31 years ago on this day (7 December 1982), Charles Brooks, Jr., (September 1, 1942 – December 7, 1982) was a convicted murderer who was the first person in the United States to be executed using lethal injection. He was the first prisoner executed in Texas since 1964.
I
will post the information on Letha injection from Wikipedia.
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The "death chamber" at the Texas
Department of Criminal Justice Huntsville Unit in Huntsville, Texas. (AFP
Photo/Paul Buck) [PHOTO SOURCE: http://news.yahoo.com/texas-rejects-death-penalty-appeal-argued-racial-bias-221343316.html]
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Lethal injection
is the practice of injecting a person with a fatal dose of drugs (typically a barbiturate,
paralytic, and potassium solution) for the express purpose of causing immediate
death. The main application for this procedure is capital punishment, but the
term may also be applied in a broad sense to euthanasia and suicide. It kills
the person by first putting the person to sleep, and then stopping the
breathing and heart, in that order.
1 History
Lethal
injection gained popularity in the late twentieth century as a form of execution
intended to supplant other methods, notably electrocution, hanging, firing
squad, gas chamber, and beheading, that were considered to be more painful. It
is now the most common form of execution in the United States of America.
Lethal
Injection, known as putting someone to death, was first proposed on January 17,
1888, by Julius Mount Bleyer, a New York doctor who praised it as being cheaper
than hanging. Bleyer's idea, however, was never used. The British Royal
Commission on Capital Punishment (1949–53) also considered lethal injection,
but eventually ruled it out after pressure from the British Medical Association
(BMA). Half a century later, Nazi Germany developed the Action T4 euthanasia
programme as one of its methods of disposing Lebensunwertes Leben
("life unworthy of life").
On
May 11, 1977, Oklahoma's state medical examiner, Jay Chapman,
proposed a new, less painful method of execution, known as Chapman's Protocol:
"An intravenous saline drip shall be started in the prisoner's arm,
into which shall be introduced a lethal injection consisting of an
ultra-short-acting barbiturate in combination with a chemical paralytic."
After the procedure was approved by anesthesiologist Stanley Deutsch, formerly
Head of the Department of Anaesthesiology of the Oklahoma University Medical
School, the 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
adopted the new method of execution, switching to lethal injection from
electrocution. 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.
The
People's Republic of China began using this method in 1997, Guatemala in 1998,
the Philippines in 1999, Thailand in 2003, and the Republic of China (Taiwan)
in 2005. Vietnam reportedly now uses this method. The Philippines has since
abolished the death penalty.
Nazi
Germany's T-4 Euthanasia Program used lethal injection
as one of several methods to destroy what the Nazi government dubbed "life unworthy of life".
The
export of drugs to be used for lethal injection was banned by the European
Union (EU) in 2011, together with other items under the EU Torture
Regulation.
2 Procedure
2.1 Procedure in China
executions
Further information: Execution
van
The People's Republic of China used to execute
prisoners exclusively 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.
2.2 Procedure in U.S.
executions
The condemned person is strapped onto a gurney; two intravenous cannulae ("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
in an adjacent room is attached 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 before the cannula is inserted. The
needles and equipment used are 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 after the cannulae have
been inserted, as happened in the case of James Autry 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 not blocked, ensuring the chemicals have not
precipitated in the IV lines and blocked the needle, preventing the drugs from
reaching the subject. A heart monitor is attached so prison officials can
determine when death has occurred.
In most states, the intravenous
injection is a series of drugs given in a set sequence, designed to
first induce unconsciousness
followed by death through paralysis of
respiratory muscles and/or by cardiac arrest through depolarization of cardiac muscle cells. The execution of the
condemned in most states involves three separate injections (in sequential
order):
1. Sodium thiopental or pentobarbital: ultra-short action
barbiturate, an anesthetic agent used at a high dose that renders the prisoner
unconscious in less than 30 seconds. Depression of respiratory activity is one
of the characteristic actions of this drug. Consequently, the lethal-injection
doses, as described in the Sodium Thiopental section below, will — even in the
absence of the following two drugs — cause death due to lack of breathing, as
happens with overdoses of opioids.
2. 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 asphyxiation.
3. Potassium chloride:
stops the heart, and thus causes death by cardiac arrest.
The drugs are not mixed externally as that can
cause them to precipitate. Also, a sequential injection is key to
achieve the desired effects in the appropriate order: administration of the
pentobarbital essentially renders the inmate unconscious; the infusion of the
pancuronium bromide induces complete paralysis, including that of the lungs and
diaphragm rendering the inmate unable to breathe. If the condemned were not
already completely unconscious, the injection of a highly concentrated solution
of potassium chloride could cause severe pain at the site of the IV line as
well as along the punctured vein, but it interrupts the electrical activity of
the heart muscle and causes it to stop beating, bringing about the death of the
inmate.
