Since 1976, when capital punishment was reinstated in the USA, 1418 inmates have been executed under its laws as of 28 October 2015.1 While this topic has remained controversial for decades, it has been featured more prominently in the American mainstream media in recent years as US prisons have struggled to obtain pharmaceutical agents used for carrying out lethal injection, the form of execution used in the 31 states still rendering the death penalty.

For nearly three decades, US prisons used sodium thiopental as an anaesthetic agent in executions, but when the drug's US manufacturer stopped production in 2009, prisons began seeking overseas suppliers. After the UK halted supply of sodium thiopental to the US in opposition to its intended use, many states transitioned to the use of pentobarbital. Danish pharmaceutical company Lundbeck made headlines in 2011 by banning the use of pentobarbital in executions. As stocks of pentobarbital have dwindled in US prisons, states have turned to other drugs, such as midazolam.

Aside from obstacles met in obtaining drugs for use in capital punishment, there is another challenge that has presented itself in carrying out death sentences, although media coverage of this issue has been substantially less. Physicians have grown more reluctant to participate in this practice.

North Carolina executed a total of 27 inmates between 2000 and 2006, but no state-sanctioned executions have occurred there since that time.1 This abrupt change does not stem from a state-imposed moratorium on capital punishment, but is attributed to a position statement from the North Carolina Medical Board (NCMB) published in January 2007 indicating that physicians participating in judicially ordered executions may be subject to disciplinary action.2

In constructing this position statement, the NCMB cited the American Medical Association Code of Medical Ethics Opinion 2.06, which states: “A physician, …