PSYCHIATRISTS AND THE DEATH-PENALTY - ETHICAL PRINCIPLES AND ANALOGIES

A doctor's involvement in capital punishment is defined ethically acco rding to the 'proximity' to execution per se. There are degrees of 'pr oximity' or 'remoteness' which vary according to participation in the criminal justice 'stages' of (1) investigation, (2) determination of f itness for trial, (3) verdict determination, (4) sentencing, (5) asses sment and treatment for execution, (6) execution per se and (7) certif ication of execution death. Differing degrees of proximity potentially determine differing ethical dilemmas, both for individual clinicians and for corporate professional bodies. The World Psychiatric Associati on's Declaration on the Participation of Psychiatrists in the Death Pe nalty (1989), and also in the UK the Royal College of Psychiatrists' ' Resolution' (1992), can properly be analysed in terms of 'pursuit of b eneficence and avoidance of maleficence', but substantial ethical ambi guities remain arising from the different degrees of 'participation' i mplied in relation to different criminal justice 'stages' Also, doctor s may distinguish between medical practice directed towards a medical purpose, therefore Hippocratically requiring of beneficence, and such practice directed, as a 'good citizen', at a judicial purpose. Profess ional bodies may proscribe participation in some stages and they may a lso support a range of professional ethical decisions of individual do ctors, albeit without prescribing; them. Differences between the ethic al positions of individual doctors and a particular corporate professi onal body are most likely to arise from differing views about whether a narrow or a broad definition of medical beneficence is appropriate, that is, restricted or not, according to whether the medical treatment is directed solely towards a medical purpose. In the UK it is general ly accepted individual professional practice to participate in stages 1-3, with the absence of any corporate proscription; participation in stage 4 is similarly accepted, although the Royal College policy is si lent on it. The college policy does, however, proscribe any involvemen t in stage 5 when the eventual purpose is execution, as well as proscr ibing participation in stages 6 and 7. There are clear ethical analogi es between involvement in capital punishment and in any other form of judicial punishment. These make the ethical analysis that is offered i n this paper relevant to all forensic psychiatric practice, wherever i t takes place.