Lethal Injection

What is lethal injection?

Lethal injection is the practice of killing a person using a lethal dose of drugs administered intravenously. Two methods of lethal injection exist today, one using a three-drug protocol and another using one large dose of a barbiturate.

Each state that employs lethal injection is legally required to have detailed protocols for its practice, and though the set of rules differ from state to state, the process of killing a condemned inmate varies little, and begins with the lethal injection team securing the inmate to a gurney and connecting him to an electrocardiogram (EKG) machine that monitors heart activity. Inserted into the inmate's veins are two intravenous lines (one as a backup) that lead out of a separate infusion room, where members of the intravenous team monitor the initial harmless saline drip.

At the warden's signal, the execution chamber is exposed to witnesses in an adjoining room, and in states that use the three-drug protocol the inmate is injected with sodium thiopental or pentobarbital, anesthetics intended to put the inmate to sleep. Presumably after a member of the intravenous team determines the inmate is sufficiently unconscious, he is then injected with pancuronium bromide, which paralyzes the entire muscle system and stops the inmate's breathing. In most cases, the inmate's consciousness is again checked, and finally potassium chloride stops his heart. In ideal circumstances, death results from anesthetic overdose and respiratory and cardiac arrest while the condemned person is unconscious.

The process of lethal injection using just one drug follows nearly the same procedure, except the inmate dies from the one large dose of anesthetic, either sodium thiopental or pentobarbital.

[Sources: Death Penalty Information Center, California Department of Corrections and Rehabilitation (pdf)]

History of Lethal Injection

Physicians in Nazi Germany initially used lethal injection in the course of the Nazi euthanasia program against the country's physically and intellectually disabled children and adults in the late 1930s and early 1940s (referred to now as Action T4). Poison gas was adopted later as lethal injection became prohibitively expensive.

After the Supreme Court reinstated the death penalty in 1976 following a four-year hiatus, the U.S. ventured into the lethal injection game in 1977, when a young Oklahoma pastor and legislator named Bill Wiseman and the state's medical examiner, Jay Chapman, made an attempt to develop a method of executing inmates that would be less gruesome than electrocution. Though Wiseman has since come out against the death penalty, Oklahoma became the first of many states to adopt lethal injection as a means of executing inmates.

Lethal injection was first used in the United States on December 2, 1982, when the State of Texas killed Charles Brooks, Jr. California used lethal injection for the first time on William Bonin, in 1996, after a court ruled in 1994 that using lethal gas (then the method of execution) constituted "cruel and unusual punishment," in opposition to the Constitution's Eighth Amendment. Today, 35 of the 36 states that retain the death penalty use this method of execution.

China, by far the world's most active executioner (though they don't report the number, it is believed to be in the thousands every year), began phasing out its use of firing squads in 1997 in favor of lethal injection, which is commonly thought to be more humane, but also reduces the risk of spreading disease among the execution team. Thailand, Guatemala, the Philippines, have also adopted lethal injection since 1997, though the latter two have since abolished the death penalty.

[Sources: U.S. Holocaust Memorial Museum, Mother Jones, Sept./Oct. 2005, pg.34-39, Amnesty International (pdf), Death Penalty Information Center]

Read the full text of the article "A Guilty Man" in Mother Jones magazine.

Recent Developments

Shortly after the only U.S. manufacturer of sodium thiopental, Hospira Inc., ran low on the raw materials necessary to produce the barbiturate in 2009, they exited the thiopental market completely in 2010 under pressure from the European death penalty abolitionist countries that house the company's factories. This prompted a number of states to scramble to find a thiopental source from overseas, with many turning to a dingy pharmaceutical wholesaler in London by the name of DreamPharma. The handful of states that were successful in obtaining thiopental before the U.K. banned its export for use in lethal injections then engaged in a legally questionable drug trade that had corrections officials skirting federal drug laws to allow thiopental into the country from overseas suppliers without oversight from the Food and Drug Administration. Those states then went on to swap the thiopental without testing the drug's efficacy, and several have had their thiopental stocks confiscated by the FDA in 2011, while others continue to use the tainted stocks in executions. Among the states with possibly tainted thiopental that once came from DreamPharma or an Indian supplier named Kayem Pharmaceutical are Alabama, Arizona, Arkansas, California, Georgia, Kentucky, Nebraska, South Carolina, South Dakota, and Tennessee.

Several states have already changed their lethal injection protocols to allow for the use of the more readily available pentobarbital - long used to euthanize animals - in place of sodium thiopental, including Mississippi, Ohio, Oklahoma, Texas, and Virginia.

[Sources: NY Times, Associated Press, KALW]

Follow The Informant's coverage of the lethal injection scramble at KALW.

Problems Associated with Lethal Injection

Two men from Georgia and one from Arizona were executed in 2011 using thiopental the states purchased from a DreamPharma in London. All three inmates reportedly kept their eyes open long after the sodium thiopental was administered, which indicates the drug was ineffective in sedating them. The inmates would then have experienced excruciating pain, but would have been unable to express it, while the two final drugs used in the protocol paralyzed them, stopped their breathing, and induced cardiac arrest. In cases such as these, protocols for assessing the consciousness of the inmates were not followed, calling into question how the rules can be reliably enforced. Without following the protocols, corrections officials unwittingly become torturers, as the drugs they administer cause inmates great pain.

Another issue surrounding lethal injection is the involvement of medical personnel. Though doctors and nurses are presumably the most qualified to administer drugs to an inmate, medical ethics preclude doctors from participating in executions. The American Medical Association issued a statement prohibiting physician involvement in capital punishment, saying it is contrary to the Hippocratic Oath and would erode the public's trust in medical professionals. The American Nurses Association and the American Society of Anesthesiologists have both adopted similar positions. The result is that lethal injections are too often carried out by inexperienced technicians and orderlies, increasing the possibility of mistakes that can cause painful or drawn out executions.

A number of high profile executions have been botched when technicians inadvertently injected drugs into an inmate's muscle or the execution team was unable to find a vein due to the inmate's past intravenous drug use.

Visit the Death Penalty Information Center for a list of well-known botched executions from the past 30 years.

[Source: KALW, Death Penalty Information Center]

Additional Resources

UC Berkeley's Death Penalty Clinic has gathered legal resources and journal articles and organized it into this lethal injection clearinghouse.

California Lethal Injection Protocols (pdf)

California Executions Remain on Hold Through 2011, San Jose Mercury News. May 3, 2011.

Georgia Execution Drug is Seized, Wall Street Journal. March 16, 2011.

A Brief History of Lethal Injection,Time Magazine. Nov. 10, 2009.

In the Eye of the Storm: A Judge's Experience In Lethal Injection Litigation, Jeremy Fogel. Fordham Urban Law Journal, 35. June 2008.

The Pharmacokinetics and Pharmacodynamics of Thiopental as Used in Lethal Injection For Execution(pdf) Mark Dershwitz & Thomas K. Henthorn. Fordham Urban Law Journal, 35. June 2008.

So Long as They Die: Lethal Injections in the United States, Human Rights Watch. April 2006.

When Law and Ethics Collide - Why Physicians Participate in Executions, Atul Gawande. New England Journal of Medicine, 354. March 2006.


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