What Is Midazolam and Why Do Protesters Claim Its Use in Executions Is Cruel?

In January 2014, convicted rapist and murderer Dennis McGuire was strapped to a gurney in an Ohio prison execution chamber and injected with the sedative midazolam and the opioid hydromorphone.

McGuire's priest, Lawrence Hummer, who witnessed the execution, described what happened next.

"Over those 11 minutes or more, he was fighting for breath, and I could see both of his fists were clenched the entire time. His gasps could be heard through the glass wall that separated us. Toward the end, the gasping faded into small puffs of his mouth. It was much like a fish lying along the shore puffing for that one gasp of air that would allow it to breathe."

McGuire's death took 26 minutes, and protesters believe that the cause of his extended death was the drug that was supposed to ensure the execution was painless: midazolam.

Midazolam slows brain activity, allowing for relaxation and sleep, according to the National Institutes of Health. It is sometimes used as a sedative before anesthetics are administered in operations.

States first started using the drug as part of a cocktail of chemicals for executions after pharmaceuticals companies stopped selling them the anesthetic sodium thiopental. The companies said they didn't want the drug used in executions.

5 U.S. states have used midazolam as part of their chemical cocktails for executions: Florida, Oklahoma, Alabama, Virginia and Arkansas.

McGuire's execution is 1 of a series in which prisoners injected with the drug have appeared to suffer agonizing deaths. In 2014, rapist and murderer Clayton Lockett moaned and writhed after being injected with drugs including midazolam in Oklahoma. His death took 43 minutes.

Prisoners Kenneth Williams, in Arkansas in April, and Joseph Wood, in Arizona in 2014, heaved and struggled for breath after being injected with the drug during their executions, according to the Death Penalty Information Center.

Alabama's use of midazolam in the execution of Ronald Smith in December 2016 was followed by Smith heaving and gasping for breath for nearly 15 minutes.

In February, several death row inmates brought a case before the Supreme Court, challenging the use of the drug for executions.

Dr. David Lubarsky testified that the drug's effectiveness as a sedative was limited if administered with drugs that cause severe pain, as in the case in executions.

"From the doses that have been looked at, [midazolam] provides sedation, but not true anesthesia," Patrick Forcelli, an assistant professor of pharmacology at Georgetown University Medical Center, told Livescience.

In the end, the justices sided with another expert, who argued that at high doses the drug in effect paralyzes the brain, meaning it is effective as an anesthetic in face of extreme pain.

However, 4 justices dissented.

"In reaching this conclusion, the court sweeps aside substantial evidence showing that, while midazolam may be able to induce unconsciousness, it cannot be utilized to maintain unconsciousness in the face of agonizing stimuli," they wrote.

Some states have rejected the use of midazolam in executions.

Florida in January stopped using midazolam in executions as part of its 3-drug protocol, and in December 2016, Arizona abandoned its use of midazolam in 2- or 3-drug protocols.

Ohio, after abandoning the drug following the execution of McGuire, reintroduced its use in 2016, to be administered as part of a different combination of drugs.

On Wednesday, child killer Roland Phillips became the 1st person to be executed in Ohio since McGuire, and midazolam was among the drugs used.

Source: newsweek.com, July 27, 2017

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