The Public Health Effects of the Death Penalty

The Public Health Effects of the Death Penalty JONATHAN B. WEISBUCH President, The Foundation for Health and Fitness GUEST EDITORIAL > G X cruel irony exists that brings together, here, in Dallas, Texas, members of the American Public Health Association to discuss the impact of the death penalty on the public's health. This Association has a policy not to meet P c) ~~in states that failed to ratify the Equal Rights Amend- Ks(e ~ 5 ment, or in cities that do not fluoridate the water. Yet, here we are in a state that is the first to use pharmacologic agents in lethal doses to execute human beings; where health professionals were directly involved in specific activities leading up to the legal homicide. The Hippocratic Oath, the World Medical Association's statement of policy on medical involvement in torture, the American Medical Association's policy on physician involvement in death by injection are dead letters. I am not here, however, to make a case for or against the death penalty as a responsible judicial act, or as preventive against heinous crimes, or as a way for society to gain vengeance against the malefactor. I am here simply to make the case that in our society, a state policy supporting the death penalty is a policy against the public's health, and therefore should be opposed by all of us who serve in that capacity. State executions have an impact on public health in three ways: 1. Evidence indicates that legal homicide is associated with an increase in subsequent illegal homicide; and that other forms of social disorder, not only murder, occur with an increased frequency following executions. 2. Capital cases are inordinately more expensive than non-death penalty cases. Virtually all the resources required to prosecute and defend capital cases must come from the state-at the expense of other programs. 3. Health professionals working within a system that uses capital punish- 305 Palgrave Macmillan is collaborating with JSTOR to digitize, preserve, and extend access to Journal of Public Health Policy www.jstor.org

306 JOURNAL OF PUBLIC HEALTH POLICY * SEPTEMBER 1984 ment inevitably will find themselves in conflict between their responsibility to the ethical principles of their profession and their responsibility to their employer. LEGAL HOMICIDE TO MURDER AS A STIMULOUS AND VIOLENCE The central argument by those who supporthe death penalty is that it will serve as a deterrent to the crime of murder. But those who have studied this contention find it not in concert with the data. In 1846, Robert Rantoul, Jr. presented the first statistical evidence tllat life is considered less sacred by community members whcn the law violates the sanctity of life through execution (1). Karl Marx, writing in The New York Daily Tribune, February 18, 1853, observed that "... not only suicides but also murders of the most atrocious kind [follow] closely upon the execution of criminals." A variety of recent reviews and studies assessing deterrence and social "brutalization" following executions all come to a similar conclusion: street murder is not diminished by execution, it is stimulated (2,3,4,5,6,7). The most detailed study in this recent group is by Bowers and Pierce (8). Their conclusions support the contention that executions result in social brutalization. These authors reviewed the number of murders which occurred in the months following state executions in the State of New York from 1907 to 1963. During this span over 6oo sentences of death were carried out in the electric chair. In the two months following each execution, the actual number of homicides in the state exceeded the expected number by two or three. Homicide is a significant public health problem. It is the fifth leading cause of death for children 1 to 17 years old. Over 20,000 murders occur annually in the United States. If the executions of the more than 1000 inmates on death row each result in two or three excess murders, the results could be considered an epidemic of social violence. The prevention of between 2000 and 3000 unnecessary deaths to innocent human beings appears to be a relevant public health objective. Murder is not the only untoward event following legal homicide. In a paper by Espy (9), a vast amount of anecdotal material was reviewed. Drawn from his files of the accounts of over 12,000 executions, examples of suicides, murders, and other forms of violence following these executions are described. While not a statistically sound study, the implications of Espy's paper are clear. Violence breeds violence. Once again, public

