Lethal injection
Encyclopedia
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
, paralytic
Neuromuscular-blocking drug
Neuromuscular-blocking drugs block neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. This is accomplished either by acting presynaptically via the inhibition of acetylcholine synthesis or release or by acting postsynaptically at the...
, and potassium solution
Potassium chloride
The chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...
) for the express purpose of causing the immediate death of the subject. The main application for this procedure is capital punishment
Capital punishment
Capital punishment, the death penalty, or execution is the sentence of death upon a person by the state as a punishment for an offence. Crimes that can result in a death penalty are known as capital crimes or capital offences. The term capital originates from the Latin capitalis, literally...
, but the term may also be applied in a broad sense to euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
and suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
. It kills the person by first putting the person to sleep, then stopping the breathing and heart in that order.
Lethal injection gained popularity in the twentieth century as a form of execution intended to supplant other methods, notably electrocution
Electric chair
Execution by electrocution, usually performed using an electric chair, is an execution method originating in the United States in which the condemned person is strapped to a specially built wooden chair and electrocuted through electrodes placed on the body...
, hanging
Hanging
Hanging is the lethal suspension of a person by a ligature. The Oxford English Dictionary states that hanging in this sense is "specifically to put to death by suspension by the neck", though it formerly also referred to crucifixion and death by impalement in which the body would remain...
, firing squad
Execution by firing squad
Execution by firing squad, sometimes called fusillading , is a method of capital punishment, particularly common in the military and in times of war.Execution by shooting is a fairly old practice...
, gas chamber
Gas chamber
A gas chamber is an apparatus for killing humans or animals with gas, consisting of a sealed chamber into which a poisonous or asphyxiant gas is introduced. The most commonly used poisonous agent is hydrogen cyanide; carbon dioxide and carbon monoxide have also been used...
, and beheading
Decapitation
Decapitation is the separation of the head from the body. Beheading typically refers to the act of intentional decapitation, e.g., as a means of murder or execution; it may be accomplished, for example, with an axe, sword, knife, wire, or by other more sophisticated means such as a guillotine...
, that were considered to be more painful. It is now the most common form of execution in the United States of America
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
.
The concept of lethal injection as a means of putting someone to death was first proposed on January 17, 1888 by Julius Mount Bleyer
Julius Mount Bleyer
Julius Mount Bleyer was the New York doctor who first proposed lethal injection on 17 January 1888.-References:Julius Mount Bleyer is related to the Bleyers of Temora in New South Wales, Australia...
, a New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
doctor who praised it as being cheaper than hanging
Hanging
Hanging is the lethal suspension of a person by a ligature. The Oxford English Dictionary states that hanging in this sense is "specifically to put to death by suspension by the neck", though it formerly also referred to crucifixion and death by impalement in which the body would remain...
. Bleyer's idea, however, was never used. The British Royal Commission
Royal Commission
In Commonwealth realms and other monarchies a Royal Commission is a major ad-hoc formal public inquiry into a defined issue. They have been held in various countries such as the United Kingdom, Australia, Canada, New Zealand, and Saudi Arabia...
on Capital Punishment (1949–53) also considered lethal injection, but eventually rejected it after pressure from the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
(BMA).
On May 11, 1977, Oklahoma
Oklahoma
Oklahoma is a state located in the South Central region of the United States of America. With an estimated 3,751,351 residents as of the 2010 census and a land area of 68,667 square miles , Oklahoma is the 28th most populous and 20th-largest state...
's state medical examiner, Jay Chapman, proposed a new, less painful method of execution, known as Chapman's Protocol: "An intravenous
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
drip shall be started in the prisoner's arm, into which shall be introduced a lethal injection consisting of an ultra-short-acting barbiturate
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
in combination with a chemical paralytic." After being approved by anesthesiologist
Anesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....
Stanley Deutsch, Reverend Bill Wiseman introduced the method into the Oklahoma legislature where it passed and was quickly adopted (Title 22, Section 1014(A)). Since then, until 2004, thirty-seven of the thirty-eight states using capital punishment introduced lethal injection statutes. On August 29, 1977, Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...
adopted the new method of execution from the electric chair to lethal injection. On December 7, 1982, Texas became the first state to use lethal injection to carry out capital punishment, for the execution of Charles Brooks, Jr.
Charles Brooks, Jr.
Charles Brooks, Jr. was a convicted murderer who was the first person executed by the state of Texas since it resumed capital punishment. Brooks was also the first person in United States to be executed using lethal injection.-Biography:Brooks was raised in a well-off Fort Worth, Texas family and...
.
The People's Republic of China
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...
began using this method in 1997, Guatemala
Guatemala
Guatemala is a country in Central America bordered by Mexico to the north and west, the Pacific Ocean to the southwest, Belize to the northeast, the Caribbean to the east, and Honduras and El Salvador to the southeast...
in 1998, the Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
in 1999, Thailand
Thailand
Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...
in 2003, and Taiwan
Taiwan
Taiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
in 2005. Vietnam
Vietnam
Vietnam – sometimes spelled Viet Nam , officially the Socialist Republic of Vietnam – is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea –...
reportedly now uses this method. The Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
has since abolished the death penalty.
Nazi Germany
Nazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...
's T-4 Euthanasia Program used lethal injection as one of several methods to destroy what the Nazi government dubbed "life unworthy of life
Life unworthy of life
The phrase "life unworthy of life" was a Nazi designation for the segments of populace which had no right to live and thus were to be "euthanized". The term included people with serious medical problems and those considered grossly inferior according to racial policy of the Third Reich...
".
Lethal injection has also been used in cases of euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
to facilitate voluntary death in patients with terminal or chronically painful conditions. Both applications have used similar drug combinations.
Procedure in China executions
The People's Republic of China used to exclusively execute prisoners by means of shooting, but has been changing over to lethal injection in recent years. The specific lethal injection procedures, including the drug or drugs used, are a state secret and not widely known. In at least some cases, prisoners facing death by lethal injection have been sedated at a prison, then placed inside an execution van that is disguised to look like a regular police van.Procedure in U.S. executions
The condemned person is strapped onto a gurneyGurney
A gurney, known as a trolley in British medical context, is the U.S. term for a type of stretcher used in modern hospitals and ambulances in developed areas. A hospital gurney is a kind of narrow bed on a wheeled frame which may be adjustable in height. For ambulances, a collapsible gurney is a...
