The American Medical Association has decried the participation of doctors in executions as a clear violation of medical ethics. Nonetheless, since all 38 states with the death penalty use lethal injections, doctors are needed -- and doctors do participate. In the latest issue of the New England Journal of Medicine some of them explain why.

There was a range of reasons cited by the four interviewed. Most became involved only gradually. Typically, they lived in an area near a prison and agreed to witness the execution and issue a death certificate. After attending a few times, they became more and more involved. One doctor felt that the criminals deserved death for their crimes -- and didn't know that participation violated the AMA's code of ethics. Another wanted to ensure that the prisoner did not suffer unnecessarily. Another, Dr Carlo Musso, of Georgia, opposes the death penalty, but believes that his "patients" need comfort in their dying moments so that death happens painlessly and humanely.

Even though the number of doctor-executioners is very small, the author of the article complains that "their actions have made our ethics codes effectively irrelevant in society". This is important, he argues, because of the increasing tendency of the government to subvert medical practice for its own purposes, such as cooperation in the torture of terror suspects.

Although he recognises that some of the doctors have reflected on their own ethical stand and seem to be people of integrity, he says that they should be prepared to face the consequences of their decisions. Unfortunately, he said, the doctors and nurses he interviewed chose to remain anonymous and evade that responsibility. The exception, Dr Musso, gives his side of the story on an .