Prisoners Executed By Lethal Injection May Suffocate In Pain While Awake
Featured ArticleMain Category: Pain / Anesthetics
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Article Date: 25 Apr 2007 - 0:00 PDT
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A new US study suggests that some prisoners executed by lethal injection die from asphyxiation while conscious, paralyzed and in pain.
The study is published in the journal PLoS Medicine.
Dr Leonidas Koniaris and colleagues from the University of Miami in Florida, USA, reviewed data on executions from two US states, North Carolina and California, and assessed the medical literature on the three drugs that are used to administer lethal injections.
They concluded that the lethal injection system used to execute prisoners may not be working in the way intended.
The lethal injection is a cocktail of three drugs, each of which is supposed to be fatal on its own, according to those who originally designed the method.
-- Drug number 1 is a barbiturate: thiopental. This is an anesthetic but not a painkiller (analgesic).
-- Drug number 2 is a a neuromuscular blocker: pancuronium bromide. This paralyses the muscles, including those that control breathing.
-- Drug number 3 is an electrolyte: potassium chloride. This stops the heart beating.
These three drugs combined are supposed to cause death by rendering the prisoner unconscious and then inducing respiratory and cardiac arrest. However, the researchers suggest that the doses are not tailored to the individual prisoner, for instance to adjust for body weight.
Reports on a number of recent executions reveal that some prisoners take many minutes to die, and others become very distressed, because the method is not working as intended.
Dr Koniaris and colleagues say their findings suggest that in some cases the dose of the anasthetic, thiopental, is not sufficient to cause death and may even not be enough to keep the prisoner unconscious for the duration of the execution.
They also suggest that the dose of potassium chloride is sometimes not enough to stop the heart, which results in prisoners being conscious while the paralysis brought about by the pancuronium bromide asphyxiates them.
The research team concluded that:
"The conventional view of lethal injection leading to an invariably peaceful and painless death is questionable."
"We concluded that the original design of the lethal injection drug protocol itself is flawed," said Dr Teresa A. Zimmers, research assistant professor of surgery at the Miller School of Medicine and lead author of the report.
"The drug protocol is based on little clinical and scientific data and contradicts clinical veterinary practice," she added.
Dr Koniaris and colleagues mention that the current regimens for lethal injection in the US are derived from one designed by Oklahoma legislators and appear to be founded on personal opinion rather than independent research.
In an accompanying editorial titled "Lethal injection is not humane", the journal's editors discuss these findings and their reason for publishing them.
They declare that their intention is not to encourage further research to "improve" lethal injection methods.
"As editors of a medical journal, we must ensure that research is ethical, and there is no ethical way to establish the humaneness of procedures for killing people who do not wish to die", they write.
Explaining that "The data presented by Koniaris and colleagues adds to the evidence that lethal injection is simply the latest in a long line of execution methods that have been found to be inhumane", they argue that this strengthens the constitutional case for abandoning executions altogether in the US.
Lethal injection is used as a capital punishment to execute prisoners in a number of countries, most notably the US and China.
It is also used in euthanasia for patients with terminal or chronically painful conditions.
"Lethal Injection for Execution: Chemical Asphyxiation?"
Teresa A. Zimmers, Jonathan Sheldon, David A. Lubarsky, Francisco López-Muñoz, Linda Waterman, Richard Weisman, Leonidas G. Koniaris.
PLoS Medicine Vol. 4, No. 4, e156
doi:10.1371/journal.pmed.0040156
Click here for Abstract.
Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
MLA
14 Feb. 2012. <http://www.medicalnewstoday.com/articles/68867.php>
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Lethal Injection: What Pain? - Current Controversies Resolved
posted by Dudley Sharp on 26 Apr 2007 at 12:47 pmLethal Injection: What Pain? - Current Controversies Resolved
Dudley Sharp, Justice Matters, contact info, below
updated 4/24/07
Several issues have come up with regard to lethal injection.
