Death Row inmates who die by lethal injection may commonly experience acute pain, according to a study published Thursday in The Lancet, a prominent British medical journal.
The finding stands in stark contrast to public perception that most executions are painless and seems likely to spur further challenges to the death penalty, though some experts questioned the researchers’ methods.
Poorly trained corrections staff may not mix or administer drugs properly and give too little anesthetic to inmates being executed, according to the report, prepared by physicians at the University of Miami’s Miller School of Medicine in Florida.
Anesthetics are meant to induce a deep, sleeplike state in which prisoners can’t feel the effects of subsequent drugs that cause paralysis and stop their hearts. But the study suggests that in as many as 4 out of 10 cases, doses appear to be much lower than recommended, allowing the condemned to remain conscious but unable to react as they expire.
“As it’s practiced now, lethal injection is cruel and could even be called torture in some cases,” said Dr. Leonidas Koniaris, a cancer specialist at the University of Miami and lead author of the study.
The authors of the paper reviewed autopsies of 49 inmates executed in Arizona, Georgia, North Carolina and South Carolina. In 43 inmates, levels of thiopental–a short-acting anesthetic–were lower than that required for surgery, while 21 had concentrations “consistent with awareness.”
Those findings suggest that doses were inadequate to mute pain and that several inmates may have suffered substantially, the authors said.
Without anesthesia, a condemned person would experience “asphyxiation, a severe burning sensation, massive muscle cramping, and finally cardiac arrest” because of the other drugs commonly used in executions, the Lancet paper said.
The authors acknowledge it isn’t clear whether drug levels administered during an execution can be inferred from tests conducted several days later in an autopsy.
“It’s not been well-studied,” said co-author Dr. David Lubarsky, chairman of the department of surgery at the University of Miami. “Is it possible the levels are higher when they die? Yes.”
The more important point, he suggests, is that execution chambers have no systems to monitor how drugs are administered and whether they are effective. In a hospital, machines track a patient’s vital signs and brain activity, indicating when an anesthetic is taking effect.
In the prisons, “you can’t tell if they’re botching it. They do nothing,” Lubarsky said.
The report is sure to fuel controversy over whether lethal injection should be barred because it constitutes cruel and unusual punishment. Although the issue isn’t new, it’s become far more prominent in the last 18 months through more than a dozen legal appeals in death penalty cases.
Last year, New Jersey became the first state to suspend lethal injections after courts there called for more information about execution procedures and their medical underpinnings.
Some advocates responded to Thursday’s study by calling for a national moratorium on lethal injections–a move that would effectively halt the death penalty in the United States. All of the 59 inmates put to death last year were injected with drugs that ended their lives.
“This report justifies a thorough review of lethal-injection practices and a halt to executions by this method until procedures can be better explained,” said Richard Dieter, a prominent death penalty opponent and executive director of the Death Penalty Information Center.
Others said there was no reason to end lethal injections.
“Every murder victim’s family I know would much prefer that their loved one died through an injection … because they were stabbed, raped, strangled or beaten to death, like my son,” said Gail Leland, program coordinator for Homicide Survivors, which is based in Tucson, Ariz.
“It’s just absurd to think about whether these people are suffering when you consider what they did to their victims,” she said.
The Criminal Justice Legal Foundation, which supports the death penalty, suggested the search for a trouble-free mode of execution was unrealistic.
“We’ve gone from hanging to the electric chair to the gas chamber to lethal injection,” noted Michael Rushford, the organization’s president. “Each time it’s been because groups opposed to the death penalty in any form for any crime say it is not humane.
“This study needs to be looked at much more extensively before we all run out and say we have a big problem here.”
Though execution procedures call for drug doses that should be more than large enough to induce anesthesia, experts say administering anesthetics can be complicated.
A technician could fail to mix or measure a medication properly, resulting in the wrong concentration or the wrong dose. The three drugs used in executions–one to mute pain, a second to induce paralysis and a third to stop the heart–could be given out of order.
If cheap intravenous tubing is used, it might not have valves that force the drugs into the arm of the inmate, and they could drift back into the bag if not carefully watched, Lubarsky said. If the drug is injected into muscle, not a vein, it could be absorbed more slowly.
And because thiopental, the anesthetic routinely used in executions, lasts a little more than eight minutes on average, it could wear off if things go wrong or take longer than expected, he said.
Dieter said the study points out how little medical science has gone into administering executions. The people performing the procedures “are not medical doctors or medical professionals. They are corrections workers,” he said.
The study raises the question of whether “the medical profession needs to become more deeply involved in executions,” he said, adding that doctors have historically resisted on grounds it would violate their Hippocratic oath to do no harm.
“You’ve got a Catch-22: People with a medical background won’t get involved in making sure executions are done well because of ethics, and people doing this are hampered because they don’t have a medical background,” said Deborah Denno, a professor at Fordham University Law School in New York and a death penalty opponent.
Several condemned inmates have challenged their sentences on the grounds that lethal injection is inhumane. One such lawsuit is set to go to trial Monday in Kentucky. In that case, Ralph Baze, one of two men convicted of murdering a sheriff and a deputy, claims that lethal injection would violate his 8th Amendment right against cruel and unusual punishment.
Kentucky officials referred questions about the case to Mark Dershwitz, a Boston anesthesiologist the state hired to testify.
Dershwitz, a professor of anesthesiology, biochemistry and molecular pharmacology at the University of Massachusetts, said execution procedures call for dosages of thiopental many times larger than the amount needed to render a person completely unconscious.
Typically, a normal-size adult would require 300 to 400 milligrams of thiopental to fall unconscious for six or seven minutes, Dershwitz said. Most states use 2,000 to 5,000 milligrams of the drug in executions, which would be fatal in most cases even without the other drugs, he said.
Kentucky uses 3,000 milligrams of thiopental, he said, “which is far more likely by itself to cause death.”
Dershwitz said the Lancet study is fundamentally flawed because the autopsy studies use venous blood samples that did not accurately reflect the concentrations of the drug in the bloodstream. He said he was surprised that the journal published the study, and he experts peer criticism of the study to be severe.
“It’s an apples to oranges comparison,” he said.
The first lethal injection in the United States was performed in Texas in 1982, based on a technique suggested by an Oklahoma physician five years before. All but one of 38 states that allow the death penalty endorse the practice.
Some advocates for the death penalty say the study in Lancet was designed to further the cause of abolishing capital punishment.
“I think this is a speculative report that is more junk science than anything,” said Dianne Clements, president of Houston-based Justice For All, a victims advocacy group that is pro-death penalty. “I think this is meant to cause doubt and perhaps be an avenue for those appealing executions.
“The bottom line is we are putting people to death. There is a cognizant effort to put them to death with as little suffering as possible,” Clements said. “My gut tells me that any time you are put to death there may be one instant of discomfort.”