; two intravenous cannula
Cannula
A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...
e ("IVs") are inserted, one in each arm. Only one is necessary to carry out the execution; the other is reserved as a backup in the event the primary line fails. A line leading from the IV Line
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
in an adjacent room is attached and secured to the prisoner's IV, and secured so the line does not snap during the injections.
The arm of the condemned person is swabbed with alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
before the cannula is inserted. The needles and equipment used are also sterilized. There have been questions about why these precautions against infection are performed despite the purpose of the injection being death. There are several explanations: cannulae are sterilized during manufacture, so using sterile ones is routine medical procedure. Secondly, there is a chance that the prisoner could receive a stay of execution
Stay of execution
A stay of execution is a court order to temporarily suspend the execution of a court judgment or other court order. The word "execution" does not necessarily mean the death penalty; it refers to the imposition of whatever judgment is being stayed....
after the cannulae have been inserted, as happened in the case of James Autry
James Autry
James David Autry was a convicted murderer in the U.S. state of Texas, executed by lethal injection....
in October 1983 (he was eventually executed on March 14, 1984). Finally, it would be a hazard to prison personnel to use unsterilized equipment.
Following connection of the lines, saline drips are started in both arms. This too is standard medical procedure: it must be ascertained that the IV lines are patent, ensuring that the chemicals do not mix in the IV lines and occlude the needle, preventing the drugs from reaching the subject. A heart monitor is attached so that prison officials can monitor when death has occurred.
The intravenous injection
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
is usually a series of drugs given in a set sequence, designed to first induce unconsciousness
Unconsciousness
Unconsciousness is the condition of being not conscious—in a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. Being in a comatose state or coma is a type of unconsciousness. Fainting due to a drop in blood pressure and a...
followed by death through paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
of respiratory muscles and/or by cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
through depolarization
Depolarization
In biology, depolarization is a change in a cell's membrane potential, making it more positive, or less negative. In neurons and some other cells, a large enough depolarization may result in an action potential...
of cardiac muscle
Cardiac muscle
Cardiac muscle is a type of involuntary striated muscle found in the walls and histologic foundation of the heart, specifically the myocardium. Cardiac muscle is one of three major types of muscle, the others being skeletal and smooth muscle...
cells. The execution of the condemned in most states involves three separate injections (in sequential order):
- Sodium thiopentalSodium thiopentalSodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...
or pentobarbitalPentobarbitalPentobarbital is a short-acting barbiturate that was first synthesized in 1928. Pentobarbital is available as both a free acid and a sodium salt, the former of which is only slightly soluble in water and ethanol....
: ultra-short action barbiturate, an anaesthetic agent capable of rendering the prisoner unconscious in a few seconds. - Pancuronium bromide: non-depolarizing muscle relaxant, causes complete, fast and sustained paralysis of the skeletal striated muscles, including the diaphragm and the rest of the respiratory muscles; this would eventually cause death by asphyxiaAsphyxiaAsphyxia or asphyxiation is a condition of severely deficient supply of oxygen to the body that arises from being unable to breathe normally. An example of asphyxia is choking. Asphyxia causes generalized hypoxia, which primarily affects the tissues and organs...
tion. - Potassium chloridePotassium chlorideThe chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...
: stops the heart, and thus causes death by cardiac arrestCardiac arrestCardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
.
The drugs are not mixed externally as that can cause them to precipitate
Precipitation (chemistry)
Precipitation is the formation of a solid in a solution or inside anothersolid during a chemical reaction or by diffusion in a solid. When the reaction occurs in a liquid, the solid formed is called the precipitate, or when compacted by a centrifuge, a pellet. The liquid remaining above the solid...
. Also, a sequential injection is key to achieve the desired effects in the appropriate order: administration of the barbiturate is essential to minimize physical distress during the process; the infusion of the muscle relaxant induces complete paralysis but not unconsciousness, and the injection of a highly concentrated solution of potassium chloride can cause severe pain in the site of the IV line as well as along the punctured arm.
The intravenous tubing leads to a room next to the execution chamber, usually separated from the offender by a curtain or wall. Typically a prison employee trained in venipuncture
Venipuncture
In medicine, venepuncture, venopuncture or venipuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. This procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics,...
inserts the needle, while a second prison employee orders, prepares and loads the drugs into the lethal injection syringes. Two other staff members take each of the three syringes and secure them into the IVs. After the curtain is opened to allow the witnesses to see inside the chamber, the condemned offender is then permitted to make a final statement. Following this, the warden will signal that the execution may commence, and the executioner(s) (either prison staff or private citizens depending on the jurisdiction) will then manually inject the three drugs in sequence. During the execution, the condemned's cardiac rhythm is monitored. Death is pronounced after cardiac activity stops. Death usually occurs within seven minutes, although the whole procedure can take up to two hours, as was the case with the execution of Christopher Newton
Christopher Newton (criminal)
Christopher J. Newton was an American criminal whose 2007 execution by the state of Ohio motivated additional discussion about executions by lethal injection....
on May 24, 2007. According to state law, if a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
's participation in the execution is prohibited for reasons of medical ethics, then the death ruling can be made by the state Medical Examiner's Office. After confirmation that death has occurred, a coroner
Coroner
A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...
signs the condemned’s death certificate.
In three states (Delaware
Delaware
Delaware is a U.S. state located on the Atlantic Coast in the Mid-Atlantic region of the United States. It is bordered to the south and west by Maryland, and to the north by Pennsylvania...
, Illinois
Illinois
Illinois is the fifth-most populous state of the United States of America, and is often noted for being a microcosm of the entire country. With Chicago in the northeast, small industrial cities and great agricultural productivity in central and northern Illinois, and natural resources like coal,...
and Missouri
Missouri
Missouri is a US state located in the Midwestern United States, bordered by Iowa, Illinois, Kentucky, Tennessee, Arkansas, Oklahoma, Kansas and Nebraska. With a 2010 population of 5,988,927, Missouri is the 18th most populous state in the nation and the fifth most populous in the Midwest. It...
