain and suffering, since criminal execution is
permitted by the community and society according to law.

Moreover,
the policy uses the word “discourages” rather than “prohibits” in its exact
language. The APhA House of Delegates could easily have used stronger wording
to make it absolutely certain that pharmacists should not be involved in
executions at any level. “Discourages” seems somewhat less mandatory than
“prohibits” and allows for individual pharmacist discretion. The slant toward
the pharmacist not being involved appears the preferred or recommended course,
but the policy falls short of condemning pharmacists for unprofessional or
unethical conduct if they elect to participate in executions as authorized by
law.

Lastly,
one is reminded that broad, generalizable moral principles as enunciated by
professional oaths, codes, and policies must be interpreted in light of other established
standards and the particularities of a set of facts. Even with the Ten
Commandments that proclaim to adherents that they should not kill, scholars say
that it would be better interpreted as “You shall not murder” or “You shall not
kill without justification.
” 

The
opinion of the APhA regarding the proper professional role of pharmacists – or
not – in state executions is an important one that should be stated and heard.
However, whether or not the state should allow capital punishment at all is a
separate issue for the community and society to answer after listening carefully
and reflectively to all viewpoints. If the APhA opposes capital punishment as a
criminal penalty then it should have more directly and forthrightly stated that
in their new policy.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website. 

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