Generally, they are:
1) The inmate experiencing pain during execution;
2) The ethics of medical professionals participating in executions; and
3) Proper training of execution personnel.
1) PAIN AND LETHAL INJECTION
The evidence, including the immediate autopsy of executed serial murderer/rapist Michael Ross, supports that there is no pain within the lethal injection process.
There is a concern that some inmates may be conscious, but paralyzed, during execution, because one of the three drugs used may have worn off, prior to death.
First, there is no evidence this has occurred.
Secondly, if properly administered, it cannot occur with the properties and amounts of the chemicals used and within the time frame of an execution.
An Associated Press reporter correctly stated that "there is little to support those claims except a few anecdotes of inmates gasping and convulsing and an article in the British medical journal Lancet." (AP, "Death penalty foes attack lethal-injection drug", 7/5/05)
The British Medical Journal, The Lancet, published an article critical of lethal injection. The article did not/could not identify one case where evidence existed than an inmate was conscious during execution.
The Lancet article identified 21 cases of execution where the level of "post mortem" (after death) sodium thiopental was below that used in surgery and, therefore, may suggest consciousness was possible.
A more accurate description would be all but impossible.
A "long after execution" post mortem measurement of sodium thiopental is very different from a moment of death measurement.
Dr. Lydia Conlay, chair of the department of anesthesiology, Baylor College of Medicine (Texas Medical Center, Houston) said the extrapolation of postmortem sodium thiopental levels in the blood to those at the time of execution is by no means a proven method. "I just don't think we can draw any conclusions from (the Lancet study) , one way or the other."
Actually, we can. The science is well known. Sodium thiopental is absorbed rapidly into the body. Long after execution blood testing of those levels means absolutely nothing with regard to the levels at the time of execution.
The Lancet article did not dispute the obvious -- for executions, the sodium thiopental is administered in dosages roughly 10-20 times the amount necessary for sedation unconsciousness during surgical procedures.
Unconsciousness occurs within the first 30 seconds of the injection/execution process. The injection of the three drugs takes from 4-5 minutes. Death usually occurs within 6-7 minutes and is pronounced within 8-10 minutes.
The researchers also failed to note the much lower probability (impossibility?) that the murderer could be conscious, while all three drugs are coursing through the veins, concurrently.
Despite the Lancet article's presumptions and omissions, there is no scientific evidence that consciousness could occur with the amounts and methods of injecting those three chemicals within the execution period.
The AP article also stated that "They (death penalty opponents) also attack lethal injection by saying that the steps to complete it haven't been reviewed by medical professionals."
That is both deceptive and irrelevant.
The unchallenged reality is that medical professionals have both reviewed and implemented injection procedures for decades. The same procedures are used in executions. Criminal justice professionals have been trained in this application.
The chemicals used in lethal injection, as well as their individual and collective results, at the dosages used, are also well known by medical and pharmacology professionals.
Further, lethal injection is not a medical procedure, but the culmination of a judicial sentence carried out by criminal justice professionals, the result of which is intended as death, the outcome of every case.
A similar article "Lethal Injection for Execution: Chemical Asphyxiation?" was published on 4/24/07. (Public Library of Science (PLoS) Medicine). Dr. Koniaris was an author in both this and the Lancet article. The question mark from the title says it all.
From the Conclusion:
" . . . our findings suggest that current lethal injection protocols "may" not reliably effect death through the mechanisms intended, indicating a failure of design and implementation. "If" thiopental and potassium chloride fail to cause anesthesia and cardiac arrest, potentially aware inmates "could" die through pancuronium-induced asphyxiation." (Underline, quote and color change are mine, for emphasis)
In other words, the authors tell us they cannot prove this has ever happened. They are speculating.
Skip the speculation: Some Reality
From Harford Courant, "Ross Autopsy Stirs Execution Debate----Results Cited To Counter Talk Of Pre-Death Pain", August 11, 2005
The below is a paraphrase of parts of that article, including some exact quotes.
