Lethal injection

Lethal injection is a method of capital punishment. It gained popularity in the twentieth century as a supposedly humane form of execution meant to supplant methods such as electrocution, hanging, firing squad, gas chamber, or decapitation; the actual humaneness of the technique has become debated in recent decades.

Table of contents

1 Procedure 2 Procedure in the United States 3 History 4 Controversy

Procedure

In theory the process of "lethal injection" could refer to a wide variety of means of execution: besides the diverse deadly chemicals available for use, intravenous administration can be achieved in a number of different ways. The technique has historical precedents in other forms of execution by poisoning, such as the forced suicide undergone by Socrates, and also in the widespread use of lethal injection as a means of animal euthanasia. The present section discusses the methods of lethal injection in current active use in the world.

Procedure in the United States

After the condemned is fastened on the execution table, two intravenous catheters are inserted, one in each arm. Only one is used for the execution, the other is reserved as a backup in case the primary IV fails for some reason.
The arm of the condemned is swabbed with alcohol before the needle is inserted. Along with its antiseptic use, the alcohol also causes the blood vessels to rise to the skin's surface, making it easier to insert the needle. The needles and equipment used are also sterilized, though this is because they are standard medical products that are sterilized during manufacturing. There is also a chance that the prisoner could receive a stay of execution after the needles have been inserted as happened in the case of James Autry in October 1983 (he was executed eventually on 14 March 1984). Also it would be a hazard for those handling the equipment.
The injection is intravenous and is usually a mixture of compounds, designed to induce rapid unconsciousness followed by death through muscular paralysis of the lungs and/or by inducing cardiac depolarization.
The execution of a victim in most states involves three separate injections:

1. Sodium thiopental: to induce a state of unconsciousness intended to last while the other two injections take effect.
2. Pancuronium/Tubocurarine: to stop all muscle movement except the heart. This causes involuntary muscle paralysis, collapse of the diaphragm, and eventually death by asphyxiation.
3. Potassium chloride: to stop the heart from beating, and thus the victim's death: see cardiac arrest.

The drugs are not mixed externally as that can cause them to precipitate.
The intravenous tubing leads to a room next to the execution chamber, usually separated from the inmate by a curtain or wall. Usually some type of IV technician with certification to insert the IV tube performs that role, while the chemical technician, who is usually a member of the prison staff orders, prepares, and loads the chemicals into the machine. After the curtain is opened to allow the witnesses to see inside the chamber, the condemmed person will then be permitted to make a final statement. Following this, the warden will signal for the execution to commence, and the executioner(s), either prison staff or private citizens, depending on the jurisdiction will then activate the machine, which mechanically delivers the three drugs in sequence. Other than visual observation by prison staff, the doctor, and the witnesses, there is no mechanical or scientific monitoring of the inmate during the process and no effort is made to determine whether anesthesia is ever in fact induced. Death usually results within seven minutes, although the whole procedure can take up to 45 minutes.
The American Medical Association's Code of Ethics prohibits doctors from participating in executions. However there is always a physician present to officially declare the prisoner dead.

History

Hitler's personal doctor, Karl Brandt, was the first to suggest injecting a lethal dose of poison as an execution method, specifically for euthanizing disabled people. The T-4 Euthanasia Program used lethal injection among other methods. At the Auschwitz concentration camp, SS personnel killed prisoners that were ill or that had been sentenced to death by injection of phenol and other poisons.
The United States was thus, strictly speaking, the second nation to experiment with lethal injection as a means of execution, using it first on December 7, 1982 when Charles Brooks, Jr. was executed in Texas.
The concept had been proposed in 1888 by J. Mount Bleyer in New York, but was not approved. It was also rejected by the British Royal Commission on Capital Punishment (1949–1953) after pressure from the British Medical Association. In 1977, Oklahoma became the first state to adopt lethal injection after the idea was revived in the US in February 1977 by Dr. Stanley Deutsch. Since then, the majority of US states using capital punishment prefer to use lethal injection.
The practice extended outside the US when it was adopted by the People's Republic of China in 1997, Guatemala in 1998, and the Philippines in 1999. Some other countries have adopted the method in law but not in practice.
The staff that inserts the needle into the arm and inject the drugs are not medical professionals, as performing a medical procedure to kill the "patient" would seem to violate the Hippocratic Oath. In the United States, the code of ethics of the American Medical Association forbids doctors or nurses from taking part in lethal injection procedures, but volunteer emergency medical technicians have been used for this purpose.

