The Lethal Injection Debate
Background
The adoption of lethal injection as a common method for execution in the U. S. is described by Stuart Banner in his book The Death Penalty – An American History. While the concept of execution using poison goes back to ancient Greece, Banner points out that the use of lethal injection was never given more than cursory consideration in the United States until the 1970s. He points out that since the technology of intravenous administration of medicine had been familiar and that lethal injection was commonly used to put down sick or unwanted animals that there must have been other factors that slowed the adoption of lethal injection for executing people. The two factors he suggests are the necessary closeness of the executioner to the condemned person and that the injection of substances into human veins has traditionally been the role of physicians. What changed in America to overcome these barriers? In 1976 when the Supreme Court allowed states to reinstate the death penalty the electric chairs and gas chambers used by the states for executions had not been maintained for years. Faced with the high costs of replacing this specialized equipment, lethal injection was an attractive, readily available, low cost alternative. Banner cites a report from The North Carolina Department of Correction in 1979 that estimated the cost of lethal injection equipment to be less than $350 per execution. The other advantage of lethal injection was that it was considered to be painless and clean. Oklahoma and Texas were the first states to adopt lethal injection in 1977. The first execution by lethal injection in the United States took place in 1982 in Texas. The inmate was strapped to a gurney and injected with a sequence of three drugs. The first was sodium thiopental, a barbituate intended to produce unconsciousness. The second was pancuronium bromide, a muscle relaxant administered to paralyze the lungs. Third was potassium chloride to stop the heart. The process was considered painless because the initial injection of sodium thiopental would assure deep anaesthesia and loss of consciousness. In 2006, lethal injection is the preferred method of execution in 37 of 38 states with the death penalty. The facilities of North Carolina at the Central Prison in Raleigh shown in this photo gallery are typical.
The Role of Physicians in Lethal Injection
Dr. Jonathan I. Groner, an outspoken opponent of the participation of medical professionals in executions, describes the difficulty carrying out the lethal injection protocol for the execution of Jose High in Georgia in 2001. In the room used for executions a nurse had attempted unsuccessfully for 30 minutes to start an intravenous line to be used to administer the drugs when a doctor on contract to the facility stepped in and placed the line that would allow the execution to go forward. Dr. Groner points out that lethal injection is unique because it simulates a medical procedure; the intravenous induction of general anaesthesia. In addition, lethal injection differs from other means of execution because the participation of skilled healthcare professionals is required. Starting intravenous lines, setting up intravenous infusion sets, and the measurement and administration of the appropriate drugs require the skills of a trained medical professional or a technician trained by professionals. Dr. Groner argues against the participation of medical professionals in executions citing the American Medical Association Council on Ethical and Judicial Affairs which condemns the participation of doctors in executions. In addition, he notes that the American Nurses Association is "strongly opposed" to participation in executions.
Public Perception Challenged
In April 2005, the results of a study describing blood levels of thiopental, the lethal injection anaesthesia, in 49 inmates following their execution were published in the journal Lancet by Koniaris, Zimmers, Lubarsky, and Sheldon. The study found that, “post-mortem concentrations of thiopental in the blood were lower than that required for surgery in 43 of 49 executed inmates (88 percent); 21 (43 percent) inmates had concentrations consistent with awareness.” Their study concluded, “Our data suggest that anaesthesia methods in lethal injection in the USA are flawed. Failures in protocol design, implementation, monitoring and review might have led to the unnecessary suffering of at least some of those executed. Because participation of doctors in protocol design or execution is ethically prohibited, adequate anaesthesia cannot be certain. Therefore, to prevent unnecessary cruelty and suffering, cessation and public review of lethal injections is warranted.”
Moratoriums and Court Challenges
The Death Penalty Information Center (DPIC) reports that in recent weeks stays of execution were granted to 8 death row inmates based on challenges to lethal injection. Since January 25, 2006, 5 executions in Texas and 1 in Indiana have gone forward despite challenges. The DPIC summarizes the challenges to lethal injection as being based on the claim that “the drugs used in the executions cause extreme and unnecessary pain, and that the combination of chemicals masks the pain being experienced by the inmate from the sight of those administering the death penalty. The appeals assert that this is a violation of the Eighth Amendment's ban on cruel and unusual punishments.”
In the case of Michael Morales in California, reported by the Christian Science Monitor, a federal district judge ordered that the drugs for the execution be administered by licensed medical personnel. When two anaesthesiologists refused to monitor the administration of the sodium thiopental, the execution was postponed and all other executions were suspended. According to the Pew Research Center, all executions in the state of California will be suspended at least until May, when a federal judge will hold the state's first hearings on the constitutionality of lethal injection. Temporary suspensions of executions are also in force in Florida, Louisiana, and Missouri pending court challenges to the lethal injection procedure.