Results of the autopsy done on serial killer Michael Ross are being cited by several prominent doctors to refute a highly publicized article that appeared in The Lancet, the British medical journal, in April, 2005.
Critics of the Lancet article say it does not account for postmortem redistribution of the anesthetic - thiopental. The redistribution, the critics say, accounts for the lower levels of thiopental on which Dr. Koniaris based his Lancet article conclusions that the levels of anesthetic were inadequate. The Ross autopsy results document this redistribution, bolstering the critics' assertions.
Dr. H. Wayne Carver II, Connecticut's chief medical examiner, was aware of the controversial Lancet article before performing the Ross autopsy. As a result, he took the additional step of drawing a sample of Ross's blood 20 minutes after he was pronounced dead at 2:25 a.m. May 13. Carver took a subsequent sample during the autopsy, which began about 7 hours later, at 9:40 a.m.
The 1st sample showed a concentration of 29.6 milligrams per liter of thiopental; the second sample showed a concentration of 9.4 milligrams per liter. The 1st sample was drawn from Ross' right femoral artery, and the second from his heart, which can account for some of the discrepancy. But Dr. Mark Heath, a New York anesthesiologist and one of the numerous doctors who have signed letters to The Lancet challenging the Koniaris article, said it clearly substantiates the postmortem redistribution of the thiopental.
Dr. Jonathan Groner, a pediatric surgeon from Ohio said he interviewed a number of forensic toxicologists before adopting the view that thiopental in a corpse leaves the blood and is absorbed by the fat, causing blood samples taken hours after death to be an unreliable marker of the levels of thiopental in the body at the time of death.
Groner described the Ross autopsy results as "a powerful refutation" of the Lancet-Koniaris study.
Dr. Ashraf Mozayani, a forensic toxicologist with the Harris County Medical Examiner's Office in Texas, said the level of thiopental "drops quite a bit" after death. Even in the living, Mozayani said, thiopental levels decline rapidly after administration of the drug. She cited one study in which a patient was administered 400 milligrams of thiopental intravenously. After two minutes the concentration in the blood was measured at 28 milligrams, but dropped to 3 milligrams concentration 19 minutes after the anesthetic was injected.
Mozayani said the declining concentration of thiopental cited in the Ross autopsy report "make sense."
On The Lancet article, she said, "I don't think they have the whole story - the postmortem redistribution and all the other things they have to consider for postmortem testing."
The Veterinary sidetrack
Opponents of the death penalty, as well as other uninformed or deceptive sources, have been stating that even vets do not use the paralytic agent in the euthanasia of animals. This is a perversion of the veterinary position, which actually provides support, however unintended, for the human execution process.
Some fact checking is in order -- http://www.avma.org/issues/animal_welfare/euthanasia.pdf
2. THE MEDICAL/ETHICAL DILEMMA
Medical groups cite that there is an ethical conflict for participation in the lethal injection process, because medical professionals have a requirement to "do no harm".
Those ethical codes pertain to their medical profession, only.
For example, both doctors and nurses can be police and soldiers and can kill, when deemed appropriate, within those lines of duty and without violating the ethical codes of their medical profession. Similarly, medical professionals do not violate their codes of ethics, when acting as technical experts, for executions, in a criminal justice procedure.
Physicians are often part of double or triple blind studies where there is hope that the tested drugs may, someday, prove beneficial. The physicians and other researchers know that many patients, taking placebos or less effective drugs, will suffer more additional harm or death because they are not taking the subject drug or that the subject drug will actually harm or kill more patients than the placebo of other drugs used in the study.
Physicians knowingly harm individual patients, in direct contradiction to their "do no harm" oath.
For the greater good, those physicians sacrifice innocent, willing and brave patients.
The greater good is irrelevant, from an ethical standpoint, if "Do no harm" means "do no harm". Physicians knowingly make exceptions to their "do no harm" requirement, every day, within their profession, where that code actually does apply.
The "do no harm" has no ethical effect in a non medical context, because this ethical requirement is for medical treatments, only.