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 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 on May 24, 2007. According to state law, if a physician'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 signs the condemned’s death certificate.
In two states (Delaware and Missouri) there is a lethal injection
machine designed by Massachusetts-based
Fred A. Leuchter 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). 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.
Eleven states have switched, or have stated their
intention to switch, to a one-drug lethal injection protocol. A one-drug method
is using the single drug sodium thiopental to execute someone. The first state
to switch to this method was Ohio, in December 8, 2009. In 2011, after pressure
by activist organizations, the manufacturers of sodium thiopental and pentobarbital halted supply of the drugs to
U.S. prisons performing lethal injections and required all resellers to do the
same.
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Execution room in the San Quentin State Prison in California
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3 Drugs
3.1 Conventional lethal
injection protocol
Typically,
three drugs are used in lethal injection. Sodium thiopental is used to induce
unconsciousness, pancuronium bromide
(Pavulon) to cause muscle paralysis and respiratory arrest, and potassium chloride
to stop the heart.
3.1.1 Sodium thiopental
Main
article: 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 0.35 grams. 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.
A full
medical dose of Thiopental reaches the brain in about 30 seconds. This induces
an unconscious state. Five to twenty minutes after injection, approximately 15%
of the drug is in the brain, with the rest in other parts of the body.
The half-life
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, because repeated
doses — or a single very high dose as in lethal injection — accumulate in high
concentrations in body fat, from which the thiopental is gradually released.
This is the reason why an ultra-short acting barbiturate, such as thiopental,
can be used for long-term induction of medical coma. Historically,
thiopental has been one of the most commonly used and studied drugs 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. In euthanasia
protocols, the typical dose of thiopental is 1.5 grams; the Dutch
Euthanasia protocol indicates 1-1.5 grams or 2 grams in case of high
barbiturate tolerance. The dose used for capital punishment is therefore about
3 times more than the dose used in euthanasia.
3.1.2 Pancuronium
bromide (Pavulon)
Main article: Pancuronium
Lethal injection dosage: 100 milligrams
Pancuronium bromide (Trade name: Pavulon): The
related drug curare, like pancuronium, is a non-depolarizing
muscle relaxant (a paralytic agent) that
blocks the action of acetylcholine at
the motor end-plate of the neuromuscular
junction. 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.
Pancuronium bromide is a derivative of the alkaloid malouetine
from the plant Malouetia bequaertiana
3.1.3 Potassium chloride
Main article: Potassium chloride
Lethal injection dosage: 100 mEq (milliequivalents)
Potassium is an
electrolyte, 98% of which is intracellular. The 2% remaining outside the cell
has great implications for cells that generate action potentials. Doctors
prescribe potassium for patients when there is insufficient potassium, called hypokalemia, 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,
causes the resting electrical potential of the heart muscle cells to be lower
than normal (less negative). Without this negative resting potential, cardiac
cells cannot repolarize (prepare for their next 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. 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.
3.2 New lethal injection
protocols
The Ohio protocol, developed after the
incomplete execution of Romell Broom,
ensures the rapid and painless onset of anesthesia by only using sodium thiopental and eliminating the use
of Pavulon and potassium as the second and third drugs, respectively. It also
provides for a secondary fail-safe measure
using intramuscular injection of midazolam and hydromorphone in the event
intravenous administration of the sodium thiopental proves problematic. The
first state to switch to use Midazolam as the
first drug in a new three-drug protocol protocol was Florida on October 15,
2013. Then on November 14, 2013, Ohio made the same move.
·
Primary: Sodium thiopental, 5 grams,
intravenous
·
Secondary: Midazolam, 10 mg, intramuscular, and hydromorphone, 40 mg, intramuscular
In 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, and such physicians would
be thrown out of the medical community and shunned for engaging in such deeds, even if
they could not lawfully be stripped of their license.
On December 8, 2009, Kenneth Biros became the first person
executed using Ohio's new single-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, seven states (Arizona, Georgia,
Idaho, Ohio, South Dakota, Texas
and Washington) have used the single-drug execution protocol. Four additional
states (Arkansas, Kentucky, Louisiana and Missouri) have announced that they are
switching to a single-drug protocol but, as of May 2013, have not executed
anyone since switching protocols.
After sodium thiopental began being used in
executions, Hospira, 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, a
drug often used for animal euthanasia,
was used as part of a three drug cocktail for the first time on December 16,
2010, when John David Duty
was executed in Oklahoma. 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.