Controversy

The concern has been raised that execution by lethal injection, as practiced in the United States, is not actually humane. It has been argued that the ultrashort-acting anaesthetic may wear off, leaving the inmate fully conscious, yet rendered paralyzed by the paralytic agent. There are several reasons for the concern.
First, sodium thiopental is an ultrashort-acting barbiturate, used in surgery only in the induction phase of anesthesia, specifically so that the patient may awaken and breathe on his or her own power if any complications arise in inserting a breathing tube pre-surgery. It is not used to maintain a patient in a surgical plane of anesthesia because of its short-acting nature.
Second, the second injected chemical, pancuronium bromide, may act to dilute the initial injection of sodium thiopental.
Third, because the personnel involved in administering the injection lack training and expertise in anesthesia, the risk of failing to induce unconsciousness is greatly increased. The dosage of sodium thiopental must be measured with precision, and the administration of the proper amount of the dosage depends upon both the concentration of the drug and the size and condition of the subject. Because of the manner in which the drugs are administered (remotely, with no observation of the inmate), the risk of errors in the injection causing insufficient amounts of chemicals to enter the bloodstream is greatly increased.
The effect of dilution or improper administration of sodium thiopental is that the inmate dies an agonizing death through slow suffocation while fully conscious, yet unable to express any pain. While pancuronium bromide paralyzes skeletal muscles, including the diaphragm, it has no effect on consciousness or the perception of pain or suffering. For this reason, the use of paralysing agents for the euthanizing of animals like cats and dogs has been made illegal — either directly or by reference to the American Veterinary Medical Association's panel on euthanisia, which prohibits the practice generally — in at least 19 states, including Texas, the state that executes the most people by lethal injection. However, the use of these agents for execution continues.
On occasion, there have also been difficulties inserting the delivery needles, sometimes taking over half an hour to find a suitable vein. Some of the previous errors in Texas executions include:

• Technicians punctured the inmate repeatedly in both arms and legs for 45 minutes before a vein was located. (Stephen Peter Morin , March 13, 1985)
• Executioners struggled for 35 minutes to insert the catheter into an inmate's veins. (Elliot Johnson, June 24, 1987)
• 24 minutes elapsed between the time the initial injection occurred and the time the inmate was pronounced dead; two minutes into the procedure, the syringe came out of the inmate's arm and the chemicals sprayed out towards witnesses. (Raymond Landry, December 13, 1988)
• After an inmate had a violent physical reaction to the drugs as they were injected, the Texas Attorney General stated the inmate "seemed to have a somewhat stronger reaction," adding "The drugs might have been administered in a heavier dose or more rapidly." (Stephen McCoy, May 24, 1989)

In 2005, University of Miami researchers reported in the medical journal The Lancet that they believed in 43 out of the 49 executions they investigated, the levels of thiopental in the blood was lower than that required for surgery. This has lead them to believe that the prisoners were fully aware of what was happening to them. The authors attributed the rate of likely consciousness among inmates to the lack of training and monitoring in the process, and recommended that states take a look at the American Veterinary Medical Association's recommendations on animal euthanasia, which prohibits the use of paralytic agents in combination with barbiturates and recommends animals like cats and dogs be euthanized by a single injection of a long-acting barbiturate such as sodium pentobarbital.
Opponents of lethal injection as currently practiced argue that the procedure employed is entirely unnecessary and is aimed more towards creating the appearance of serenity and a humane death than an actually humane death. Pancuronium bromide, the paralytic agent employed in lethal injection, is used in surgery to keep patients immobilized during delicate surgical procedures that occur near vital organs. By contrast, its use in lethal injection serves no purpose, since there is no need to keep the inmate completely immobilized and the inmate is physically restrained. Because death can be painlessly accomplished, without risk of consciousness, by the injection of a single large dosage of barbiturate, the use of any other chemicals is entirely superfluous and only serves to unnecessarily increase the risk of torture during the execution. Legal challenges, however, have to date been unsuccessful, and federal courts have employed a range of procedural obstacles to avoid reaching the merits of the complaints, likely to avoid the temporary moratorium that would occur while states moved to alter their respective execution protocol.