The acknowledged anti death penalty editors of The Public Library of Science (PLoS) Medicine seem to agree. In their op/ed "Lethal Injection Is Not Humane" (4/24/07), they write: "Execution by lethal injection, even if it uses tools of intensive care such as intravenous tubing and beeping heart monitors, has the same relationship to medicine that an executioner's axe has to surgery."
The PLoS Medicine editors have made the same point many of us have been making - similar acts and similar equipment do not establish any equivalence or connection.
There is no connection between medicine and lethal injection, per se, therefore there is no ethical prohibition for medical professionals to participate in executions.
To put it clearly: The execution of death row inmates is not equivalent or connected to the treatment of patients.
Is this a mystery?
Obviously, execution is not a medical treatment, but a criminal justice sanction. The basis for medical treatment is to improve the plight of the patient, for which the medical profession provides obvious and daily exceptions. The basis for execution is to carry out a criminal justice sentence where death is the sanction.
Justice, deterrence, retribution, just punishments, upholding the social contract, saving innocent life, etc., are all recognized as aspects of the death penalty, all dealing with the greater good.
Are murderers on death row willing participants? They willingly committed the crime and, therefore, willingly exposed themselves to the social contract of that jurisdiction.
Lethal injection is not a medical procedure. It is a criminal justice sanction authorized by law. Therefore, there is no ethical conflict with medical codes of conduct and medical personal participating in executions.
40,000 to 100,000 innocents die, every year, in the US because of medical misadventure or improper medical treatment. (1)
Do no harm? The doctor doth protest too much, methinks.
There is no proof of an innocent executed in the US since 1900.
3. PROPER TRAINING
In every state, there are hundreds or thousands of people trained for IV application of drugs or the taking of blood. Even many hard core drug addicts are proficient in IV application.
There may be only 1 or 2 times where personnel error may have led to problems in the lethal injection process. That is out of nearly 900 lethal injections in the US.
It appears that some 500-1000 innocent patients die, every year, in the US, due to some type of medical misadventure, with anesthesia. (1)
Do no harm? Glass house. Stones.
I am unaware of evidence that shows criminal justice professionals are more likely to commit some error in the lethal injection process than are medical professionals in IV application.
Furthermore, even with errors in lethal injection, those cases resulted in the death of the inmate - the intended outcome for the guilty murderer.
In the errors of medical professionals, we are speaking of a large number of deaths and injuries to innocent patients - the opposite of the intended outcome.
1) see "Deaths from Medical Misadventure"at
http://www.wrongdiagnosis.com/m/medical_misadventure/deaths.htm
and
"Health Grades Quality Study: Patient Safety in American Hospitals, July 2004"
http://www.healthgrades.com/media/english/pdf/HG_Patient_Safety_Study_Final.pdf
originally written May, 2005. Updated as merited.
copyright 2005-2007
Dudley Sharp, Justice Matters
e-mail sharpjfa(at)aol.com, 713-622-5491
Houston, Texas
Mr. Sharp has appeared on ABC, BBC, CBS, CNN, C-SPAN, FOX, NBC, NPR, PBS and many other TV and radio networks, on such programs as Nightline, The News Hour with Jim Lehrer, The O'Reilly Factor, etc., has been quoted in newspapers throughout the world and is a published author.
A former opponent of capital punishment, he has written and granted interviews about, testified on and debated the subject of the death penalty, extensively and internationally.
Pro death penalty sites
http://homicidesurvivors.com/categories/Dudley%20Sharp%20-%20Justice%20Matters.aspx
http://www.dpinfo.com
http://www.cjlf.org/deathpenalty/DPinformation.htm
http://www.clarkprosecutor.org/html/links/dplinks.htm
http://joshmarquis.blogspot.com/
http://www.lexingtonprosecutor.com/death_penalty_debate.htm
http://www.prodeathpenalty.com
http://www.yesdeathpenalty.com/deathpenalty_contents.htm (Sweden)
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