4 Euthanasia protocol
Lethal injection has also been used in cases of euthanasia to facilitate voluntary death in
patients with terminal or chronically painful conditions. 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.
5 Constitutionality
in the United States
In
2006, the Supreme Court ruled in Hill
v. McDonough 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. 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.
Though
the practice of lethal injection has been ruled unconstitutional in California
in 2006, the state has continued to execute prisoners on death row. As of 2011,
California has nearly 700 prisoners condemned to death with the use of lethal
injection despite a five-year moratorium. They have opened a facility costing
over $800,000 used for performing the executions.
On
September 25, 2007, the United States Supreme Court agreed to hear a lethal
injection challenge arising from Kentucky, Baze v.
Rees. 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 thereby
upholding Kentucky's method of lethal injection in a majority 7–2 decision. Ruth
Bader Ginsburg and David Souter dissented. Several states immediately indicated
plans to proceed with executions.
6 Ethics of lethal
injection
The American Medical Association 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 professional capacity with the exception
of "certifying death, provided that the condemned has been declared dead
by another person" and "relieving the acute suffering of a condemned
person while awaiting execution". Amnesty International argues that the
AMA's position effectively "prohibits doctors from participating in
executions." The AMA, however, 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.
Some
states specifically detail that participation in a lethal injection is not to
be considered practicing medicine. For example, Delaware law reads "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" (excerpt from Title 11, Chapter 42, § 4209). State law allows for the
dispense of the drugs/chemicals for lethal injection to the state's Department
of Corrections (DOC) without a prescription.
7 Controversy
7.1 Opposition
7.1.1 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 awareness) 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, 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
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.
7.1.2 Research
In
2005, University of Miami researchers, in cooperation with an attorney
representing death row inmates, published a research letter in the medical
journal The Lancet. 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 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. 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 2005 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, 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 – 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.
7.1.3 Single drug
According
to the New Lethal Injection Protocols section above, single-drug lethal
injection is already in use, or intended, in eleven states.
The
execution can be painlessly accomplished, without risk of consciousness, by the
injection of a single large dose of a barbiturate. By this logic, the use of any
other chemicals is entirely superfluous and only serves to unnecessarily
increase the risk of pain during the execution. Another
possibility would be the infusion of a powerful and fast-acting narcotic, such as fentanyl, which would ensure comfort while
suppressing the victim's respiratory drive.
When
sodium pentobarbital, a barbiturate used in
animal euthanasia,
is administered in an overdose, it causes rapid unconsciousness. Respiratory
arrest follows next, through paralysis of the diaphragm
and collapse of the lungs. The drug would then suppress cardiac activity, thus
causing death.
7.1.4 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
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 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 when he signed the death warrant for Mark Dean Schwab on July 18, 2007.
On November 1, 2007, the Florida Supreme Court unanimously upheld the state's
lethal injection procedures.
A
study published in 2007 in the peer-reviewed journal PLoS Medicine
suggested that "the conventional view of lethal injection leading to an
invariably peaceful and painless death is questionable".
The
execution of Romell Broom 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.
7.1.5 European Union
export ban
Due
to its use for executions in the US, the UK introduced a ban on the export of
sodium thiopental in December 2010, after it was established that no European
supplies to the US were being used for any other purpose. The restrictions were
based on "the European Union Torture Regulation (including licensing of
drugs used in execution by lethal injection)". From 21 December 2011 the
European Union extended trade restrictions to prevent the export of certain
medicinal products for capital punishment, stating that "The Union
disapproves of capital punishment in all circumstances and works towards its
universal abolition".
7.2 Support
7.2.1 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 cardioplegia. 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.
7.2.2
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 lipophilicity.
Only a few other drugs, such as methohexital,
etomidate,
or propofol
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 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 may then
be given to cause paralysis which facilitates intubation,
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.
7.2.3 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
interactions 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 or through
elimination in the kidney.
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.
7.3 Single drug
Amnesty
International, Human Rights Watch, Death Penalty Information Center, Reprieve,
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
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 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.
8 Use of Lethal
Injection in the Middle East
Saudi
Arabia is the only country in the world where a death sentence results in
beheading in a public square, and sometimes shootings as an alternative. There
have been calls in the Kingdom for replacing beheadings with lethal injection
because of the beliefs that they should be more humane when it comes to executions,
but nothing has been changed to this day.
PLEASE WATCH THIS
VIDEO TO SEE A SCENE FROM THE 1995 MOVIE, ‘DEAD MAN WALKING’:
VIDEO SOURCE: http://www.youtube.com/watch?v=jDFDpzWJj2s
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