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Capital Punishment: An Ethical Dilemma for Nurses

Capital punishment, also known as the death penalty, is defined as “the practice of killing people as punishment for serious crimes” (Webster, 2020). According to the American Nurses Association (ANA), direct or indirect participation in the execution process is unethical. It goes against the Nursing Code of Ethics, specifically provisions one, eight, and nine (Position Statement, 2016). The Nursing Code of Ethics is a set standard of non-negotiable ethical principles for nurses, which outline duties and obligations that inform nursing practice. Provision one states that nurses need to respect human dignity (ANA, 2015, p.

17). Provision 8.2 and 8.3 talk about the nurse’s obligation to bring attention to issues in health, human rights, and health diplomacy in any context (ANA, 2015, p. 49). Provision 9 states that nurses must maintain professional integrity, values, as well as, uphold social justice (ANA, 2015, p 36). Therefore, based on the provisions from the ANA and other ethical principles such as justice, nonmaleficence, and beneficence, capital punishment, as well as, nurse involvement is unethical.

Bioethical Principles

Nursing practice is based in caring and relief of suffering in the community.

Nurses aim to preserve human dignity, promote health, and uphold human rights of all people, as well as, follow ethical principles such as justice, beneficence, nonmaleficence and fidelity. The most common form of capital punishment, legal injection, is not as pain-free or simple as it would seem. Lethal injection typically includes a barbiturate to sedate, a paralytic to paralyze the muscles, and a potassium chloride solution to stop the heart (Bryant, 2018). Human dignity is addressed in the first provision of Nursing Code of Ethics and usually applicable in circumstances of self-expression, aging, illness, and when people are dying (Butts & Rich, 2020, p.

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44). Lethal injection can be violent and take a long time, which harms human dignity. This is what happened in 2014 in the execution of Clayton Lockett in Oklahoma. It took 43 minutes for Lockett to die and he “thrashed on the gurney, writhing and groaning” during this time (Bryant, 2018, p. 3). A similar situation was seen in the execution of Kenneth Williams in Arkansas in April 2017. Williams lurched and convulsed 20 times after the injection of midazolam, the medication that was supposed make him unconscious. There have also been many documented occasions when the inmates wake up in the middle of the execution process (Bryant, 2018, p 4). Midazolam is a popular medication used to induce unconsciousness. In 2015 numerous doctors “testified that midazolam has no pain-relieving properties, and does not produce the deep, coma-like state of unconsciousness necessary to relieve suffering,” yet this drug continues to be used in the lethal injection process (Bryant, 2018, p 5). These situations are just a few examples of how capital punishment is unethical, inhumane, and violates basic human rights. It is not a “painless” process as some claim depending on the situation it can be very painful. Therefore, it is unethical for a nurse to participate in the process.

Another ethical principle nurses strive to follow is nonmaleficence and beneficence, which work interchangeably. Butts and Rich (2020) define nonmaleficence as an ethical principle to “not to cause harm” (p. 36). On the other hand, beneficence is “actions taken to benefit and promote welfare of other people (Butts & Rich, 2020, p. 38). Participation in capital punishment creates an ethical dilemma for nurses because the medication administered cause harm, with the aim to end a life. Lethal injection medications are given through intravenous catheters placed in the inmate’s arm. Two IVs are typically placed because these medications are vesicants and can irritate veins and be no longer patent. If the IV is incorrectly placed or becomes occluded, extreme pain can occur from medication injection. In the case of Elliot Johnson in 1987, due to collapsed veins it took almost an hour to finish the lethal injection process. Moreover, in the case of Charles Walker, due to human error and equipment failure (kinked tubing, incorrectly placed iv) this inmate “suffered excruciating pain during his execution” (Radelet, 2018, para 16). According Radelet (2018), 7.12 percent of lethal injections are botched in one way or another. Lethal injections are unethical because nonmaleficence and beneficence are not able to be maintained. Capital punishment by definition is unethical and causes harm since the end goal is death and, in many cases, a painful death.

Legislative Influence

Currently, there are no federal regulations or legislation in place that prevent and protect nurses’ rights to not participate in capital punishment. That being said, nurses’ code of ethics does protect them from participating. Additionally, the American Nurses Association (ANA) released a position statement in 2016 in opposition to capital punishment. The ANA has advocates in congress, lobbying for healthcare policy that support nurses and patients. Nurses can sign-up on the ANA website to get alerts about current issues nurses are lobbying in congress, as well as, advocacy opportunities that nurses can come out for. Nurses have a strong voice and they can affect change in legislature both on the state and federal level. Nurses can contribute to change by be involved in these advocacy programs, as well as, writing letters to state representative about issues such as capital punishment.


In conclusion, based on ethical principles such as justice, nonmaleficence, and beneficence, capital punishment, as well as, a nurse’s involvement is unethical. Upholding this statement is important to ethical practice because it reiterates the ethical principles of nonmaleficence and beneficence, which are the cornerstone of nursing. Every person has basic human rights. As a nurse, I am responsible for promoting health and upholding human rights of all people, as well as practicing ethics and advocating for those how cannot advocate for themselves. Capital punishment and the use of lethal injections go directly against promoting health and upholding human rights. The only way capital punishment can support ethical nursing practice is by removing it completely.


  1. American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive Statements. Retrieved from
  2. Bryant, B. (2018, March 5). Life and Death Row: How the lethal injection kills. Retrieved from
  3. Position Statement: Nurses’ Participation in Capital Punishment. (2016). statements/capital-punishment-position-statement_2017.pdf
  4. Radelet, M. (2018). Botched Executions. Retrieved from
  5. Webster, M. (2020). Capital Punishment. Retrieved from https://www.merriam- punishment

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Capital Punishment: An Ethical Dilemma for Nurses. (2021, Mar 09). Retrieved from

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