Last year The Lancet argued that any debate within medicine about physicians' involvement in capital punishment becomes simpler if doctors' organisations take an unambiguous positions on the death penalty itself. That does not mean that organisations unwilling to do this can have nothing to contribute. The American Medical Association's pronouncement in 1992 fell short of a collective abolitionist stance but the AMA's robust statement on physicians partecipation in executions and its clarification of what participation means has proved very influential. The American College of Physicians had pushed the AMA towards that declaration but has not itself got an official view on capital punishment; nor, even more curiously, has Physicians for Human Rights. Last week both of them, with two other groups, joined together in a substantial contribution. The four organisations were interested in »what really happens . Statutes sometimes speak of »may and »invite but doctors employed by the state can be in a difficult

position. In July, 1992, one state medical examiner, himself opposed to the death penalty, swore an affidavit on the likely efficiency of a penitentiary's draft instructions on judicial hanging. Other physician employees of state correction departments have found their position made untenable. More to the point, the report lists examples from several states of physician participation breaching AMA guidelines. States vary. The report's recommendations aim at more uniformity. The thirty-six states with the death penalty should incorporate into their laws and regulations the AMA's guidelines and »laws mandating physician presence and pronouncement of death should be changed in specifically exclude physician partecipation . State medical associations should adopt the guidelines too. Once participation has been generally accepted as a violation of ethics medical boards that license and discipline physicians would be in a position to take action. This week another quartet, including the AMA and the American Colleg

e of Physicians, has issued a similar statement relating to disciplinary action. Furthermore, doctors (and nurses) who are government employees or contractors are obligated to »uphold professional ethical standards and that obligation »cannot be modified by the conditions of their employment .

Psychiatrist seeking clarification will be disappointed. Their ethical role has proved especially hard to resolve and "Breach of trust" recognises this. So do the AMA and co-signatories these associations may get together again to look at other types of health professional involvement in executions, and the role of psychiatrists is among »related issues being considered by some of us . On most fronts, however, real progress is being made. There are still those who argue that if executions are carried out they should be mercifully efficient and some form of medical involvement will ensure efficiency. But if execution is potentially inefficient (and horror stories already abound') it will then become an even more »cruel and unusual punishment and so outlawed under the US Constitution. (The Lancet)