WEISBUCH * EFFECTS OF THE DEATH PENALTY 307 health professionals must ask if it is reasonable to perpetrate an activity which results in injury and death to a large number of innocent human beings. THE COST OF CAPITAL CASES AND ITS EFFECT One of the arguments often heard from death penalty advocates is that execution will save Government resourcesince it must be cheaper to kill an individual after only a few years in prison than to keep the individual incarcerated for the remainder of his or her naturalife, which may be as long as 40 years at $20,000 per year, or $8oo,ooo. Once again the conventional wisdom falls slhort of actual fact. The criminal justice system is expensive. Incarceration is expensive. When they combine in a capital offense the process is more expensive still (10). In an effort to assess the total costs of trial, sentence, appeal and execution, the New York State Defenders Association, Inc., conducted a study of the price of the death penalty (11). The conclusions of this study are summarized in Table I. TABLE I Cost of Guilt, Penalty and Appeals Trial Phase: Establishment of Guilt Determination of Sentence Defense Costs $176,350 $176,350 Prosecution Costs 422,700 422,700 Court Costs 150,000 150,000 Total $749,050 + $749,0S0=$1,498,ioo Appeal Phase: State Court Review Federal Court Review Defense Costs $ 8o,ooo $ 85,ooo Prosecution Costs 8o,ooo 85,ooo Total $160,000 + $170,000=$ 330,000 Total Costs for Trial and Appeal $1,828,100 SOUR CE: Capital Losses: The Price ofthe Death Penalty in New York State (ii). To establish guilt and define the penalty, the defense spends an estimated $3 50,000, the prosecution, $8so,ooo; in most cases, with a poor defendent, the public pays both sides of the cost. Special court costs (sequestration of thejury, extra manpower, overhead, etc.) add another $300,000, for a total expense to determine guilt and sentence of nearly $1.5 million!

308 JOURNAL OF PUBLIC HEALTH POLICY - SEPTEMBER 1984 Moving the case through the appellate process, both state and federal, results in another series of staggering costs: over $300,000. These costs do not include the actual cost of the execution itself, which has been estimated at between $1oo,ooo and $200,000. Communication linkages, radio and TV, security around the prison, etc. all become part of the expense. To execute a human being in modem America, assuring him all the rights of due process, will cost nearly 2.0 million dollars for the average case. Complex cases will be more expensive: the Claus van Buelot case is reputed to have cost $1,000,000 on both sides for the trial portion of the process alone. The additional expenses to the correctional system for the added cost of security and protection in maintaining Death Row, and the loss of the productive work of death-sentenced prisoners in contrasto ordinary "lifers" within the prison population, were not estimated by the New York study, but should be considered part of the expense of a capital punishment system. The point of the cost argument is not that our society should reduce the cost of trial and appeal in capital cases. The rapid approach to justice found in Saudi Arabia (12), where one found guilty of murder is executed within a week of the homicide, is anathema to our system of innocence until proven guilty, and the right of due process. The point is that a capital punishment system places an incredible burden on the public treasury. In a period of tight budgets, the excess funds needed to carry out an execution will not come from new taxes. These funds will be drawn at the expense of other programs. My experience in public service is that the social services, educational services and the public health system are the areas from which scarce resources are extracted. Certainly this has been the case during the past four years of federal and state budget cuts. The past 13 years has been a period of reform in the prison health system: more financial resources, more health professionals, and better systems to provide the services have been the rule. It would be unfortunate to see these benefits degraded because the funds are siphoned off to pay for the process of capital punishment. THE CONFLICT FOR CORRECTIONAL HEALTH PROFESSIONALS A capital punishment prison system places its health providers in an untenable situation. These medical directors, physician assistants and nurse practitioners, prison pharmacists, aides and technicians are all placed in par-

WEISBUCH * EFFECTS OF THE DEATH PENALTY 309 ticular jeopardy under death penalty systems, especially those "modern" systems exploiting "death by injection." All health professionals have a responsibility to prevent illness and death when possible, to care for the sick and injured, to ease pain, and do no harm. When health professionals perform any function in the preparation of, or the conduct of an execution, they demean us all. In the past, electrocution, hanging, gas, the firing squad have not required the expertise and participation of health professionals, excepting the act of examination prior to the killing to determine that the individual is healthy enough to be killed. But, when "death by injection" is the method of choice, a cut-down may be required, or the insertion of a venous catheter. The prison physician will have to write the prescription for death, and the pharmacist will have to fill it. The preliminary examination by a nurse practitioner or physician's assistant will require more than assessment of health; it will have to determine the quality of veins, the prior history of drug reaction, the prisoner's weight for accurate dosage, etc. These actions are in conflict with the ethical principles of health professionals. Yet for many prison health workers, failure to carry out these tasks may result in the loss of one's job. The implications for the prison health system are enormous. If an individual who is unwilling to be party to capital punishment unable to work for the system, we could easily descend into the morass of ten years ago. The providers in the system who see themselves as providing a valuable service to a population in great need, but who will not be party to execution, will leave the prison environment, thereby reducing the pool of available professionals. The health care to the thousands of prisoners who are not on death row will suffer simply because of the madness to maintain the execution mentality. Is the compromise of values worth the gain? SUMMARY In summary, a state policy to perform executions is in conflict with the public's health. - Following legal homicide, private citizens are placed at greate risk of being a victim of murder or violence than prior to the execution. - The huge cost of the process places a grave burden on the system, result-

