In this extract from http://missouripsych.wordpress.com,
Miriam discusses the ethical dilemma of assessing someone's
competency to face the death penalty.
During the day there is always a window of opportunity to pass
by Dr Reynolds's office and catch up on how the day is going. I
really enjoy these chats, as more often than not, the ‘catch up’
turns into an hour long (plus!) discussion about interesting cases,
ethical dilemmas etc. So I usually top up my coffee en route to his
(Here I must add that there is a constant supply of free,
fresh coffee for all the staff in the hospital in every department.
Britain, please take note.)
One of my first ‘catch ups’ with Dr Reynolds involved a lengthy
discussion on the Death Penalty, a relevant topic to being a
forensic psychiatrist in the state of Missouri.
He must have sensed my curiosity in the matter before I even
voiced it. Missouri is one of 5 states that make up 65% of the
executions that take place in the US. There have been 82 executions
in the state of Missouri since 1976, all by lethal injection.
I, as I suspect many Brits would, struggle with the whole idea
of the death penalty. Are we really still doing this in 2015?
For and against the death penalty
The opinions that still drive the existence of the death penalty
include views such as ‘it is the ultimate punishment’,
‘proportionality for the crime committed’ and that this form of
‘justice’ would act as a ‘deterrent’. Some also believe that an
execution would save the state money on appeals and
However, those states that have outlawed executions have based
this on their views that
- executions are a violation of the 8th amendment of the US
constitution (‘Excessive bail shall not be required, nor excessive
fines imposed, nor cruel and unusual punishments inflicted’)
- execution is irreversible and does not allow for
- the paucity in evidence that execution acts as an effective
- other countries without the death penalty often have lower
- the risk of executing an innocent person.
The psychiatrist's role
I wanted to know what role a forensic psychiatrist had in all of
this. Is it like abortions in the UK, where if you are morally
opposed you do not have to take part?
Thankfully this is the case. When a forensic psychiatrist is
asked to be involved in the assessment of a defendant who is at
risk of facing the death penalty, the psychiatrist can refuse to
take on the case. The only forensic psychiatric issue exclusive to
death penalty cases, concerns the competency to be executed. If
found incompetent, an execution cannot be carried out, due to:
'prohibition of execution of an insane prisoner'.
I wondered that if the forensic psychiatrist’s evaluation
ultimately results in the defendant being executed, does this
indirectly conflict with the doctor’s oath of ‘thou shalt do no
Dr Reynolds was able to assist me with this ethical dilemma as
he previously worked on a death penalty case and spent a
considerable amount of time in the lead up to the trial researching
the ethics of his involvement. He informed me that many people
agree that whilst it is ethical for a forensic psychiatrist to
comment on a defendant’s competency, it is not ethical to assist in
the execution itself, with regards to administering drugs and
Dr Reynolds also shared with me other considerations he had had
to make: what if a defendant was facing the death penalty and you
not getting involved in the case may mean that another, perhaps
less qualified / experienced doctor got involved instead,
misperceived a defendant as competent, and then they incorrectly
With this in mind, is it not more ethical to involve yourself in
a case if you feel confident about your clinical skills, and know
that you will act honestly?
What would I do if I was working in Missouri and was
asked to assist in a Death Penalty case?
I am going to be honest. I am most definitely against the Death
Penalty, and prior to my chat with Dr Reynolds I would have said
with confidence that I would refuse to take on a Death Penalty
However, if I had the opportunity to look over the case first, I
may take it on if I felt confident that the patient was in fact
incompetent and that my involvement would prevent the defendant
facing the Death Penalty.
However, if the trial did not go my way could I live with the
thought that perhaps I underperformed in my ability to convince the
court of my clinical findings? Or if I discovered that,
on closer assessment, the patient was in fact competent and I must
therefore act with honesty and inform the court?
Honestly, I am just glad that this is one ethical minefield that
we do not have to deal with back home in the UK.
Read more of Miriam's