There has been much press coverage recently on the constitutionality of California's method of executing prisoners by lethal injection, and the ethical propriety of providing any role for physicians in ensuring that such procedures do not inflict unnecessary pain and suffering on the person being executed.

The legal argument that has been made by attorneys for Michael Morales, the prisoner who was scheduled to be executed by lethal injection, is that this form of execution constitutes cruel and unusual punishment in violation of the Eighth Amendment to the Constitution because there is a possibility that the prisoner will remain conscious during some portion of the execution process, despite the initial administration of a drug intended to render him unconscious.

In response to arguments by Morales' attorneys, a U.S. District Court Judge for the Northern District of California issued a stay of the execution until the State of California agreed to have an anesthesiologist present in the room with the prisoner (and another standing by) to insure that he had been rendered unconscious before the execution proceeded.

Subsequently, the two anesthesiologists declined to participate in the execution. While their identity remains confidential, the physicians explained their decision in the following terms: "While we contemplated a positive role that might enable us to verify a humane execution protocol for Mr. Morales, what is being asked of us now is ethically unacceptable. As a result, we have withdrawn from participation in this current process."

Instead of simply verifying that the prisoner had been rendered unconscious by the first drug (sodium pentothal) of a three-drug execution process, the physicians were being asked to supervise the administration of a single lethal dose of barbiturates.

The execution has now been indefinitely postponed, and the federal court has scheduled a full hearing on these issues in May.

Physicians participate in executions in most states, but only to the very limited extent of certifying death. Nevertheless, there are widely divergent views concerning the ethics of a physician playing any role in an execution whatsoever.

The original order by the federal District Court was to the effect that anesthesiologists should be present at the execution of the prisoner Morales solely to ensure that he did not experience unnecessary pain or physical suffering. The California Medical Association and the American Society of Anesthesiologists have condemned physician involvement in any way as contrary to the physician's responsibility to act only for the benefit of patients. Those positions are consistent with the previously articulated position of the American Medical Association.

The Medical Board of California, on the other hand, has declared that the California Medical Practice Act does not preclude physician participation in executions, and a physician who chooses to be present would not be subject to disciplinary action for unprofessional conduct.

Many individuals and organizations have stated that it is very problematic for a physician to be present and to participate in a state-sanctioned execution of an unwilling person. Because the mere presence of a physician at the time of the execution can be construed to give it a further legitimacy, a physician who is contemplating such a role must very carefully balance the laudable objective of ensuring that the condemned person does not experience pain and suffering with the unavoidable result that the physician's participation would also enable the execution to go forward.

These are extremely complex ethical issues and it is important that they be directly and forthrightly confronted. The hearing scheduled for May offers an excellent opportunity to do so.

Physicians in California and across the nation, as well as the associations that represent them and the agencies which license and review their professional practice, should diligently pursue some measure of ethical and professional consensus that can responsibly guide future conduct.

Ben Rich is an associate professor of bioethics. For more details, see bioethics.ucdavis.edu.