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
|
2 Procedure in the United States
|
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:
- Sodium thiopental: to induce a state of unconsciousness intended to last while the other two injections take effect.
- Pancuronium/Tubocurarine: to stop all muscle movement except
the heart. This causes involuntary muscle paralysis, collapse of the
diaphragm, and eventually death by asphyxiation.
- 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.