) there is a lethal injection machine designed by Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
-based Fred A. Leuchter
Fred A. Leuchter
Frederick A. Leuchter, Jr. is an American Federal Court qualified expert in execution technology and author of forensic Holocaust denial material. He claims to have improved the design of instruments for capital punishment and had execution equipment contracts with several states...
that comprises two components: the delivery module and the control module. Two staff members each have a station in which they key the machine on and depress two stations buttons to be ready in case of mechanical failure. Each person presses one station button on the console which travels to a computer which starts all three injections electronically. The computer then deletes who actually started the syringes so that participants are not aware if their syringe contained saline or one of the drugs necessary for execution (to assuage guilt in a manner similar to the blank cartridge in execution by firing squad
Execution by firing squad
Execution by firing squad, sometimes called fusillading , is a method of capital punishment, particularly common in the military and in times of war.Execution by shooting is a fairly old practice...
). The delivery module has eight syringes. The end syringes containing saline, syringes 2, 4, 6 containing the lethal drugs for the main line and syringes 1, 3, 5 containing the injections for the back-up line. The system was used in New Jersey before the abolition of the death penalty in 2007. Illinois previously used the computer, and Missouri and Delaware use the manual injection switch on the delivery panel.
In 2011, after pressure by activist organizations, the manufacturers of sodium thiopental
Sodium thiopental
Sodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...
and pentobarbital
Pentobarbital
Pentobarbital is a short-acting barbiturate that was first synthesized in 1928. Pentobarbital is available as both a free acid and a sodium salt, the former of which is only slightly soluble in water and ethanol....
halted supply of the drugs to U.S. prisons performing lethal injections and required all resellers to do the same.
Conventional lethal injection protocol
Typically, three drugs are used in lethal injection: sodium thiopentalSodium thiopental
Sodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...
is used to induce unconsciousness; pancuronium bromide (Pavulon) to cause muscle paralysis and respiratory arrest; and potassium chloride
Potassium chloride
The chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...
to stop the heart.
Sodium thiopental
- Lethal injection dosage: 2-5 grams
Sodium thiopental (US trade name: Sodium Pentothal) is an ultra-short acting barbiturate, often used for anesthesia induction and for medically induced coma. The typical anesthesia induction dose is 3–5 mg/kg. Loss of consciousness is induced within 30–45 seconds at the typical dose, while a 5 gram dose 14 times the normal dose is likely to induce unconsciousness in 10 seconds.
Thiopental reaches the brain within seconds of the total dose in about 30 seconds. At this level, when used in medicine, the patient is unconscious. Within 5 to 20 minutes the percentage in the brain falls to about 15% of the total dose, since the drug redistributes to the rest of the body.
The half-life
Half-life
Half-life, abbreviated t½, is the period of time it takes for the amount of a substance undergoing decay to decrease by half. The name was originally used to describe a characteristic of unstable atoms , but it may apply to any quantity which follows a set-rate decay.The original term, dating to...
of this drug is about 11.5 hours, and the concentration in the brain remains at around 5-10% of the total dose during that time. When a 'mega-dose' is administered, as in state-sanctioned lethal injection, the concentration in the brain during the tail phase of the distribution remains higher than the peak concentration found in the induction dose for anesthesia. This is the reason why an ultra-short acting barbiturate, such as thiopental, can be used for long-term induction of medical coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
.
Historically, thiopental has been one of the most commonly used and studied drugs
DRUGS
Destroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...
for the induction of coma. Protocols vary for how it is given, but the typical doses are anywhere from 500 mg up to 1.5 grams. It is likely that this data was used to develop the initial protocols for state-sanctioned lethal injection, according to which one gram of thiopental was used to induce the coma. Now, most states use 5 grams to be absolutely certain the dosage is effective.
Barbiturates are the same class of drug used in medically assisted suicide, but it is the only drug used, in contrast to the three-drug cocktail typically employed for capital punishment. In euthanasia protocols, the typical dose of thiopental is 1.5 grams. The dose used for capital punishment is therefore about 3 times more than the dose used in euthanasia.
Pancuronium bromide (Pavulon)
- Lethal injection dosage: 100 milligrams
Pancuronium bromide (Trade name: Pavulon): The related drug curare
Curare
Curare is a common name for various arrow poisons originating from South America. The three main types of curare are:* tubocurare...
, like pancuronium, is a non-depolarizing muscle relaxant
Neuromuscular-blocking drug
Neuromuscular-blocking drugs block neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. This is accomplished either by acting presynaptically via the inhibition of acetylcholine synthesis or release or by acting postsynaptically at the...
(a paralytic agent) that blocks the action of acetylcholine
Acetylcholine
The chemical compound acetylcholine is a neurotransmitter in both the peripheral nervous system and central nervous system in many organisms including humans...
at the motor end-plate of the neuromuscular junction
Neuromuscular junction
A neuromuscular junction is the synapse or junction of the axon terminal of a motor neuron with the motor end plate, the highly-excitable region of muscle fiber plasma membrane responsible for initiation of action potentials across the muscle's surface, ultimately causing the muscle to contract...
. Binding of acetylcholine to receptors on the end-plate causes depolarization and contraction of the muscle fiber; non-depolarizing neuromuscular blocking agents like pancuronium stop this binding from taking place.
The typical dose for pancuronium bromide in capital punishment by lethal injection is 0.2 mg/kg and the duration of paralysis is around 4 to 8 hours. Paralysis of respiratory muscles will lead to death in a considerably shorter time.
Other drugs in use are tubocurarine chloride and succinylcholine chloride
Suxamethonium chloride
Suxamethonium chloride , also known as suxamethonium or succinylcholine, is a paralytic drug used to induce muscle relaxation and short-term paralysis, usually to facilitate tracheal intubation. Suxamethonium is sold under the trade names Anectine, Quelicin, and Scoline. It is used as a paralytic...
.
Pancuronium bromide is a derivative of the alkaloid
Alkaloid
Alkaloids are a group of naturally occurring chemical compounds that contain mostly basic nitrogen atoms. This group also includes some related compounds with neutral and even weakly acidic properties. Also some synthetic compounds of similar structure are attributed to alkaloids...
malouetine from the plant Malouetia bequaertiana. http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2044.2000.01423.x
Potassium chloride
- Lethal injection dosage: 100 mEq (milliequivalents)
Potassium
Potassium
Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...
is an electrolyte, 98% of which is intracellular. The 2% remaining outside of the cell has great implications for cells that generate action potentials. Doctors prescribe potassium for patients when there is insufficient potassium, called hypokalemia
Hypokalemia
Hypokalemia or hypokalaemia , also hypopotassemia or hypopotassaemia , refers to the condition in which the concentration of potassium in the blood is low...
