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Lethal yes, painless no

The three-drug cocktail used in executions may leave prisoners suffering horribly but paralyzed, unable to say anything.

April 24, 2006|Jamie Fellner | JAMIE FELLNER is director of the U.S. program at Human Rights Watch and the co-author of "So Long as They Die: Lethal Injections in the United States."

IT IS EASY to understand why lethal injection has become the most frequently used method of execution in the United States. The procedure yields no gruesome spectacle of bodies bursting into flame in electric chairs, twitching at the end of gallows ropes, convulsing from lethal gas. Instead, lethal injection executions look reassuringly like a medical procedure: The prisoner is strapped to a gurney, injected with drugs and dies. A quiet, sanitized, efficient and ostensibly painless killing -- as seemingly benign as putting a horse to sleep, as Ronald Reagan suggested.

But appearances are deceiving. Mounting evidence suggests at least some prisoners may have suffered horribly before they died, awake and wracked by pain but unable to move to let anybody know.

Dr. Jay Chapman, an Oklahoma medical examiner with no pharmacology experience, came up with the lethal injection protocol in 1977 at the request of a state legislator. Without doing any research, he dictated a two-drug sequence, which he then expanded to the three-drug cocktail now used in California and 35 other states. (Nevada, which uses lethal injections, won't say what kind, and Nebraska executes by electrocution.)

First, a massive dose of the anesthetic sodium pentothal is injected, followed by pancuronium bromide -- a drug that paralyzes voluntary muscles, including the lungs and diaphragm, but leaves the prisoner conscious and able to experience pain. Then potassium chloride brings swift cardiac arrest. Why these three drugs? "Why not?" Chapman asked. The third drug is known to be so painful that veterinarian guidelines prohibit its use on dogs unless the vet first ensures they are deeply unconscious. But those precautions do not apply to prisoners. Their executioners stay behind a wall pushing drugs into IV tubes. No one makes sure the prisoner is unconscious; if he is not, he will be aware of suffocating from the pancuronium bromide and will feel the fiery pain of potassium chloride coursing through his veins to his heart.

Logs from six recent executions in California reveal that prisoners' chests were still moving regularly up and down long after the anesthetic should have stopped their breathing -- suggesting they were awake and suffering. Toxicology reports from executions in North Carolina also suggest some prisoners had been inadequately anesthetized.

Of course, the idea of a "humane execution" is an oxymoron; they are all inherently cruel. Yet no state defends its lethal injection protocol as the most humane possible method. Indeed, California officials point out that they are not constitutionally obliged to choose the "best" method -- only one that is not unconstitutionally cruel. Whatever the legal merits of this position, it can scarcely be justified morally.

Moreover, international human rights law imposes on California officials the obligation to ensure its executions will cause the least possible pain and suffering for the condemned. But California does not meet that standard.

A federal judge in California recently refused to permit the execution of Michael Morales to go forward under the existing rules. The judge suggested the alternative of a single injection of a massive dose of a barbiturate. State officials rejected that option, however, because although it would guarantee a painless death for the prisoner, it could take 30 to 45 minutes. And officials want to spare witnesses and executioners having to wait so long for the prisoner's heart to stop beating.

Another proposal was to have a qualified person monitor the prisoner to make sure he was fully anesthetized before the other drugs were administered. But the California Department of Corrections failed, before the court's deadline, to find any anesthesiologists willing to violate the ethical guidelines that prohibit physicians from participating in executions.

Monitoring whether the prisoner is fully anesthetized would be easier without the paralytic agent. But corrections officials like it because it imposes a welcome "chemical veil" between the prisoner and the executioners and witnesses. Without the paralytic agent, the prisoner's body might twitch or jerk in agony when the potassium chloride is administered -- something corrections officials would prefer nobody see.

Corrections officials recently announced some tinkering with their lethal injection procedures. Attorneys for the state say the new method reflects consultations among corrections officials. But they do not say they have consulted with anyone who has the medical expertise to help them evaluate the lethal drugs, dosages and protocols.

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