Autopsy Reports Expose Cruelty of Lethal Injection

It's the stuff of nightmares, and the very definition of cruel and unusual punishment: A prisoner remaining aware, but paralyzed and unable to speak, while a deadly, caustic drug flows through his veins.

This could be the reality of execution in the United States. Lethal injections, the preferred method of execution in every state but Nevada , use three drugs: sodium thiopental, a surgical anesthetic, followed by the paralytic drug pancuronium bromide, and finally potassium chloride, which stops the heart and causes death.

A medical journal's review of autopsy reports in 49 executions by lethal injection in Texas and Virginia showed that 43 had critically low levels of anesthetic in their bloodstreams, and 21 had so little that they were likely conscious throughout the painful process of stopping their heart.

This is unwelcome news to death-penalty supporters, but no surprise to those familiar with the history of lethal injection. It's a procedure that's frequently botched. The American Medical Association and other professional medical groups condemn capital punishment, so doctors and nurses usually refuse to participate in executions. That means executions are often performed by under-trained medical technicians, who often have a hard time finding a vein. Even in states where trained medical personnel are involved in executions, it's often to insert intravenous lines into veins scarred by drug abuse.

If the drugs aren't administered properly, the line used to feed them into the prisoner's body can clog, delaying the execution. Even when everything goes technically right, things go wrong: When the state of California executed 76-year-old Clarence Ray Allen last month, the first dose of drugs wasn't enough to stop his heart.

Florida 's lethal injection process follows that of other states. The only difference is that Florida inmates are offered Valium, a mild tranquilizer, before the execution starts. It's hard to imagine a pill powerful enough to calm the terror and agony of feeling veins burning as if acid had been injected into them.

This isn't the first time an execution method fell short. Two gory electrocutions in Florida speeded the demise of the electric chair as an execution method (only Nevada now uses it.) Hanging too often resulted in prolonged deaths, the firing squad is on its way out in the last two states that use it and the gas chamber, perhaps the cruelest of methods used in this country, probably won't be used again in the United States.

Now lethal injection is under attack. Two Florida executions are now on hold while the U.S. Supreme Court decides whether the inmates will be able to challenge lethal injection as cruel and unusual. Clarence Hill, who murdered a police officer in 1982, was strapped to a gurney with IV tubes in his arms when the Supreme Court issued a stay. Arthur Rutherford, who killed a Milton woman in 1985, was scheduled to die a few days later.

State officials argue that Hill and Rutherford showed no mercy to their victims, and deserve none from the state.

Their vision is skewed. The state should not fight for the right to sink to the same level as murderers.

The grim reality of the death penalty is that it's hard to end the lives of healthy human beings without torturing them in some way. Even if the death penalty had been proven to be effective in stopping crime (it hasn't) or were fairly administered (it isn't), it is inescapably cruel, reprehensible to any just society.

Rather than searching for acceptable methods, Florida leaders should declare their intent to end the death penalty in this state.

Lethal Injection- A Doctor Speaks

(Edward Brunner, M.D., Ph.D., is the Eckenhoff professor and chairman emeritus of anesthesia at Northwestern Medical School and at Northwestern Memorial Hospital. A death penalty opponent, he was a practicing anesthesiologist for decades.)

Question: Is lethal injection a painless way to die?

Answer: Not necessarily. It may be, but more often than not it is messed up. It is misused in its application because the people who use drugs for lethal injection don't understand the mode of action or the time couse over which the drugs act.

Question: Describe what happens during lethal injection.

Answer: Three drugs are used. The first one is sodium thipental, an ultrashort-acting drug. It acts within a minute to make the brain unconscious. From that point on, it begins to wear off. Depending on the dosage, the individual may wake up within three or four minutes. The second drug is called succinylcholine. It acts at the point where the nerves enervate the muscles and it causes an overstimulation of the muscle, so you get twitching all over the body. The muscles are then completely flacid and unable to move. This drug will act for about 10 minutes, but if given in much larger doses it can act longer. The final drug that is used is potassium chloride. We use that drug to stop the heart beating when we are doing heart surgery and in lethal injection, it is used to stop the heart beating, never to start again.

Question: What can go wrong in lethal injections?

Answer: In misuse of the drugs, the thiopental will cause the patient to look like he is falling asleep. The second drug will paralyze him. If the drugs are not given properly, the sleep drug can wear off, allowing the patient to be aware, but unable to move, even to breathe. He undergoes suffocation and asphyxiation in a horribly painful way, even though he looks completely calm as he is lying on the table. Then, he experiences that deep burning sensation as the potassium courses through his veins on the way to the heart.

Question: How often are mistakes made?

Answer: We know that in about 40% of cases where lethal injection has been used, there has been misuse in one way or another and it has taken as long as 45 minutes for the person to die. The problem is they tried to make this a very sterile kind of a procedure, but no matter how you dress it up, you are still killing someone.

Question: What can go wrong technically?

Answer: The chemistry of the drugs is such that thiopental and succinylcholine, when they react to each other, cause a precipitation of a white, flaky substance that will block up the needle from the IV. What has happened in a number of cases is that they give the thiopental and follow with the succinylcholine, then they get this precipitate whichs blocks the needle. The thiopental wears off. The patient is partly paralyzed and partly not, and begins to move around. In a number of circumstances, they have to close the curtains so that people can't see the struggling. Sometimes they have to start all over again. It's not a clean process because the people who are using the drugs aren't trained to use them.

Question: Why can't doctors administer the drugs?

Answer: Every medical society has looked at the problem, at this issue- the American Medical Association, the American College of Surgeons, the American College of Physicians and the American College of Pathologists. The whole spectrum of medical professional groups has condemned the participation of physicians in this process. Doctors are trained to heal, not to kill and so it is unethical for doctors to participate.

Source: Death Row Speaks, Feb. 2006