, in the blood. The potassium can be given orally, which is the safest route; or it can be given intravenously, in which case there are strict rules and hospital protocols on the rate at which it is given.
The usual intravenous dose is 10-20 mEq per hour and it is given slowly since it takes time for the electrolyte to equilibrate into the cells. When used in state-sanctioned lethal injection, bolus potassium injection affects the electrical conduction of heart muscle. Elevated potassium, or hyperkalemia
Hyperkalemia
Hyperkalemia refers to the condition in which the concentration of the electrolyte potassium in the blood is elevated...
, causes the resting electrical potential of the heart muscle cells to be lower than normal (more positive). Without a negative resting potential, cardiac cells cannot generate impulses that lead to contraction.
Depolarizing the muscle cell inhibits its ability to fire by reducing the available number of sodium channels (they are placed in an inactivated state). ECG changes include faster repolarization (peaked T-waves), PR interval prolongation, widening of the QRS, and eventual sine-wave formation and asystole
Asystole
In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow...
. Cases of patients dying from hyperkalemia (usually secondary to renal failure) are well known in the medical community, where patients have been known to die very rapidly, having previously seemed to be normal.
Potassium chloride is also used in certain abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
s to terminate pregnancies. (See, e.g., Justice Anthony Kennedy
Anthony Kennedy
Anthony McLeod Kennedy is an Associate Justice of the United States Supreme Court, having been appointed by President Ronald Reagan in 1988. Since the retirement of Sandra Day O'Connor, Kennedy has often been the swing vote on many of the Court's politically charged 5–4 decisions...
's description in the U.S. Supreme Court's opinion in Gonzales v. Carhart
Gonzales v. Carhart
Gonzales v. Carhart, 550 U.S. 124 , is a United States Supreme Court case that upheld the Partial-Birth Abortion Ban Act of 2003. The case reached the high court after U.S. Attorney General Alberto Gonzales appealed a ruling of the United States Court of Appeals for the Eighth Circuit in favor of...
http://www.law.cornell.edu/supct/html/05-380.ZO.html.)
It is also used in cardioplegia (cardo-Heart; plegia-paralysis) solutions used to arrest the heart during cardiac surgeries performed on a heart-lung machine.
New lethal injection protocols
The OhioOhio
Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus...
protocol, developed after the incomplete execution of Romell Broom
Romell Broom
Romell Broom is an American convicted of murder, kidnapping, and rape. He was convicted in 1984 of abducting and killing Tryna Middleton, age 14, who was walking home from a football game in East Cleveland, Ohio. In 2003, Broom took up an offer from the state of Ohio for a DNA test to prove his...
, ensures the rapid and painless onset of anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
by only using sodium thiopental
Sodium thiopental
Sodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...
and eliminating the use of Pavulon and potassium as the second and third drugs, respectively. It also provides for a secondary fail-safe
Fail-safe
A fail-safe or fail-secure device is one that, in the event of failure, responds in a way that will cause no harm, or at least a minimum of harm, to other devices or danger to personnel....
measure using intramuscular injection of midazolam and hydromorphone in the event intravenous administration of the sodium thiopental proves problematic.
Primary: Sodium thiopental, 5 grams, intravenous
Secondary: Midazolam
Midazolam
Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...
, 10 mg, intramuscular, and hydromorphone
Hydromorphone
Hydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug...
, 40 mg, intramuscular
The brief for the U.S. courts written by accessories, the State of Ohio implies that they were unable to find any physicians willing to participate in development of protocols for executions by lethal injection, as this would be a violation of the Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
, and such physicians would be thrown out of the medical community and shunned
Shunning
Shunning can be the act of social rejection, or mental rejection. Social rejection is when a person or group deliberately avoids association with, and habitually keeps away from an individual or group. This can be a formal decision by a group, or a less formal group action which will spread to all...
for engaging in such deeds, even if they could not lawfully be stripped of their license.
On December 8, 2009, Kenneth Biros
Kenneth Biros
Kenneth Biros was an American convicted murderer who was sentenced to death and executed for the aggravated murder, attempted rape, aggravated robbery and felonious sexual penetration of a young woman...
became the first person executed using Ohio's new 1-drug execution protocol. He was pronounced dead at 11:47 a.m. EST, 10 minutes after receiving the injection. On September 10, 2010; Washington became the second state to use the single-drug Ohio protocol with the execution of Cal Coburn Brown. Currently, Ohio and Washington are the only states that use the single drug method.
After sodium thiopental began being used in executions, the only American company that made the drug stopped manufacturing it due to its use in executions. The subsequent nationwide shortage of sodium thiopental led states to seek for other drugs. Pentobarbital
Pentobarbital
Pentobarbital is a short-acting barbiturate that was first synthesized in 1928. Pentobarbital is available as both a free acid and a sodium salt, the former of which is only slightly soluble in water and ethanol....
, a drug often used for animal euthanasia
Animal euthanasia
Animal euthanasia is the act of putting to death painlessly or allowing to die, as by withholding extreme medical measures, an animal suffering from an incurable, especially a painful, disease or condition. Euthanasia methods are designed to cause minimal pain and distress...
, was used as part of a three drug cocktail for the first time on December 16, 2010, when John David Duty
John David Duty
John David Duty was an American who was executed in Oklahoma for first-degree murder. According to the Oklahoma Department of Corrections, he is the first person in the United States to have been put to death with pentobarbital...
was executed in Oklahoma
Oklahoma
Oklahoma is a state located in the South Central region of the United States of America. With an estimated 3,751,351 residents as of the 2010 census and a land area of 68,667 square miles , Oklahoma is the 28th most populous and 20th-largest state...
. It was then used as the drug in a single drug execution for the first time on March 10, 2011, when Johnnie Baston was executed in Ohio.
Euthanasia protocol
Euthanasia can be accomplished either through oral, intravenous, or intramuscular administration of drugs. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia, with the old protocol listed first and the new protocol listed second:- First a coma is induced by intravenous administration of 1 g thiopental sodium (Nesdonal), if necessary, 1.5-2 g of the product in case of strong tolerance to barbiturates. Then 45 mg alcuronium chloride (Alloferin) or 18 mg pancuronium bromide (Pavulon) is injected. In order to ensure optimal availability, these agents are preferably given intravenously. However, there are substantial indications that they can also be injected intramuscularly. In severe hepatitis or cirrhosis of the liver, alcuronium is the agent of first choice.
- Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium bromide or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium dibromide are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.
A euthanasia machine may allow an individual to perform the process alone.
An overdose of potassium would lead to cardiac arrest within 20 seconds.
Constitutionality in the United States
In 2006, the Supreme Court ruled in Hill v. McDonoughHill v. McDonough
Hill v. McDonough , was a case decided by the United States Supreme Court challenging the use of lethal injection as a form of execution in the state of Florida. The Court ruled unanimously that a challenge to the method of execution as violating the Eighth Amendment to the United States...
that death-row inmates in the United States could challenge the constitutionality of states' lethal injection procedures through a federal civil rights lawsuit. Since then, numerous death-row inmates have brought such challenges in the lower courts, claiming that lethal injection as currently practiced violates the ban on "cruel and unusual punishment" found in the Eighth Amendment to the United States Constitution
Eighth Amendment to the United States Constitution
The Eighth Amendment to the United States Constitution is the part of the United States Bill of Rights which prohibits the federal government from imposing excessive bail, excessive fines or cruel and unusual punishments. The U.S. Supreme Court has ruled that this amendment's Cruel and Unusual...
. Lower courts evaluating these challenges have reached opposing conclusions. For example, courts have found that lethal injection as practiced in California, Florida, and Tennessee is unconstitutional. On the other hand, courts have found that lethal injection as practiced in Missouri, Arizona, and Oklahoma is constitutionally acceptable. On September 25, 2007, the United States Supreme Court agreed to hear a lethal injection challenge arising from Kentucky, Baze v. Rees
Baze v. Rees
Baze v. Rees, 553 U.S. 35 , was a United States Supreme Court case. The court agreed to hear the appeal of two men, Ralph Baze and Thomas Bowling, who were sentenced to death in Kentucky. The men argue that executing them by lethal injection would violate the 8th Amendment prohibition of cruel and...
. In Baze, the Supreme Court addressed whether Kentucky's particular lethal injection procedure comports with the Eighth Amendment and will determine the proper legal standard by which lethal injection challenges in general should be judged, all in an effort to bring some uniformity to how these claims are handled by the lower courts. Although uncertainty over whether executions in the United States would be put on hold during the period in which the United States Supreme Court considers the constitutionality of lethal injection initially arose after the court agreed to hear Baze, no executions took place during the period between when the court agreed to hear the case and when its ruling was announced, with the exception of one lethal injection in Texas hours after the court made its announcement.
On April 16, 2008 the Supreme Court rejected Baze v. Rees
Baze v. Rees
Baze v. Rees, 553 U.S. 35 , was a United States Supreme Court case. The court agreed to hear the appeal of two men, Ralph Baze and Thomas Bowling, who were sentenced to death in Kentucky. The men argue that executing them by lethal injection would violate the 8th Amendment prohibition of cruel and...
thereby upholding Kentucky's method of lethal injection in a majority 7-2 decision. Ruth Bader Ginsburg
Ruth Bader Ginsburg
Ruth Joan Bader Ginsburg is an Associate Justice of the Supreme Court of the United States. Ginsburg was appointed by President Bill Clinton and took the oath of office on August 10, 1993. She is the second female justice and the first Jewish female justice.She is generally viewed as belonging to...
and David Souter
David Souter
David Hackett Souter is a former Associate Justice of the Supreme Court of the United States. He served from 1990 until his retirement on June 29, 2009. Appointed by President George H. W. Bush to fill the seat vacated by William J...
dissented. Several states immediately indicated plans to proceed with executions.
Ethics of lethal injection
The American Medical AssociationAmerican Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
believes that a physician's opinion on capital punishment is a personal decision. Since the AMA is founded on preserving life, they argue that a doctor "should not be a participant" in executions in any form with the exception of "certifying death, provided that the condemned has been declared dead by another person"http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-2.06.HTM&&s_t=&st_p=&nth=1&prev_pol=policyfiles/HnE/E-1.02.HTM&nxt_pol=policyfiles/HnE/E-2.01.HTM&. Amnesty International
Amnesty International
Amnesty International is an international non-governmental organisation whose stated mission is "to conduct research and generate action to prevent and end grave abuses of human rights, and to demand justice for those whose rights have been violated."Following a publication of Peter Benenson's...
argues that the AMA's position effectively "prohibits doctors from participating in executions." The AMA, though, does not have the authority to prohibit doctors from participation in lethal injection, nor does it have the authority to revoke medical licenses, since this is the responsibility of the individual states.
Typically, most states do not require that physicians administer the drugs for lethal injection, but many states do require that physicians be present to pronounce or certify death.
From Delaware law (Title 11, Chapter 42, § 4209)[Excerpt] "the administration of the required lethal substance or substances required by this section shall not be construed to be the practice of medicine and any pharmacist or pharmaceutical supplier is authorized to dispense drugs to the Commissioner or the Commissioner's designee, without prescription, for carrying out the provisions of this section, notwithstanding any other provision of law." State law allows for the dispense of the drugs/chemicals for lethal injection to the states DOC without a prescription.
Awareness
Opponents of lethal injection believe that it is not actually painless as practiced in the United States. Opponents argue that the thiopental is an ultra-short acting barbiturate that may wear off (anesthesia awarenessAnesthesia awareness
Anesthesia awareness, or unintended intra-operative awareness occurs during general anesthesia, on the operating table, when the patient has not been given enough of the general anesthetic or analgesic to render the patient unconscious during general anesthesia...
) and lead to consciousness and an uncomfortable death wherein the inmate is unable to express their discomfort because they have been rendered paralyzed by the paralytic agent.
Opponents point to the fact that sodium thiopental is typically used as an induction agent and not used in the maintenance phase of surgery because of its short acting nature. Following the administration of thiopental, pancuronium bromide is given. Opponents argue that pancuronium bromide not only dilutes the thiopental, but (since the inmate is paralyzed) also prevents the inmate from expressing pain. Additional concerns have been raised over whether inmates are administered an appropriate level of thiopental owing to the rapid redistribution of the drug out of the brain to other parts of the body.
Additionally, opponents argue that the method of administration is also flawed. They state that since the personnel administering the lethal injection lack expertise in anesthesia, the risk of failing to induce unconsciousness is greatly increased. In reference to this problem, Jay Chapman
Jay Chapman
Jay Chapman is the American physician and forensic pathologist who, in 1977, created the current three drug protocol used for lethal injection, the most commonly used form of capital punishment in the United States. Chapman was Chief Medical Examiner for the State of Oklahoma when he developed the...
