Matthew's Journal

This week's Lancet[1] contains important reading for those interested in the capital punishment debate. In a paper therein, Koniaris et al show that although lethal injection is the preferred means of execution in the USA because it is considered humane, so not violating the constitutional prohibition of Cruel and Unusual punishment, lack of training of staff and complete unregulation of execution protocol means that a substantial portion of prisoners are probably still conscious during their execution.

What does that mean? The first drug injected is sodium thiopental (an anaesthetic). In theory, this should render the prisoner insensible during the rest of the procedure. Next is pancuronium bromide, a neuromuscular blocker. This induces paralysis, both preventing the prisoner from communicating or moving, and stopping respiratory movements. Finally, potassium chloride is injected, which stops the heart and kills the prisoner. So, if the anaesthetic isn't effective, then the patient will be conscious, but unable to move. They will experience suffocation as they are unable to breathe, a burning sensation as the KCl is injected, massive muscle cramping, and cardiac arrest.

By way of contrast, it is considered unprofessional to euthanase animals using neuromuscular blockers, due to the possibility that the animal will remain conscious but paralysed; use of neuromuscular blockers during surgery is a skilled procedure, requiring careful attention to ensure the patient remains unconscious.

An Editorial in the same issue provides some more background.

As the authors conclude, "to prevent unnecessary cruelty and suffering, cessation and public review of lethal injections is warranted.".

[1]registration required, bugmenot.com works.

Citation:
Leonidas G Koniaris, Teresa A Zimmers, David A Lubarsky, Jonathan P Sheldon "Inadequate anaesthesia in lethal injection for execution", Lancet 2005; 365: 1412-14