310 JOURNAL OF PUBLIC HEALTH POLICY * SEPTEMBER 1984 ing in the potential reduction in monies in the health and social service network both outside and within the prison system. - A system that performs capital punishment, especially with lethal injection, places its health providers in a crisis of conscience, forcing some to leave the system, diminishing the pool of workers, and reducing the quality of health care for the system. The roles of health provider, on the one hand, and executioner on the other, are mutually exclusive; capital punishment and the delivery of quality prison health services are also inimical. The death penalty serves no one. The executed victim is a loser. The family of t-he original victim is brutalized each time the killer becomes a media celebrity. The public loses when violence following the execution takes its toll on a few innocents; and when scarce tax dollars, used to carry out the process, are not available for use in other areas of government. The criminaljustice system loses since capital cases absorb an inordinate volume of time and resources. The correctional system gains nothing either, only more headachcs, more expense, more adverse publicity, and the withdrawal of quality workers who will not serve a system that kills. We are all losers when a system seeks vengeance rather than justice. What an absurdity! Ackniowledgment: This editorial is based on a paper presented on November 14, 1983, at the Annual Meeting of the American Public Health Association in Dallas, Texas, at a session sponsored by the New Professionals Section. REFERENCES i. Hamilton, L., ed. The Memoirs, Speeches, and Writings of Robert Rantoul, Jr. Boston: John P. Jewett, publishers, 1854, p. 494. 2. Zeisel. H. "The Deterrent Effect of the Death Penalty: Facts v. Faith", in Kurland, P., ed. The Supreme Court Review, 1976. Chicago: University of Chicago Press, 1977. 3. Bailey, W. C. "Deterrence and the Celerity of the Death Penalty: A Neglected Question in Deterrence Research," Social Forces 58 (1980): 1308-33. 4. Dann, R. H. "The Deterrent Effect of Capital Punishment," Friends Social Science Review 29 (1935): 1. s. Savitz, L. "A Study in Capital Punishment," J. Criminal Law, Criminology and Police Science 49 (1958): 3 3 8-41.

WEISBUCH - EFFECTS OF THE DEATH PENALTY 311 6. Graves, W. F. "A Doctor Looks at Capital Punishment," J. Loma Linda University School of Medicine 10 (1956): 137. 7. King, D. R. "The Brutalizing Effect: Execution Publicity and the Incidence of Homicide in South Carolina," Social Forces 57 (1978): 683-87. 8. Bowers, W. and G. Pierce, "Deterrent or Brutalization: What Is the Effect of Executions?" Crime and Delinquency 26 (1980): 453-84. 9. Espy, M. W. "Capital Punishment and Deterrence: What the Statistics Cannot Show," Crime and Delinquency 26 (1980): 537-44. 1o. In the landmark case, Furman v. Georgia, 408 U.S. 238, 357-8:1972, Justice Marshall concluded his arguments regarding the cost issue with the following: " When all is said and done, there can be no doubthat it costs more to execute a man than to keep him in prisonfor life." ii. New York State Defenders Association, Inc. "Capital Losses: the Price of the Death Penalty for New York State," A Report from the Public Defense Backup Center to the Senate Finance Committee, the Assembly Ways and Means Committee and the Division of the Budget, April 1, 1982. 12. AMA News, Jan 21, 1982, p. 3.