, the creator of lethal injection, said, "It never occurred to me when we set this up that we’d have complete idiots administering the drugs." Also, they argue that the dose of sodium thiopental must be customized to each individual patient, not restricted to a set protocol. Finally, the remote administration results in an increased risk that insufficient amounts of the lethal injection drugs enter the bloodstream.
In total, opponents argue that the effect of dilution or improper administration of thiopental is that the inmate dies an agonizing death through suffocation
Suffocation
Suffocation is the process of Asphyxia.Suffocation may also refer to:* Suffocation , an American death metal band* "Suffocation", a song on Morbid Angel's debut album, Altars of Madness...
due to the paralytic effects of pancuronium bromide and the intense burning sensation caused by potassium chloride.
Opponents of lethal injection as currently practiced argue that the procedure employed is designed to create the appearance of serenity and a painless death, rather than actually providing it. More specifically, opponents object to the use of Pancuronium bromide, arguing that its use in lethal injection serves no useful purpose since the inmate is physically restrained. Therefore the default function of pancuronium bromide would be to suppress the autonomic nervous system, specifically to stop breathing.
Research
In 2005, University of MiamiUniversity of Miami
The University of Miami is a private, non-sectarian university founded in 1925 with its main campus in Coral Gables, Florida, a medical campus in Miami city proper at Civic Center, and an oceanographic research facility on Virginia Key., the university currently enrolls 15,629 students in 12...
researchers, in cooperation with an attorney representing death row inmates, published a research letter in the medical journal The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
. The article presented protocol information from Texas and Virginia which showed that executioners had no anesthesia training, drugs were administered remotely with no monitoring for anesthesia, data were not recorded and no peer-review was done. Their analysis of toxicology reports from Arizona, Georgia, North Carolina, and South Carolina showed that post-mortem concentrations of thiopental
Sodium thiopental
Sodium thiopental, better known as Sodium Pentothal , thiopental, thiopentone sodium, or Trapanal , is a rapid-onset short-acting barbiturate general anaesthetic...
in the blood were lower than that required for surgery in 43 of 49 executed inmates(88%); 21 (43%) inmates had concentrations consistent with awareness.http://www.atypicaljoe.com/archives/LancetInadAnesth.pdf This led the authors to conclude that there was a substantial probability that some of the inmates were aware and suffered extreme pain and distress during execution. The authors attributed the risk of consciousness among inmates to the lack of training and monitoring in the process, but carefully make no recommendations on how to alter the protocol or how to improve the process. Indeed, the authors conclude, "because participation of doctors in protocol design or execution is ethically prohibited, adequate anesthesia cannot be certain. Therefore, to prevent unnecessary cruelty and suffering, cessation and public review of lethal injections is warranted."
Paid expert consultants on both sides of the lethal injection debate have found opportunity to criticize the Lancet article. Subsequent to the initial publication in the Lancet, three letters to the editor and a response from the authors extended the analysis. The issue of contention is whether Thiopental, like many lipid-soluble drugs, may be redistributed from blood into tissues after death, effectively lowering thiopental concentrations over time, or whether thiopental may distribute from tissues into the blood, effectively increasing post-mortem blood concentrations over time. Given the near-absence of scientific, peer-reviewed data on the topic of thiopental post-mortem pharmacokinetics
Pharmacokinetics
Pharmacokinetics, sometimes abbreviated as PK, is a branch of pharmacology dedicated to the determination of the fate of substances administered externally to a living organism...
, the controversy continues in the lethal injection community and in consequence, many legal challenges to lethal injection have not used the Lancet article.
In 2007, the same group that authored The Lancet study extended its study of the lethal injection process through a critical examination of the pharmacology of the barbiturate thiopental. This study published in the online journal PloS Medicine http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0040156 confirmed and extended the conclusions made in The Lancet article and go further to disprove the assertion that the lethal injection process is painless. To date these two studies by the University of Miami team serve as the only critical peer-reviewed examination of the pharmacology of the lethal injection process. These findings also appear true to be further supported by increased reporting of problematic lethal injections in the United States.
Single drug
The execution can be painlessly accomplished, without risk of consciousnessConsciousness
Consciousness is a term that refers to the relationship between the mind and the world with which it interacts. It has been defined as: subjectivity, awareness, the ability to experience or to feel, wakefulness, having a sense of selfhood, and the executive control system of the mind...
, by the injection of a single large dose of a barbiturate
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
. By this logic, the use of any other chemicals is entirely superfluous and only serves to unnecessarily increase the risk of pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
during the execution. Another possibility would be the infusion of a powerful and fast-acting narcotic
Narcotic
The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...
, such as fentanyl, which would ensure comfort while suppressing the victim's respiratory drive.
When sodium pentobarbital
Pentobarbital
Pentobarbital is a short-acting barbiturate that was first synthesized in 1928. Pentobarbital is available as both a free acid and a sodium salt, the former of which is only slightly soluble in water and ethanol....
, a barbiturate used in animal euthanasia
Animal euthanasia
Animal euthanasia is the act of putting to death painlessly or allowing to die, as by withholding extreme medical measures, an animal suffering from an incurable, especially a painful, disease or condition. Euthanasia methods are designed to cause minimal pain and distress...
, is administered in an overdose, it causes rapid unconsciousness. Respiratory arrest
Respiratory arrest
Respiratory arrest is the cessation of breathing. It is a medical emergency and it usually is related to or coincides with a cardiac arrest. Causes include opiate overdose, head injury, anaesthesia, tetanus, or drowning...
follows next, through paralysis of the diaphragm
Thoracic diaphragm
In the anatomy of mammals, the thoracic diaphragm, or simply the diaphragm , is a sheet of internal skeletal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity from the abdominal cavity and performs an important function in respiration...
and collapse of the lungs. The drug would then suppress cardiac activity, thus causing death.
