WMA policy statement on participation of doctors in executions should be implemented

WMA policy statement on participation of doctors in executions should be implemented

Dr KK Aggarwal

Should doctors participate in state executions or capital punishments? This is a very controversial issue in medical ethics.

Doctors are required to monitor vital signs during the process of execution (hanging in case of India) and look for signs of life and then pronounce death. This is against medical ethics.

Opposing the participation of doctors, the World Medical Association (WMA) came out with a “Resolution on physician participation in capital punishment” in 1981 and amended in 2008. The resolution states as follows

“RESOLVED, that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.

The World Medical Association

REQUESTS firmly its constituent members to advise all physicians that any participation in capital punishment as stated above is unethical.

URGES its constituent members to lobby actively national governments and legislators against any participation of physicians in capital punishment”

In its general assembly in 2012, the WMA again passed a resolution reaffirming its prohibition of physician participation in capital punishment.

“There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine—first, do no harm.

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

Therefore, be it RESOLVED that:

· Physicians will not facilitate the importation or prescription of drugs for execution.

· The WMA reaffirms: “that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions”, and

· The WMA reaffirms: that physicians “will maintain the utmost respect for human life and will not use [my] medical knowledge to violate human rights and civil liberties, even under threat.”

The WMA Declaration of Geneva or the “Modern Hippocratic Oath”, first adopted in 1948 was recently amended in October 2017 at the annual general assembly in Chicago, USA. The revised version also states: “As a member of the medical profession:

· The health and well-being of my patient will be my first consideration;

· I will maintain the utmost respect for human life

· I will not use my medical knowledge to violate human rights and civil liberties, even under threat”

This final version of the Declaration of Geneva has been accepted by all member national medical associations including the Indian Medical Association (IMA).

No doctor should be present during the process of execution. This is violation of medical ethics and is a professional misconduct.

The World Medical Association today has a membership of 112 national medical associations. IMA is a founder member of this world body. This makes India a signatory to all policies and resolutions adopted by the WMA. Hence, the WMA Resolution on Physician Participation in Capital Punishment should also be implemented in our country.

Disclaimer: The views expressed in this write up are entirely my own.

AHA statement on management of poststroke fatigue

AHA statement on management of poststroke fatigue Fatigue is a debilitating sequelae of stroke, both ischemic and hemorrhagic. About half of all patients who survive an episode of stroke often report fatigue, which may be mild and occurring occasionally to that which is severe and constant. Unlike the typical tiredness, post-stroke fatigue may or may not be related to a recent activity and does not improve with rest. It adversely affects daily activities of life and limits participation of the patients in rehabilitation programs, which in turn hampers recovery. This makes post stroke fatigue an issue that is of concern not only to the affected patient and the caregivers, but also to the clinician taking care of the patient. The American Heart Association (AHA) has published a scientific statement for healthcare professionals on the management of fatigue in patients who have had a stroke. Published May 25, 2017 in the journal Stroke, the statement recognizes the multidimensional nature of poststroke fatigue and lists factors such as old age; female gender; physical impairment and functional deficits; comorbidities such as hypertension, diabetes, kidney disease, heart diseases; medications such as sedatives, antidepressants, and hypnotics and pain as factors that contribute to the fatigue. Patients should be evaluated at the time of discharge from acute care followed by regular follow-up post-discharge at 3 months, 6 months, and 1 year and then yearly. The Fatigue Severity Scale is recommended. These patients should also be evaluated for depression. The statement elucidates the evidence related to the use of tirilazad mesylate, a neuroprotective agent and Modafinil, a drug originally used for patients with hypersomnia or narcolepsy to promote wakefulness, as agents that have shown some efficacy in relieving poststroke fatigue. Vitamin B12, vitamin B1, and idebenone, a synthetic coenzyme Q10 analog may also have a role. Nonpharmacological interventions include aerobic exercise and education of the patients and their caregivers about the condition and the need for exercising, establishing good sleep patterns and avoiding sedating drugs and excessive alcohol The statement also touches upon the impact of fatigue on the caregivers and states that “caregivers can be taught to help the stroke survivor space activities out throughout the day to conserve energy if this is found to be an effective intervention”. (Source: Stroke. 2017;48:e000-e000) Dr KK Aggarwal National President IMA & HCFI