Nursing Inquiry 2003; 10(2): 140–141

R e s p o n s e

© 2003 Blackwell Publishing Ltd

Blackwell Publishing Ltd.

Response to Professor Sandelowski: Capital crimes

FEARLESS SPEECH: RISKS AND DANGERS OF PARRHÈSIA

Health care professionals working in prisons and assistingwith the process of administering death is not a new reality.Joe Sim’s, Medical power in prisons: The prison medical service inEngland, 1774–1988 (Sim 1990), explains this process indetail, beginning even before the birth of the United States ofAmerica. The point of our article, ‘Killing for the state’ (Holmesand Federman 2003), was to describe that involvementin one particular area of criminal policy: the death penalty,and in regards to one group of actors: health care profes-sionals. It bears mention here that nursing has not beenwithout stain regarding its involvement in shameful eventsin political and medical history. Nurses (and other healthprofessionals) were involved in the administration of deathduring the infamous Tuskegee Syphilis Study and theHolocaust (see Hornblum 1999; Benedict 2003a,b). So too,human rights abuses in psychiatric hospitals in the formerSoviet Union were carried out by health personnel. In allthese cases nurses were shielded by a conspiracy of silence.

Despite risks and dangers, scholars have the obligationof parrhèsia. As Michel Foucault wrote:

Parrhèsia is a kind of verbal activity where the speaker has aspecific relation to truth through frankness, a certain rela-tionship to his own life through dangers, a certain type ofrelation to himself or other people through criticism … ,and a specific relation to moral law through freedom andduty. In parrhèsia the danger always stems from the fact thatthe communicated truth is capable of hurting or angeringthe interlocutor. (Pearson 2001, 17)

Professor Sandelowski’s response (Sandelowski 2003) toour article not only illustrates the anger and frustrationbut also the distress provoked by the sensitive nature of thecapital punishment issue in the US. Nonetheless, it must beacknowledged that despite the code of silence around theindividual nurses and doctors involved, the capital punish-ment apparatus in the US — which last year killed 71 persons— is not self-executing.

This being said, we shall try to answer some of the ques-tions raised by our colleague. Nowhere in the paper did wewrite that killing was a ‘sign’ of American nursing, nor did we

equate American nursing with killing. In fact, even our titlemakes this clear: killing for the state is the darkest side ofAmerican nursing, and a disturbing reality nonetheless. Weprovided numerous examples of the legislative provision forhealth care professionals (namely nurses) to enact the capitalpunishment process, while also providing clear evidenceof the ANA’s opposition to such nursing practices. There-fore, we believe that our work provided readers with suffi-cient information regarding the tensions between nursingethics and the administration of capital punishment.

Despite the ANA’s statement regarding the participationof nurses in capital punishment, statutes and other sourcesclearly demonstrate that nurses, among others, are involveddirectly or indirectly in the process of killing condemnedinmates. These statutes allow nurses to participate in capitalpunishment while shielding their identities from publicscrutiny. We simply, but clearly, indicated that killing for thestate is an American nursing reality. It is impossible to quan-tify under current restrictions, but it is nonetheless real.

The medical profession seems more courageous in itsquest to understand the ethical breach posed by physicians’participation in the capital punishment process. Researchresults (Farber et al. 2001) published in the Annals of InternalMedicine, provide further evidence in support of our posi-tion. In effect, a survey asked physicians the following ques-tion: Do you think patients suffer less when a physicianperforms an execution via lethal injection than when anyother groups, such as nurse practitioners or prison personnel,perform them? (2001, 885).

As members of a professional community, we stronglybelieve that nurses around the world have the right to beinformed and to engage in debate regarding the involve-ment of our colleagues in the capital punishment processin the United States. Our previous work on the subject,shunned by American nursing journals, was published inPunishment & Society, a top-tier peer-reviewed internationaljournal of criminology and penology.

Parrhèsia involves risks and dangers for those who dare tospeak out. We chose to speak out and share our research inthis nursing journal because we believe the issue is important,worthy of debate, and linked to nursing ethics. This paperwas and remains an invitation to debate in a scholarly way.

Response to Professor Sandelowski: Capital crimes

© 2003 Blackwell Publishing Ltd, Nursing Inquiry 10(2), 140–141 141

REFERENCES

Benedict S. 2003a. Caring while killing: Nursing in the‘Euthanasia’ centers. In Experience and expression: Women,the Nazis, and the Holocaust, eds E Baer and M Goldenberg.Detroit: Wayne State University Press.

Benedict S. 2003b. The nadir of nursing: Nurse perpetratorsof the Ravensbruck Concentration Camp. Nursing His-tory Review, 11.

Farber NJ, BM Aboff, J Weiner, EB Davis, EG Boyer, andPA Ubel. 2001. Physicians’ willingness to participate inthe process of lethal injection for capital punishment.Annals of Internal Medicine 135(10): 884–888.

Holmes D, and C Federman. 2003. Killing for the state: The

darkest side of American nursing. Nursing Inquiry 10(1):2–10.

Hornblum A. 1999. Acres of skin. London: Routledge.Pearson P. 2001. Michel Foucault: Fearless speech. Los Angeles:

Semiotext (e).Sandelowski M. 2003. Capital crimes. Nursing Inquiry 10(2):

139.Sim J. 1990. Medical power in prisons: The prison medical service in

England, 1774–1988. Buckingham: Open University Press.

Dave HolmesUniversity of Ottawa

Cary FedermanDuquesne University