Cruel and unusual
On occasion, there have also been difficulties inserting the intravenous needles, sometimes taking over half an hour to find a suitable vein. Typically, the difficulty is found in convicts with a history of intravenous drug use. Opponents argue that the insertion of intravenous lines that take excessive amounts of time are tantamount to being cruel and unusual punishment. In addition, opponents point to instances where the intravenous line has failed, or where there have been adverse reactions to drugs, or unnecessary delays during the process of execution.On December 13, 2006, Angel Nieves Diaz
Ángel Nieves Díaz
Ángel Nieves Díaz was a Puerto Rican convict who was executed by lethal injection in Raiford, Florida. Nieves Díaz was convicted for shooting and killing the manager of a strip club in 1979...
was not executed successfully in Florida using a standard lethal injection dose. Diaz was 55 years old, and had been sentenced to death for murder. Diaz did not succumb to the lethal dose even after 35 minutes, necessitating a second dose of drugs to complete the execution. At first, a prison spokesman denied Diaz had suffered pain, and claimed the second dose was needed because Diaz had some sort of liver disease. After performing an autopsy, the Medical Examiner, Dr. William Hamilton, stated that Diaz’s liver appeared normal, but that the needle had been pierced through Diaz’s vein into his flesh. The deadly chemicals had subsequently been injected into soft tissue, rather than into the vein. Two days after the execution, then-Governor Jeb Bush
Jeb Bush
John Ellis "Jeb" Bush is an American politician who served as the 43rd Governor of Florida from 1999 to 2007. He is a prominent member of the Bush family: the second son of former President George H. W. Bush and former First Lady Barbara Bush; the younger brother of former President George W...
suspended all executions in the state and appointed a commission “to consider the humanity and constitutionality of lethal injections.” The ban was lifted by Governor Charlie Crist
Charlie Crist
Charles Joseph "Charlie" Crist, Jr. is an American politician who was the 44th Governor of Florida. Prior to his election as governor, Crist previously served as Florida State Senator, Education Commissioner, and Attorney General...
when he signed the death warrant for Mark Dean Schwab, July 18, 2007. On November 1, 2007 the Florida Supreme Court
Florida Supreme Court
The Supreme Court of the State of Florida is the highest court in the U.S. state of Florida. The Supreme Court consists of seven judges: the Chief Justice and six Justices who are appointed by the Governor to 6-year terms and remain in office if retained in a general election near the end of each...
unanimously upheld the state's lethal injection procedures.
A study published in 2007 in the peer-reviewed journal PLoS Medicine
PLoS Medicine
PLoS Medicine is a peer-reviewed medical journal covering the full spectrum of the medical sciences. It began operation on October 19, 2004. It was the second journal of the Public Library of Science , a non-profit open-access publisher. All content in PLoS Medicine is published under the Creative...
suggested that "the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable".
The execution of Romell Broom
Romell Broom
Romell Broom is an American convicted of murder, kidnapping, and rape. He was convicted in 1984 of abducting and killing Tryna Middleton, age 14, who was walking home from a football game in East Cleveland, Ohio. In 2003, Broom took up an offer from the state of Ohio for a DNA test to prove his...
was abandoned in Ohio on September 15, 2009, after prison officials failed to find a vein after 2 hours of trying on his arms, legs, hands and ankle. This has stirred up intense debate in the United States about lethal injection.
Commonality
The combination of a barbiturate induction agent and a nondepolarizing paralytic agent is used in thousands of anesthetics every day. Supporters of the death penalty argue that unless anesthesiologists have been wrong for the last 40 years, the use of pentothal and pancuronium is safe and effective. In fact, potassium is given in heart bypass surgery to induce cardioplegiaCardioplegia
Cardioplegia is intentional and temporary cessation of cardiac activity, primarily for cardiac surgery.- Overview :The word cardioplegia means cardio-the heart and plegia- paralysis. Technically this means arresting or stopping the heart so that surgical procedures can be done in a still and...
. Therefore, the combination of these three drugs is still in use today. Supporters of the death penalty speculate that the designers of the lethal injection protocols intentionally used the same drugs as used in every day surgery to avoid controversy. The only modification is that a massive coma-inducing dose of barbiturates is given. In addition, similar protocols have been used in countries that support euthanasia or physician-assisted suicide. http://www.wweek.com/html/euthanasics.html
Anesthesia awareness
Thiopental is a rapid and effective drug for inducing unconsciousness, since it causes loss of consciousness upon one circulation through the brain due to its high lipophilicLipophilic
Lipophilicity, , refers to the ability of a chemical compound to dissolve in fats, oils, lipids, and non-polar solvents such as hexane or toluene. These non-polar solvents are themselves lipophilic — the axiom that like dissolves like generally holds true...
ity. Only a few other drugs, such as methohexital
Methohexital
Methohexital, also called methohexitone, is a drug which is a barbiturate derivative. It is classified as short-acting, and has a rapid onset of action...
, etomidate
Etomidate
Etomidate is a short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedation for short procedures such as reduction of dislocated joints, tracheal intubation and cardioversion...
, or propofol
Propofol
Propofol is a short-acting, intravenously administered hypnotic agent. Its uses include the induction and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. Propofol is also commonly used in veterinary medicine...
have the capability to induce anesthesia so rapidly. (Narcotics such as Fentanyl are inadequate as induction agents for anesthesia.) Supporters argue that since the thiopental is given at a much higher dose than for medically-induced coma protocols, it is effectively impossible for the condemned to wake up.
Anesthesia awareness
Anesthesia awareness
Anesthesia awareness, or unintended intra-operative awareness occurs during general anesthesia, on the operating table, when the patient has not been given enough of the general anesthetic or analgesic to render the patient unconscious during general anesthesia...
occurs when general anesthesia is inadequately maintained, for a number of reasons. Typically, anesthesia is induced with an intravenous drug, but maintained with an inhaled anesthetic given by the anesthesiologist (note that there are several other methods of safely and effectively maintaining anesthesia). Barbiturates are used only for induction of anesthesia and these drugs rapidly and reliably induce anesthesia, but wear off quickly. A neuromuscular blocking drug
Neuromuscular-blocking drugs
Neuromuscular-blocking drugs block neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles. This is accomplished either by acting presynaptically via the inhibition of acetylcholine synthesis or release or by acting postsynaptically at the...
may then be given to cause paralysis which facilitates intubation
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
, although this is not always required. The anesthesiologist has the responsibility to ensure that the maintenance technique (typically inhalational) is started soon after induction to prevent the patient from waking up.
General anesthesia is not maintained with barbiturate drugs. An induction dose of thiopental wears off after a few minutes because the thiopental redistributes from the brain to the rest of the body very quickly. However, it has a long half-life, which means that it takes a long time for the drug to be eliminated from the body. If a very large initial dose is given, little or no redistribution takes place (since the body is saturated with the drug), which means that recovery of consciousness requires the drug to be eliminated from the body, which is not only slow (taking many hours or days), but unpredictable in duration, making barbiturates very unsatisfactory for maintenance of anesthesia.
Thiopental has a half-life of approximately 11.5 hours (however, the action of a single dose is terminated within a few minutes by redistribution of the drug from the brain to peripheral tissues) and the long acting barbiturate phenobarbital has a half-life of approximately 4–5 days. It contrasts towards the inhaled anesthetics have extremely short half-lives and allow the patient to wake up rapidly and predictably after surgery.
The average time to death once a lethal injection protocol has been started is about 7 – 11 minutes. Since it only takes about 30 seconds for the thiopental to induce anesthesia, 30–45 seconds for the pancuronium to cause paralysis, and about 30 seconds for the potassium to stop the heart, death can theoretically be attained in as little as 90 seconds. Given that it takes time to administer the drug, time for the line to flush itself, time for the change of the drug being administered, and time to ensure that death has occurred, the whole procedure takes about 7–11 minutes. Procedural aspects in pronouncing death also contribute to delay and, therefore, the condemned is usually pronounced dead within 10 – 20 minutes of starting the drugs. Supporters of the death penalty say that a huge dose of thiopental, which is between 14 - 20 times the anesthetic induction dose and which has the potential to induce a medical coma lasting 60 hours, could never wear off in only 10 to 20 minutes.
Dilution effect
Death penalty supporters state that the claim that pancuronium dilutes the sodium thiopental dose is erroneous. Supporters argue that pancuronium and thiopental are commonly used together in surgery every day and if there were a dilution effect, it would be a known drug interaction.Drug interaction
Drug interaction
A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...
s are a complex topic. Some drug interactions can be simplistically classified as either synergistic or inhibitory interactions. In addition, drug interactions can occur directly at the site of action, through common pathways or indirectly through metabolism of the drug in the liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
or through elimination in the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
. Pancuronium and thiopental have different sites of action, one in the brain and one at the neuromuscular junction. Since the half-life of thiopental is 11.5 hours, the metabolism of the drugs is not an issue when dealing with the short time frame in lethal injections. The only other plausible interpretation would be a direct one, or one in which the two compounds interact with each other. Supporters of the death penalty argue that this theory does not hold true. They state that even if the 100 mg of pancuronium directly prevented 500 mg of thiopental from working, there would be sufficient thiopental to induce coma for 50 hours. In addition, if this interaction did occur, then the pancuronium would be incapable of causing paralysis.
Supporters of the death penalty state that the claim that the pancuronium prevents the thiopental from working, yet is still capable of causing paralysis, is not based on any scientific evidence and is a drug interaction that has never before been documented for any other drugs. Supporters of the death penalty question if this is an invented false claim.
Single drug
Amnesty InternationalAmnesty International
Amnesty International is an international non-governmental organisation whose stated mission is "to conduct research and generate action to prevent and end grave abuses of human rights, and to demand justice for those whose rights have been violated."Following a publication of Peter Benenson's...
, Human Rights Watch
Human Rights Watch
Human Rights Watch is an international non-governmental organization that conducts research and advocacy on human rights. Its headquarters are in New York City and it has offices in Berlin, Beirut, Brussels, Chicago, Geneva, Johannesburg, London, Los Angeles, Moscow, Paris, San Francisco, Tokyo,...
, the Death Penalty Information Center
Death Penalty Information Center
The Death Penalty Information Center is a non-profit organization that focuses on disseminating studies and reports related to the death penalty by itself and others to the news media and general public...
, and other anti-death penalty groups have not proposed a lethal injection protocol which they believe is less painful. Supporters of the death penalty argue that the lack of an alternative proposed protocol is testament to the fact that the painfulness of the lethal injection protocol is not the issue. Instead supporters argue that the issue is the continued existence of the death penalty, since if the only issue was the painfulness of the procedure, then Amnesty International, HRW, or the DPIC should have already proposed a less painful method.
Regardless of an alternative protocol, some death penalty opponents have claimed that execution can be less painful by the administration of a single lethal dose of barbiturate. Supporters of the death penalty, however, state that the single drug theory is a flawed concept. Terminally ill patients in Oregon who have requested physician-assisted suicide have received lethal doses of barbiturates. The protocol has been highly effective in producing a painless death, but the time to cause death can be prolonged. Some patients have taken days to die, and a few patients have actually survived the process and have regained consciousness up to three days after taking the lethal dose. In a Californian legal proceeding addressing the issue of the lethal injection cocktail being "cruel and unusual," state authorities said that the time to death following a single injection of a barbiturate could be as much as 45 minutes.
Scientifically, this is readily explained. Barbiturate overdoses typically cause death by depression of the respiratory center, but the effect is variable. Some patients may have complete cessation of respiratory drive, whereas others may only have depression of respiratory function. In addition, cardiac activity can last for a long time after cessation of respiration. Since death is pronounced after asystole
Asystole
In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow...
and given that the expectation is for a rapid death in lethal injection, multiple drugs are required; specifically potassium chloride to stop the heart. In fact, in the case of Clarence Ray Allen
Clarence Ray Allen
Clarence Ray Allen was an American murderer who was executed by lethal injection at San Quentin State Prison in California for the murders of three people. At age 76 in 2006, he became the second-oldest inmate to be executed in the United States since 1976, after John B. Nixon of Mississippi who...
a second dose of potassium chloride was required to attain asystole. The position of most death penalty supporters is that death should be attained in a reasonable amount of time.
Supporters of the death penalty agree that the use of pancuronium bromide is not absolutely necessary in the lethal injection protocol. Some supporters believe that the drug may decrease muscular fasciculations when the potassium is given, but this has yet to be proven.
See also
- Capital punishment in the United StatesCapital punishment in the United StatesCapital punishment in the United States, in practice, applies only for aggravated murder and more rarely for felony murder. Capital punishment was a penalty at common law, for many felonies, and was enforced in all of the American colonies prior to the Declaration of Independence...
- EuthanasiaEuthanasiaEuthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
- Execution chamberExecution chamberAn execution chamber, or death chamber, is a room or chamber in which a legal execution is carried out. Execution chambers are almost always inside the walls of a maximum-security prison, although not always at the same prison where the death row population is housed...